The third big NHS deception

The public will not fall for the government's deception over the hospital closure clause - even if MPs have.

Guy Collis
13 March 2014

When it comes to voting in May 2015, there are three dates voters who care about the NHS should keep in mind.

First, and most important, is 20 March 2012 when the Health and Social Care Act - which abolished the Secretary of State's duty to secure a comprehensive health service - stumbled out of the House of Commons and onto the statute books.

Next comes 24 April 2013, when the Privatisation (Section 75) regulations following the Act cleared their final hurdle in the House of Lords.

And now to this list of shame can be added 11 March 2014.

For this is the date which many Tory and Lib Dem MPs may find themselves looking back on and wishing they had finally shown some backbone.

A meagre total of just seven MPs – six Tory and one Lib Dem – rebelled against the government’s hospital closure clause.

The clause had been crow-barred into the Care Bill - supposed to address long overdue changes to the social care landscape.

Instead it was hijacked by Hunt, who had just been overruled in the High Court on his plan to downgrade Lewisham’s emergency and maternity services as part of the plan to rescue the finances of the neighbouring South London Healthcare Trust.

Hunt’s new clause allows any hospital to be downgraded or even closed simply because its patients and money happen to catch the eye of a Special Administrator appointed to ‘fix’ a different trust in financial distress.

In the Commons yesterday it was a depressingly familiar tale. Liberal Democrat politicians promised to soften the sharpest edges of Tory policies - and then bottled it.

Lib Dem MP Paul Burstow produced a compromise amendment that – although far from perfect, particularly on public engagement – would at least have given a greater power to local commissioners to protect thriving hospitals.

The amendment attracted considerable cross-party support, based on the assumption that it was more likely than the Labour move – backed by unions and campaigners – to get the Parliamentary numbers needed.

But at literally the last minute, Burstow declined to push his own amendment to the vote, leaving it to the Labour benches to do so.

Burstow announced to fellow MPs that he was “satisfied” that the government had promised enough changes in the debate to address his concerns.

They promised to update guidance “to make it clear that the agreement of commissioners to the TSA report should include their agreement that essential services have been protected at other trusts, as well as at the failing trust”.

And they had offered him the chairship of a committee of MPs and peers to consider this “guidance”.

But - aside from an (unpaid) job for Burstow - what are we actually left with?

In terms of what is actually there in black and white, the clause is slightly better than it was when first introduced last October.

There is slightly more provision for some involvement of staff, commissioners and local authorities in the new process, and there must now be a meeting involving local HealthWatch organisations.

However, the fundamental dangers remain.

The Trust Special Administration regime is based on narrow financial considerations.

The time period for meetings with “stakeholder groups” (40 working days) is dramatically shorter than that allowed previously in major service changes.

Involving HealthWatch is worthwhile, but early reports from the nascent public involvement bodies suggest these are highly variable in how well they are functioning.

There is still - fundamentally - no duty to properly consult the public at large, under this duty.

The truncated so-called “consultation” period of the Administration process (actually just a public meeting or two) gives the community no real chance to shape the outcome – just ask campaigners at Lewisham or Mid Staffordshire.

The words of the Nuffield Trust remain instructive here: “the kind of curtailed consultation required of the Special Administrator isn’t appropriate when a non-failing trust is involved... Any changes needed to a successful neighbouring organisation for the overall benefit of the health economy should be subject to the normal service change consultation requirements".

This remains manifestly not the case in the Care Bill.

Administration is still set to become a backdoor mechanism for widespread reconfiguration of services across entire regions.

But anyone inside or outside Parliament who heard the government’s reassurances around the Health and Social Care Act or the Privatisation (Section 75) regulations, knows that these have proved utterly worthless out in the real world.

Why should those delivering and receiving health services have any faith in reassurances from a government which promised “no more top down reorganisations” shortly before embarking on the largest overhaul in NHS history?

Why should they believe the promises of a government proclaiming there would be “no decision about me without me” while riding roughshod over proper patient and public engagement in major decisions on service change?

And why should they take any solace from assurances from ministers who promised to “end the centrally dictated closure of maternity and A&E”, at the same time as they centralise powers in the hands of the Secretary of State to close down services and hospitals?

The simple answer is the public will not fall for any of this – it is just deeply regrettable that more MPs have not see through this ruse.

In May 2015, it will be the duty of all who love the NHS to make sure that these MPs feel the pain where it hurts most – in the ballot box.

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