CHRIS PHILP: Is Royal Free facing death by a thousand cuts?

The idiom Death by a thousand cuts has a striking definition: lots of small bad things happening, none fatal in itself, but all adding up to a slow and painful demise. I am beginning to wonder if the Royal Free is in danger of suffering death by a thous

The idiom 'Death by a thousand cuts' has a striking definition: lots of small bad things happening, none fatal in itself, but all adding up to a slow and painful demise.

I am beginning to wonder if the Royal Free is in danger of suffering death by a thousand cuts. Lots of small bad things have happened recently. None is fatal, but cumulatively they are highly damaging.

For example, the Royal Free did not win the contract to be one of London's major trauma centres, despite having an excellent A&E service. It is about to lose its emergency acute stroke facilities to UCLH - increasing journey times for emergency stroke patients. This comes despite the Royal Free having the second best stroke unit in the UK (out of 216) and a rating of 96 per cent. Physiotherapy was contracted out to the private sector earlier this year - again, despite the fact that it is one of the best in London. The list goes on.

So perhaps it's no surprise to hear that the new Chief Executive, David Sloman, thinks that it will be "very difficult" to survive without merging the Royal Free with the nearby Whittington. Reports suggest that a merger would result in a dramatic reduction in the number of patients treated, the closure of the Whittington's A&E department, a seven per cent reduction in the budget of the two hospitals and staff cuts.

One of the reasons cited for the merger is the need to create a hospital that has critical mass. Well, if services at the Royal Free hadn't been cut over the last few years it would still have critical mass - without the need for a merger.

The Royal Free is a great institution and must be maintained and developed as a leading hospital. It has a history going back to 1828, when it was founded on Gray's Inn Road. It is the largest employer in the north of the borough, with 4,600 staff. It treats 700,000 patients each year and has 900 beds.

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Mostly, standards are very high. Dr Foster recently rated the Royal Free as the trust with the lowest mortality rate in the whole country. It has renowned specialisms in liver, kidney and bone marrow transplants, in renal care, in HIV treatment, neuroscience, in infectious diseases and the diagnosis and treatment of cancer, to name just a few. Of course there are always things which can be improved, but the Royal Free is generally a good hospital.

I spoke to an 80-year-old lady on Saturday who broke her arm about a year ago. She said: "The care I received was outstanding. The food wasn't great, but treatment was fantastic and it is wonderful to have a hospital like this so close by."

We have spent a lot on the NHS. The overall budget has gone up from about �35 billion to �110 billion over the last 10 years. I support that increase and I think that the NHS budget should be protected even in these difficult economic times when savings will certainly be needed elsewhere.

But given this huge increase in NHS spending, why are we being told that outstanding services like physiotherapy must be contracted out? Why are we losing the country's second highest rated acute stroke service? Why are we being told we must have hospital mergers and job cuts?

The Government may have been big spenders, but they have not been wise spenders. Targets, central micro-management, excess administration and bureaucracy have meant much of the spending increases have been wasted.

With this level of NHS spending, we have paid for a service that should be both excellent and local. Patient choice should be at the heart of it. This is not happening.

So I was pleased to read in the Health Service Journal last week that David Cameron (sorry, just one sentence) "has promised a moratorium on [hospital service] closures and re-configurations and argued that they are often driven by short term considerations rather than long term viability." It is time to stop cutting and re-organising, and think about the long-term.

The Royal Free is our local hospital. Generally, it is a good hospital. We must fight to make sure that it isn't a victim of the Government's centralising and wasteful schemes. We must fight to make sure it never suffers death by a thousand cuts.

q Chris Philp is a local councillor and the Conservative Parliamentary Candidate for Hampstead & Kilburn