Conquest Hospital Cardiology faces closure
WE ARE WALKERS
‘We’re all walkers in our family.’ My brother makes this observation after spending the day with our dad for his birthday. It often doesn’t make sense to people how much we like to walk. Sometimes it even riles people up: ‘but it’s faster to go by x public transport.’ ‘Just get in the bloody car!’ our mum would sometimes say. Pa was always big on walking.
Yes, at some point we started calling him pa and pops. Maybe it was when his hair went white. It just seemed to fit, and he seemed to like it. It was probably around the time our parents separated, that his hair went very white. Stress. He moved to Kent, and I moved with him. Because it was much less stressful living with him, though, understandably, he did have a habit of ignoring stressful situations, which was stressful in itself. Dartford, too, was a somewhat stressful place to live. It just seems to be the centre of a very definitive misery. Which is saying something coming from the estate I grew up in.
At this point, the corrupt bosses of the university my dad worked for started to appear in the news. The redundancies were coming thick and fast. More stress. He had worked in this university most of his life. Students bought him punnets of strawberries in thanks, he was friends with all the lecturers and library staff. He was a good mediator between curmudgeonly colleagues. The question mark over his job overshadowed the whole Kent period, but what redundancy eventually allowed him to do was break free and move to the sea.
This was something he’d been trying to do since I was a kid. I remember every now and then taking DFL trips down to Brighton for him to scope it out, and coming home in disappointment because financially it was always out of reach. He’d grown up right on the North Circular, the massive motorway North of London lined with post-war social housing. I don’t even want to think about what a road like that does to someone’s developing lungs, but he instinctively craved fresh sea air. His sister had moved to Bexhill a few years before, and finally, with the unburdened means to leave the stress and misery behind, he popped down and was taken. So, Bexhill it was.
I visited him in Bexhill every couple of months. It was always a welcome break from the big concrete I’d also been trying to escape since childhood. He seemed like he’d finally found his place. Or rather, a place he deserved to be. The slowness he deserved. The cleanness of air. Clean air that we should all be entitled to, but that was robbed from us many centuries ago when we were forced into labouring in cities.
Long walks, hours gazing at the changing light, peace. Finally outside of the capitalist belly, the grey, and the noise. I was relieved for him.
Then a couple of years later, I woke up to a series of missed calls from my aunt.
“Where have you been, you silly girl!!! Your dad went to hospital last night!!”
“What?!”
The condescending bark made it harder to process what my aunt was saying. I am a silly girl. No, that’s not the important part. Pa, something about pa. He’s in hospital. Oh my god.
I couldn’t get through to him, so it must’ve been serious, I panic-looked up the number of the hospital. When I finally got through, a nurse stated with a very matter of fact tone that this patient had had a heart attack. “WHAT?????” My own heart plummeted. She seemed almost weirded out by my shock. She said it again as though it was obvious this had happened, because, you know, that’s what people in cardiology generally come in with. I reeled trying to get my head around what she was saying. My dad had nearly died. My brain said it to me again. I nearly lost my dad.
Said brain cobbled together the next question: “Is he ok???” I was told he was being seen by doctors, which didn’t answer the question. I had to wait for some time to find out what was happening. The panic in my chest and stomach grew while my partner helped me prepare my belongings.
WALKING WITH A HEART ATTACK
When I finally got through to him, he told me his chest had felt tight on the walk back from the shops that afternoon. He’d carried on walking, holding his chest. He stopped on a bench, tried to rest, then continued. An hour or so later, his chest hurt more. He thought maybe this was ‘a bit more serious,’ and called a cab to the hospital. At A&E he waited until his chest felt too tight to bear, and went up to the reception desk clutching his torso, requesting to be seen sooner. “I can’t wait any more,” he panted, holding his heart.
He told me he felt a bit better, but he wasn’t sure what was going on.
“You had a heart attack pa.”
He went quiet in disbelief
“….You nearly died waiting.”
“I guess it was all that walking.”
“No pa, that probably saved you.”
I let work know and arranged to meet my brothers to drive down. It was a quiet journey and my brother drove quickly. So much so, at one point he drove over a rabbit, which stunned us all into a much deeper silence, this unsaid sense of an omen.
Luckily they were able to stabilise him, and he was given a triple heart bypass weeks later. With some extended care from myself, which my work just about allowed me to do, he made an almost full recovery.
He has since had two more heart attacks and operations, one as a consequence of the stress of the pandemic, in which he was given stents, and another from his roof being ripped off during the big storm, where he was given a pacemaker. These are uncontrollable events. As well as his daily walks, he exercised every morning with weights and stretch bars his whole life, and though he lived by the meat-and-two-veg meals he was raised on, he’d always avoided fast food. There was high cholesterol in the family, but also, he, like the rest of his family, lived on a motorway for 35 years. No one’s running into heart disease. For many people, it is unavoidable.
Each attack weakens the heart and the rest of the body. He now knows to call the ambulance when there is pain. He is much frailer and can no longer go for walks, let alone while he is having a heart attack. Instead of the walks, he gets cabs and goes for sits. He needs help carrying potatoes and bottles of milk, and spends much of the day resting from the smallest efforts. He has heart failure, which sounds more immediate than it is. Basically it’s just managing his heart now, there are no more operations or procedures that can be done.
They got to know him on the cardiology unit. I got to know the cardiology unit quite well over the years too. He is still in contact with Conquest Cardiology Department off and on for the odd moments his angina flairs up in unusual ways. The news of the Cardiology Unit closing caused him a great deal of stress and, I worried, might even spark another attack.
Why am I sharing this? Because every person is a story, and is important to another set of people. Each story is precious and fragile. We give great care to precious stones, a life is like crystal glass, it should be safeguarded as such by a society that upholds dignity of care. What amount of money could justify the avoidable deaths of our precious selves or our treasured loved ones?
£400,000 OF SAVINGS
In a phonecall to the cardiology department, pops asked about the news of the closure. The nurse told him there would be a much-reduced department and more work for those left, but yes, most of the patients will go to Eastbourne, a 40 minute ambulance drive compared to the 10 minute drive up to Conquest. Life-saving surgery, both routine and emergency will be designated to Eastbourne. Why isn’t the NHS making sure more of these facilities exist everywhere, not less? Plans were apparently decided in a three year ‘public consultation’ in 2022, which many of us missed. The savings made will be £400,000 over a 10 year period. Now I’m not a business person, but the cost/benefit of that seems way off. Not even half a million, not even in one year, but over a decade, and in that time, Hastings patients must fight out space for urgent treatment with the pre-existing Eastbourne patients? Another town further away and with its own population of people with heart disease who will need cardiology with capacity. Once again, it pits us against each other for resources. So will they just send Hastings patients home when they run out of space? Or is the plan to run Eastbourne Cardiology into the ground and shut that down too? Blame some refugees for good measure?
Where does that leave the person who can no longer walk with a heart attack? What about the ‘two hours to never come’ wait time for the ambulances shared between towns? To die as a discrepancy of a cost-saving exercise in an unnecessarily dysfunctional system is no way to go. It strips a soul of their dignity and their place in the world, their dreams and the shared dreams of others around them.
In an interview with ITV, an East Sussex Healthcare NHS Trust employee stated ‘there will be very little difference from the closure.’ Little difference. What that dismissive little phrase actually means is that your loved one could be the ‘little difference’. Any of our loved ones could. Will be, in fact. Collateral where there needn’t be.
This neoliberal gutting out of services is failing most of us and these vital services will keep reducing, and making the quality of our lives worse. But there are examples of better practice. In The Case For Community Wealth Building, Joe Guinan and Martin O’Neill write about workable community-run models that started abroad and have been adopted here, namely by Preston City Council. The main idea being to use large anchoring institutions to levy local community wealth, local jobs, and more local control:
“The Preston model encompasses a string of public sector anchors across Preston and Lancashire, including colleges, universities and housing associations, and they are adding public pension investment to this, and laying groundwork for a community bank.”
“…..The facts cannot be ignored: The share of the public procurement budget spent in the city has risen from 5 per cent in 2013 to 18 per cent (a gain of £75m) while across Lancashire it has risen from 39 per cent to 79 percent (a gain of 200m).”
And we are somehow talking about savings of £400,000 and many unavoidable deaths…..?
It continues:
“Unemployment has also fallen from 6.5% to 3.1%. Once a poster child [like Hastings] for economic deprivation, Preston has also achieved above average improvements for health, transport, work-life balance, and youth and adult skills.
The UK’s NHS has already embraced the anchor mission as part of its long term plan. With its massive purchasing power and economic footprint, the NHS could serve as a mother of all institutions, the backbone of a series of regional industrial strategies by which health related goods and services would be provided as part of ensuring the wealth and well being of communities.”
The above book was written under Corbyn’s Labour when for a brief period, a socialist government was conceiveable. It is telling of the agenda of our current roster of Labour politicians that were all too happy to deselect so many of the good people doing the good work, like Preston’s lead councillor. Really rather incredible to actively stop that good work.
But could the above work for healthcare, with all its moving parts?
In 2023, I was sat in a talk titled How To Build A Democratic Economy featuring public-common strategies researchers of In Abundance. My ears pricked up when they mentioned a pharmaceutical cooperative working experiment being set up in France. This totally changes the dynamic of how we do health, when profit is taken out of a company’s motive and it simply exists to be at its most functional. To look after people. Mimicking human care. Again the same model of anchoring around pre-existing institutions is used. In doing this, drugs become more affordable to hospitals, hospitals have more funds, and become more effectively run.
In their book Radical Abundance, the researchers cite the example of the Saint-Genis-Laval pharmaceutical company.
“It’s the fundamental incompatibility of an industry whose decisions about research and production are guided by the extraction of maximum profit instead of collectively defined human needs….. The obvious question stands that, if there is the administrative capacity to appropriate and redistribute existing assets from failing companies, and if public financing can (repeatedly) be found to underwrite the risks of for-profit companies, then why are we not facilitating alternative models of production that are more systematically aligned with principles of public health?… Instead, the entire circuit of pharmaceutical research, production, and distribution must be mediated directly through something akin to what Pat Devine calls the political economy of a self-governing society — people making collective, democratic decisions about what pharmaceuticals we need, incorporating all of the processes that lead up to a drug being made available in a hospital or pharmacy.
Building from our collaborative work around the site in Saint-Genis-Laval, there is a model of co-ownership and co-governance of an organisation that includes three stakeholders: a public body (the Saint-Genis-Laval Commune/Lyon Metropole), the employees (as worker-owners), and here a Common Health Association (a legally constituted body in its own right). In France, such an arrangement is possible in the legal form of a Société Coopérative d’intérêt Collectif (SCIC), an ownership model introduced in 2001 based on the premise of a cooperative explicitly aimed at pursuing social objectives and which must contribute to the development of the territories to which it belongs. In many ways, there are parallels with the structure of a Community Benefit Society in the UK.
The membership of a CHA is primarily defined by an individual’s proximity to a production facility — which in Saint-Genis-Laval might be the commune, the city of Lyon, or the wider metropole — and is open to anyone within that defined territory… such as representatives of local food growers or community housing associations… What is imagined is something akin to a territorial development organisation, but whose broad objective is the furtherance of public health. In practice this is much like a company paying dividends to one of its majority shareholders, except in this case the ‘shareholder’ is a territorially rooted, democratic membership organisation with the defined objective of intervening to further public health objectives. What exactly these interventions look like are the prerogative of an individual CHA, but they will share the fundamental characteristics of being upstream, collectivised, and citizen-led responses that further public health objectives.
This is active collectivism, and it takes an active collective choice, or shift, to do this work. As a start we have to actively be sitting down together and asking ourselves these fundamental questions: What is the future of healthcare for us here in Hastings? What does it mean to us as we get older and cannot avoid the need for these types of specialist procedures or medical drug access? How do we both protect the spaces and skills needed to keep us safe, while also making sure we are all leading safer lives? I don’t have all the answers, but what I do know is a great deal of this is about getting together to do the complex and tricky work of figuring out how to protect each other and our services. But it’s not ground zero, there are these models to work with and willingness to share resources and support. It’s in the local and wider sharing, looking after each other, community care, shared spaces and fighting for the ability to do all those things, and not get distracted. Organising this means creating infrastructure for less hours spent working arbitrary jobs to cover arbitrary ‘costs of living,’ and allowing more time spent doing this future building work, as well as time with the people who matter to us dearly. If we cannot offer dignity to those we care about, we cannot live in dignity ourselves. Let’s have these conversations. Because no one wants to die on the way to Eastbourne.