Save Lewisham A&E demonstration. Photo: http://www.flickr.com/people/anngav/Ann Gav
The Care Bill: Clause for concern
The key talking points of the Care Bill were supposed to be the “cap” on the costs of social care and the implementation of the Francis recommendations following the Mid Staffordshire inquiry.
What a shame then that debate has increasingly focused on the addition of the so-called “hospital closure clause” (currently clause 118) in the House of Lords.
This was the government’s kneejerk reaction to having lost the legal case (and appeal) over the attempt to downgrade University Hospital Lewisham’s emergency and maternity services to deal with the financial problems at the neighbouring South London Healthcare Trust.
As a way of getting round this in future, clause 118 allows trust special administrators (TSAs) to “take action” against organisations that lie outside of the initial scope of their investigation.
In practice, this means hospitals could be closed or downgraded even if they are successful and financially viable.
As such, it gives far too much power to unelected TSAs and is the final nail in the coffin for the government’s claim that reform of the NHS would be led by clinicians.
It is true that the clause lengthens the time that TSAs have to consult stakeholders.
And the latest government amendments belatedly provide for some involvement of staff and commissioners in the new process.
However, even this longer time period (40 working days) is considerably shorter than those normally used in other major service changes.
And, as the people of Lewisham would attest, consultation is no guarantee of a community’s ability to shape the outcome; there is no suggestion in the Bill that the objections of a clinical commissioning group, for example, could block the TSA’s recommendations.
Moreover, the fundamental point remains: the TSA regime, based on narrow financial considerations and rooted in a truncated consultation process, is to become a backdoor mechanism for widespread reconfiguration of services across entire regions.
Pity the staff and management at a successful hospital living within exceedingly tight budgets in the expectation that this provides their organisation with protection from being broken up or sold off. These certainties would no longer exist.
As the Nuffield Trust has pointed out, with its expanded roles for the regulator Monitor and the Secretary of State, the clause directly contradicts the drive of the Liberating the NHS white paper and subsequent Health and Social Care Act.
What happened to local autonomy and GPs being in the driving seat? Wasn’t the new NHS supposed to be clinically-led?
The worsening financial position of trusts and clinical commissioning groups means that more hospitals are likely to fall foul of the failure regime. And clause 118 means that, in turn, more other trusts could now be dismembered to deal with their neighbours’ problems.
The clause can still be defeated and it is important that as many people as possible urgently contact their MPs here to raise the issue.
After all, this represents a real danger to all hospitals, and is further proof that the government’s NHS mantra of “no decision about me without me” has followed “all in this together” and “big society” to the great slogan dump in the sky.