Monday 21st October was the 208th anniversary of the Battle of Trafalgar. Victory may have been with the British on that day but to say that the day was not a good day for the beleaguered NHS would be an understatement.
An Amendment hastily tagged onto the Care Bill, Amendment 168A (to be inserted after Clause 109) gives the power to any hospital administrator appointed in England to dismantle whichever hospital services they may take a fancy to, as long as they neighbour a hospital which is deemed to be failing.
This will of course mean that local scrutiny and wishes will have little bearing on decision making – a premise the government are already busily trying to make stick in Lewisham.
Mayor of Lewisham Sir Steve Bullock commented
"The attempt by the Government to sneak through a fundamental change to the way changes are made to local Hospitals is simply undemocratic. If these amendments become law no hospital will be safe even if it is financially stable and providing good quality services. That was the position that Lewisham Hospital was in when they were targeted in order to bail out a failing trust nearby. There was no warning and no consultation."
Slippery Earl Freddie Howe, government spokesperson in the Lords, wove his rationale like a snake charmer manoeuvring a python out of a wonky raffia basket. In his opening statements he claimed that there this was merely to ‘clarify’ and make a ‘small change’ and was absolutely no policy change whatsoever:
‘The Government’s policy has been consistent. It is entirely unchanged… It is self-evidently not a change of policy’
But in his closing statements, he veered towards it being a unique opportunity to make an historic change in the management of the NHS, saying
'unless we pass the government amendment, we will have missed a historic opportunity to correct a vital lacuna in the law for the benefit of the NHS as a whole'
This at least seemed to be truthful, if more than slightly undermining his first assertion.
Howe sees the lack of ability to arbitrarily close hospitals as a gap which needs to be filled.
The clause removes what Howe called “the statutory obligations of commissioners to involve and consult patients and the public in planning and making service changes” for any hospital, no matter how successful, if services neighbour a ‘failing’ trust.
Howe explained the rationale clearly:
“One of the principal benefits of the unsustainable provider regime [which the new Clause extends even to sustainable providers] is the speed with which it delivers recommendations for clinically and financially sustainable services. This accelerated process includes…no provision for referral for local authority scrutiny.”
In response Labour health lead Lord Philip Hunt highlighted both the Lewisham situation and the fact that this measure would not be the rare event elsewhere which the Earl Howe pretended.
Whilst realising that this cannot be applied retrospectively, the interventions from the Labour benches demonstrated the government’s clear aim is to target as many hospitals across the country as possible – especially now they are flagging so many as being ‘failing’.
Hunt suggested this was too serious a matter to be rushed through in this way.
Howe’s expression mimicked that of a schoolboy caught out in the act of scrumping from our NHS apple tree.
Almost laughably, given the debate had been laid down less than a week prior to the debate and just a week before the government Appeal hearing against the Lewisham judgement, Earl Howe also maintained that it bore absolutely no relation to the Lewisham situation whatsoever. In an attempted run for cover he declared that the government were confident that their current approach to South East London did indeed fall within the law:
“we believe that the administrator’s recommendations fell squarely within the wording of the 2009 Act”
So that would be the very same law that he was at that very moment trying to change - in order to allow the changes the court had found to be illegal…
When all is said and done, no matter who says what, the Secretary of State, the unaccountable quango Monitor and NHS England will be empowered to do just exactly what they like no matter what the outcome.
Knowing what we do about the NHS England management regime, including a chair who actively avoids using the NHS, of one thing we can be certain - transferring hospital land to buy-to-let property developers and privateers is not going to be the route to supporting the population’s future health needs.
Despite their supreme contradiction of a premise, the government - with the help of hereditary peers who had pitched up in ensemble mode to give the NHS nothing less than their full disapproval, won the vote by a resounding and depressing 66 votes. Notably only one LibDem (Lord Willis) voted with the Opposition. 64 others voted with the government.
Untrammelled by the lack of a Coalition conscience, the amendment will move on to the Commons with the recommendations intact.
Given how the system is already struggling to meet acute need, I for one felt a shard of horror run through me when Howe spoke his final dismissive word on the subject.
Time is not currently on our side – the bill is likely to go to the Commons in November - so you know what to do. Lobby your MPs – especially if you live in a Coalition marginal - and soon!