11 Mar 2014

Government pushes through ‘hospital closure clause’

It’s called clause 119, used to be known as clause 118, but is more widely referred to – by its opponents – as the hospital closure clause. Inserted into the care bill by Health Secretary Jeremy Hunt it gives him and officials greater powers to intervene to close or downgrade hospital services.

The clause was written in following the controversial attempts to close maternity and emergency services at Lewisham hospital in south London last year. The court of appeal told the health secretary that he had overstepped the mark by agreeing to these wholesale changes, which had been proposed after the neighbouring South London Healthcare Trust went into administration.

It is widely acknowledged that there was fury in the Department of Health and the health secretary’s office at the failure to get the south London changes made.  But there is frustration, too, that any discussion of closure inevitably leads to years of battle, often with no resolution, and very often with a great deal of money spent on legal challenges.

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So the response to Lewisham was the new clause which would allow services to be closed or downgraded within 40 days of a trust special administrator making a decision on what should happen not just to a failing trust but across a region.  The hope appears to be that this would be an end to judicial reviews,  lengthy public consultations, and public demonstrations.

It was probably a faint hope to begin with but the government faced a cross-party revolt with Labour, the Lib Dems and possibly some Tory rebels preparing to vote against the clause in Tuesday’s vote.

There is both a new clause to fully delete 119 and yet another new clause, tabled by the former health minister and Lib Dem MP, Paul Burstow, to require more consultation with both local doctors and patients over any reorganisation proposed because of a failure of another hospital.

Labour has also released a list which claims that 32 communities in England are at risk of hospital closures because NHS regulators have identified “significant concerns over finances”.  These are the communities, Labour says, are rendered “voiceless” by clause 119.

Labour’s shadow health secretary, Andy Burnham, said that the government was riding roughshod over local communities, depriving them of the ability to fight the changes.

Yet Mr Burnham does not disapprove of change, he says. He points to Labour’s reconfiguration of heart and stroke services in London, which reduced the number of units, centralising the expertise on to fewer sites and dramatically improving survival rates.  And that is, he said, a good example of a change driven by clinical imperatives rather than financial.

But there is a great deal of political nimby-ism when it comes to reconfiguration/change/closure – call it what you will. Known as the Kidderminster effect after a doctor campaigning against the closure of maternity and emergency services unexpectedly won the seat, MPs were reluctant to support anything which might affect their local hospital.

And with a general election next year, it would have been a brave or foolhardy MP to stick his head above this particular parapet and agree to the local A&E closing,  no matter how well the case for change was made.

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