Lewisham decision exposes Hunt’s NHS ‘ratchet’ con

When I was a kid, I was fascinated by a set of ratchet spanners and screwdrivers that my dad had. All these tools had a little ‘switch’ that you could flip from one side to the other to change the way that they turned. Set the switch in the right position and the tool would only turn freely in one direction – with a very satisfying series of clicks – and would lock in the other. This meant that you could set a spanner, for example, so that no matter which way you turned it, you could only tighten the nut and not loosen it.

The great Tory ‘NHS ratchet con’

In a tool, this was a very useful feature. But it only worked if you set it right, and it wasn’t suitable for every job.

Jeremy Hunt’s speech yesterday on the South London Healthcare Trust (SLHT) issue – which was in fact more relevant to the fate of University Hospital Lewisham – was both a massive disappointment to campaigners fighting to save services at Lewisham and an object lesson in the modus operandi of how the Tories are busily attempting to fool the British public whenever it comes to the NHS.

This ‘MO’ amounts, in effect, to a ‘ratchet’ con – one in which the Tories have set the switch to allow movement in one direction only, but have locked it from moving in another, far healthier direction. They cover this by claiming that their actions are the only viable course, and that they are for the greater good.

Another way to understand the con is to think of fuel and energy prices. The watchdog may have ruled yesterday that we are not being ripped off by petrol companies, but everyone knows that whenever oil prices fall, the prices at the pump fall much later, or not at all. Petrol companies justify this by saying they have to use up reserves they’ve purchased at the old, higher price.

But when oil prices rise, that argument magically doesn’t apply. Forecourt prices rise immediately, with the petrol companies seemingly feeling no need to use up reserves built up at the lower prices before increasing prices to consumers. The same phenomenon prevails in the utilities sector and in many others, with prices rising whenever ‘necessary’, but never falling when they could. It’s a clear ‘con’, no matter what official decisions might say, and ordinary people pay the price.

Hunt: only allowing NHS funds and services to move in one direction

As I wrote yesterday, there is more than enough money ‘in reserve’ in the NHS to resolve SLHT’s problems without any need to downgrade services at Lewisham. More than 12 times more than enough.

Hunt claims that

only by looking beyond the boundaries of the trust to the wider health community could he put forward a viable solution.

He is absolutely correct. But not by ‘reconfiguring’ (i.e. cutting) services in well-performing areas adjacent to SLHT, as he has done.

The NHS ran at a surplus last year of £1.6 billion. A fraction of that sum would clear the operating debts of SLHT, if allowed to move in that direction. It would probably be far more than enough to clear the outstanding ‘Private Finance Initiative’ (PFI) money owed by the Trust completely – and a few years’ accumulation of the NHS’ regular surpluses could clear the entire PFI debt of all affected NHS Trusts. IF it was allowed to flow to where it would do so.

But Hunt and his party have set the ratchet in the other direction. The government chose to ‘claw back’ last year’s NHS surplus – an act that even an NHS executive who supports the government’s overall plans for the NHS called (privately)theft‘.

The Tory ‘ratchet’ allows the money and services to be taken away, but not to flow back in – and not just in Lewisham. This can be seen all over the NHS, as facilities and services are given to private contractors that will be very hard ever to take back, even under future governments, as buildings and land are sold off that will be far more expensive to buy back when needed, while the funds siphoned away, and local hospitals are closed in the name of ‘improvement’ while the wishes of local people are ignored and derided, and ministers lie even to MPs of their own party.

CLICK: Huge NHS surpluses are ‘clawed back’ by the Treasury.

CLICK: Lewisham is downgraded, with A&E and maternity services cut to the most basic level (no matter how Hunt tries to frame it in weasel words), to make up for SLHT’s ‘failure’. Government says it’s the ‘only viable option’.

CLICK: A hospital is closed or skeletonised, forcing local people to travel miles further for treatment, and putting lives at risk.

CLICK: GP services are bought by private companies using the NHS logo for camouflage.

CLICK: A whole NHS hospital is given to a private company for it to run for profit. Even though it is off-target in its finances, it keeps it and demands to take over more Trusts.




Each ‘click‘ seems such a small little sound amid the noise of daily life and news, and might even seem reasonable at first glance. But the accumulation of all the clicks is an ever-tighter grip on our NHS – and a near-irrevocable erosion of the NHS as it was created to be: a service free for all at the point of need.

Make no mistake, what’s happening in Lewisham is not ‘the only viable option’. It’s a choice – and it’s based on ideology and greed. The Tories could easily flip the ratchet-switch and channel surplus funds to resolve the issues at SLHT and else – but they choose not to.

What is being done to the NHS in Lewisham is a louder ‘click’ than many. We need to hear it, take notice and recognise what it both signifies and symbolises – the mores and actions of a government that spouts empty words about patient choice, protecting the NHS and the best interests of the people it should be protecting, but is following its own, far darker agenda.

That dark agenda is to bleed the NHS dry, no matter what the consequences for ordinary people, until it’s just a husk that can be broken up and devoured by the private health companies that have poured vast funds into Tory party coffers.

Lewisham campaigners are not fooled by Hunt’s ploy and weasel words, and are going to continue to fight. Whether you live near Lewisham or not, it’s in your interests to give them your full and active support – and to find out what’s happening in your own area, as the effects of the Tory subterfuge are being felt almost everywhere, if you know to look for them.


  1. And on the same day as Hunt’s downgrading of Lewisham, Gloucester Hospitals NHS Trust announced that Cheltenham A&E will be downgraded too with all emergency cases being taken to Gloucester.
    Bear in mind that if you live in this rural area, have a heart attack and need primary angioplasty outside “office hours” you will have to travel to Bristol or Oxford for the life saving intervention

  2. I have been saying for many a long and weary year when we are told ‘this hospital isn’t performing well and should close’ that the clue is in the name- NATIONAL Health Service- not local, not regional- NATIONAL; everybody, everywhere needs the Health Service and it should and must remain national. Splitting it into trusts, or any other ‘hip’ name you want to give them is just a phase towards local, privately run health services that will serve those able to pay well, and leave the less fortunate to take the services remaining when the doctors and surgeons, nurses and porters, admin and managers have served their wealthy clientele.

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