Fast-track hospital closures tagged onto Care Bill

MPs are gearing up for a furore as the government attempts to introduce a new law to fast-track hospital closures across the country, against the will of local populations.

Towards the end of business on 15th October, Shadow Health Minister in the Lords, Lord Philip Hunt tweeted that

‘Govt just put down amendment to Care Bill re Trust Special Administrators. Will make easier in future to close down A&E depts like Lewisham’

Since Lewisham’s victory in the High Court on July 31st, which preserved our brave and beleaguered hospital, campaigners have been sure that Jeremy Hunt and junior health minister Earl Freddie Howe would be investigating every angle to get round the judges’ decision.

Hunt launched an appeal against the Lewisham decision on 21st August.

But they have not left it at that.

Next week the government will attempt to introduce a sweeping law which if it succeeds in making its way intact through the Lords and the Commons, will mean quite simply that absolutely no English hospital will be safe.

New expansive powers would be attached to every ‘administrator’ appointed to any trust assessed - on pretty broad criteria - as failing.

Crucially, the powers would for the first time extend to any hospital trust unfortunate enough to find itself neighbouring a failing trust. The clauses give the ‘Trust Special Administrator’ the powers to dictate cuts or even hospital closures to other NHS trusts, rather than just the one to which they are appointed.

This was at the crux of the government’s defeat over Lewisham, which they are spending so much energy - and money - trying to overturn in the courts.

In the Lewisham case, the judge, Justice Silber, had ruled that Hunt and his administrator Matthew Kershaw had no right to use the ‘special administration process' in a neighbouring NHS trust - South London - to meddle in the affairs of unrelated Lewisham Hospital - and to ignore the view of local GPs.

In part, this sudden pop-up Amendment (to Care Bill Clause 109) is the action of a government shoring themselves up for a judicial defeat. Lewisham campaigners suspect that the government senses their Appeal, due to be heard just a week after the Lords debate has been tabled, is on rocky ground. Although the Amendment will not apply retrospectively to the Lewisham case, if it passes it would enable them to rain blows on Lewisham that they have been unable to inflict by other means, all over again.

But not just Lewisham.

Essentially this Care Bill Curve Ball amendment would be a mandate to manipulate hospital provision anywhere in the country in any way the government sees fit.

As health minister Earl Howe states in his letter – this legislation would

‘Put beyond doubt that the Trust Special Administrator has power to make recommendation, and the Secretary of State/ Monitor the power to take decisions,  that affect providers other than the one to which the administrator was appointed’.

For those who think that Foundation Trust status will ensure protection, Earl Howe’s letter demonstrates that any hospital will be deemed as fair play for his game shoot

“this regime is one way in which decisive action can be taken to deal with NHS trusts and NHS foundation trusts that are unsustainable in their current form. ‘

By the same principle the Mayor of London could have a go at simultaneously managing the affairs of Newcastle if it was deemed that city could rescue the capital’s economy.

Should we expect resistance from the Foundation Trusts themselves and the NHS establishment? Perhaps not. A letter penned just a couple of weeks earlier by the NHS Confederation and the Foundation Trust Network, encourages Jeremy Hunt to take this very action and offers their expertise in writing an Amendment.

Many have found this more shocking than the actions of the by now rather predictable government would be an understatement.

Patient satisfaction rates were at their highest ever in 2010. Since  then, services – including public health and the battered care sector, have been starved of resources, whilst £3billion was wasted on a chaotic reorganisation and £2billion so-called underspend sent back to the Treasury.

Now we are told the NHS is ‘not good enough’ and the best way to solve that is by taking out life saving services in a chaotic mash up of hospital provision – which they seek to execute without any community infrastructure in place to deal with at least a proportion of the human fall-out.

Lewisham Hospital now has the additional role of managing the QEH Woolwich along with its bottomless PFI, originally negotiated by former Secretary of State Virginia Bottomley, under the newly merged Lewisham and Greenwich NHS Trust – neither Woolwich nor Lewisham being of a size to qualify for mandatory FT status whilst flying solo. As we know, failure to become a Foundation Trust brings with it the threat of being disappeared into the jaws of a private takeover.

First and foremost Lewisham campaigners seek to protect essential life saving services for our high need population – where the life expectancy for a male is a mere 70 and conditions such as sickle cell which require very prompt A&E and sometimes ICU attention. A rising birth rate also means that the loss of our high quality maternity and paediatric services would be catastrophic.  Say it as often as they might, centralised services will not save as many lives as those which reflect the needs of the population when it comes to conditions requiring fast attention such as placenta previa, peritonitis, oesophageal bleeds and meningitis.

Mr Hunt seems more than a little out of his depth with his brief. But Earl Howe possesses a formidable intellect and a manner which can often sweep the most malodorous of objects gracefully under the nearest rock. Howe will no doubt point to the few extra days added to a fast-track closure process. But an extension from 30 to 40 days does not make it any less fast-track, compared to the years and extensive local consultation that normal hospital closures take. Nor is it clear which areas will then be all too briefly ‘consulted’ - or if the government will pay any attention to this then severely curtailed ‘consultation’, something Lewisham residents know all too well.

Even the noble Earl may struggle to hide the real intent behind this move. To those of us fighting to save hospital services across the country, or indeed the cut-price Royal Mail sell-off, it is clear this government’s only interest is in lining the pockets of party donors – 13% of whom come from the private health sector.

We are devotees of the NHS for a reason – we are all too well aware that the private sector creates fragmented services which are unaccountable to the taxpayer.

Health inequalities continue to worsen across the country. Monday saw announcements from NHS England and NHS London that services would have to be cut drastically in the face of budget requirements – and yet billions are being allowed to slip through the tax avoidance net.

Now we have the government attempting to create an environment where no neighbourhood is safe.

MPs are gearing up for what has been described as a ‘furore’ in the Commons. Meanwhile, if the government has any decency whatsoever they will think again about the 2 working day timescale that the government has given us to prepare for the debate in the Lords – for this is certainly not the way to make for a healthier population or a secure society. 

About the author

Jos Bell is a social economist and researcher who has a wide public sector background, working at national level in the fields of family & community services, the NHS & public health. She writes on health and disability issues.