Image: Flickr / Andy Worthington

The Appeal Court today dismissed a government appeal in the long running battle over substantial cuts to Lewisham Hospital. The ruling will be deservedly celebrated in the streets of Lewisham, where “Save Lewisham A&E” campaign posters have plastered the streets for months. But it also raises the stakes on new government attempts to legalise these kind of “accelerated” hospital cuts elsewhere. MPs will vote on the new move next month, in an amendment hastily tagged onto the Care Bill.

During the summer the High Court ruled that health secretary Jeremy Hunt acted unlawfully in trying to close Lewisham’s A&E and large chunks of its services, as part of an Administration process that was dealing with a different, neighbouring Hospital Trust, South London.

Today the government lost an appeal against that ruling. 

Lewisham itself is hopefully now safe. But the government - perhaps anticipating this defeat - has a plan B that will make it far easier for them to close or downgrade other hospitals across the country in future, without the consent or support of local people or GPs.

The government has added a last minute amendment to Care Bill to legalise much more widespread use of fast-track hospital closures.

The amendment will - if passed in the Commons next month - allow the government to accept recommendations from Administrators appointed to take over clinically or financially struggling Trusts, to cut or downgrade nearby hospitals that are part of other Trusts. Closure decisions - which could be taken even where these nearby hospitals themselves are successful and popular - will be able to be taken with minimal public consultation - a mere 40 days, compared to the normal 2 years or more.

Introducing the amendment in the Commons earlier this month, Earl Howe admitted the amendment drastically reduced “the statutory obligations of commissioners to involve and consult patients and the public in planning and making service changes” and extended to even successful trusts an "accelerated process" with "no provision for referal to local authority scrutiny" or need to have regard to the views of local people and clinicians.

Dr David Nicholl, Consultant Neurologist in Birmingham, and on the council of the Royal College of Physicians said 

“speaking personally I can see that this legislation has the potential to threaten any hospital, with minimal consultation" He urged other medical professionals to raise concerns with their Royal Colleges, adding “it is vital any reconfigurations are clinically led. This judgement has shown that the special administrator approach is totally the wrong one."

The Royal College of Physicians have already raised concerns over the clause in the Health Service Journal, saying "Any decisions affecting the broader health economy should be clinically-led, should be driven by the best interests of patients and should involve the wider health community from the beginning".

Vicky Penner, former patient at Lewisham and a member of the Save Lewisham Hospital campaign, warned “The Government's attempt to rush through an amendment to the Care Bill through Parliament which would give Trust Special Administrators, and in turn the Government, unlimited geographical power without proper consultation means that no hospital in the country will be safe.

“It seems that if the Government cannot win in Court, they will bully their plans through Parliament, showing their utter contempt for normal people and democracy.”

The Care Bill including the controversial ‘hospital closure clause’ is due to go to the Commons in November. All eyes will now be on MPs.

If it becomes law, hundreds of hospitals could be in the firing line for fast-track closure or downgrade, such as removing their A&E or maternity services.

Twenty trusts covering more than 60 hospitals are already so crippled by financial cuts and PFI debts that they have been identified as next in line for the special Administration process.

But if the hospital closure clause becomes law, these 60 Trust’s financial problems could be used to justify closing NHS hospitals that belong to other Trusts nearby.

There are fears that the government intends to sacrifice successful hospitals without PFI debts, to keep the money flowing to the private investors behind the PFI deals, as they tried to do in Lewisham.