It has all the hallmarks of David and Goliath.
A small, community-based campaign group in south London taking on the parliamentary might of the Secretary of State for Health, Jeremy Hunt himself. Head to head. In court.
Except this is neither a passage from the Bible nor a Hollywood movie. No, this is the reality faced by an NHS hospital that finds itself under the axe as a result of decisions alleged to have been made unlawfully by the Secretary of State. Contesting the legality of Hunt’s actions, the Save Lewisham Hospital (SLH) group - who have already fought a colourful and impassioned campaign - now plan to bring the Secretary of State to book in a judicial review to take place in the High Court in early July.
SLH was formed in 2012 by patients, GPs, doctors, nurses and other health workers in Lewisham. It came together in response to the plan to reduce services at Lewisham Hospital as part of rescue measures for the neighbouring South London Healthcare NHS Trust, brought low by cuts and its PFI deal. The plans for Lewisham were drawn up by the neighbouring trust’s ‘special administrator’ Matthew Kershaw and included downgrading Lewisham’s A&E department and closing all acute admitting wards, the intensive care unit and the maternity service.
The ramifications for the local population are huge. Campaigners argue that Lewisham is a busy, well-performing and popular hospital and that the alternatives being put forward by the Secretary of State will be extremely difficult for residents to access. They also point to serious consequences for pregnant women. With no A&E, women who require emergency services during labour will have to be transferred by ambulance - mid-crisis - to another maternity unit, putting both mother and baby at risk.
Dr. Louise Irvine, Chair of SLH said: “The plans to demolish 60 per cent of what has been a “Top 40 hospital” for five years running - including some brand new facilities - when existing provision in surrounding hospitals is already full to overflowing and blue light ambulances are being diverted to Lewisham, are dangerous in the extreme. This is why so many thousands of people in Lewisham and further afield have engaged with the campaign”.
The legal action, launched by lawyers Leigh Day on behalf of SLH, asserts that this decision was unlawful. They argue Kershaw’s powers as the SLHT administrator - and therefore the Secretary of State’s too - related to South London Healthcare NHS Trust only. They did not extend to the Lewisham Trust. Both Kershaw and Hunt stand charged with acting “ultra vires” - outside their legal powers as SHLT administrator and Secretary of State and in breach of the National Health Service Act 2006. The lawyers will also be contesting the consultation process which took place, claiming it was flawed. Mr Hunt himself required four tests to be satisfied before any reconfiguration proposals could proceed. These included ensuring GP support, clinician support, enhanced patient engagement and improved patient choice. The proposals failed on all four counts and yet are to be implemented.
Rosa Curling from law firm Leigh Day said: “We have written to the Secretary of State setting out the basis of our client’s case but to date, he has chosen not to respond. Our client has no option therefore but to issue proceedings and to request that the Court urgently intervene. The campaign is asking the Court to declare Mr Hunt’s decision unlawful and to quash it, so Mr Hunt can reconsider.”
This latest battle comes on the back of a series of high-profile campaigning events run by SLH. From marches and human chains, to events such as “The Hunt for Hunt” and media projects such as “Born in Lewisham”, SLH have shown how persistence, imagination and persistence can bring a community together around a sense of progressive civic pride. The planned legal challenge builds on months of hard work by campaigners.
Lewisham’s fight is coming to a head at a time when emergency services across the country are facing rising waiting times due to increased usage. The government has responded with increasingly dubious excuses, blaming GPs, immigrants and even women doctors in turn for our overwhelmed A&Es. Excuses that have all been decried by professionals within the system. In their search for scapegoats, they seemed unable to blame themselves; it has been demonstrated that it has in fact been Coalition government policy that has led to much of the rise in A&E attendances.
The government’s approach has been nonsensical. It seems curious that Bruce Keogh, National Medical Director of the NHS Commissioning Board, has been so exercised about rises in death rates elsewhere in the system (such as the 0.67% mortality rate for weekend operations), while simultaneously failing to comment on shocking data that shows a steep jump in deaths - by 37% - when a local A&E closed in Newark as a direct result of Coalition policy. But beguiled by some other numbers, Jeremy Hunt has justified the downgrading of Lewisham, on the basis that it would “save around 100 lives a year”. Where has this estimate come from? How can it be reconciled with the fact that A&E closures actually lead to increased mortality and morbidity? But then again, this is not the first time that Mr Hunt has been befuddled with numbers.
What remains unanswered by either Hunt or Keogh is why, if genuinely concerned about rising mortality rates, they have they not heeded calls to halt their planned closures of A&E up and down the country pending a fully independent review of the effects of such policies? Does the government really feel that achieving £20 billion in NHS savings is more important than our lives? Or are these skewed priorities revealing a predilection for the kinds of services that can generate money in a private market (such as surgery), “softening up” the rest of the NHS before introducing private “solutions”?
It is questions like these that make Lewisham’s struggle relevant to us all. Taking Hunt to court over his actions in Lewisham will force him to think again about his policies for the rest of England’s NHS.
But legal battles are costly. While Save Lewisham have managed to raise £5,000 through their own efforts, they are still far from the £20,000 that it costs for expert legal representation to effectively challenge the closures.
Recognizing both the local need and wider national implications, campaigning organization 38 Degrees have stepped in to help. Ian Palmer, Campaigns Manager at 38 Degrees said:
"The future of Lewisham hospital has become a focus for hospital campaigns across the country. Lewisham's services are being cut not because of clinical need, but to help shore up the finances of a neighbouring trust. If Lewisham can have its services slashed, no hospital is safe.
It's for this reason that 38 Degrees members across the country have been donating to the Save Lewisham Hospital legal fund, to challenge Jeremy Hunt's decision in court. Lawyers have advised that the method Jeremy Hunt used to force through the changes to Lewisham went beyond his powers and that he did not take the necessary steps.
Hopefully, if the funds for the challenge are raised, and the case is successful, Lewisham can become the line in the sand for ill-thought out hospital closures across the country."
The struggle to save local services at Lewisham matters to the whole country. It exemplifies the government’s concerted attack on the NHS itself, as it plans to roll out privatization throughout our healthcare system. It is in all of our interests that Hunt is stopped in his tracks in Lewisham, or else he will be able to wield his axe on A&E departments all over England.
Lewisham vs Hunt: the David and Goliath story for modern day England. And though we all know who comes out on top in the biblical version, it might be a good time to remind Mr Hunt.