A final chance to defeat the hospital closure clause

The TUC is calling on MPs to oppose the government’s ill-thought out hospital closure clause.

Matt Dykes is senior policy officer for Public Services at TUC

Today MPs will vote on the final stages of the Care Bill, with much attention focused on the controversial Clause 119; the so-called ‘hospital closure clause’.

The TUC together with health unions and campaigners have major concerns about these proposals and are calling on MPs to oppose the clause in today’s vote, as we believe it has major implications for the quality of services and the involvement of staff, local communities and patients in decision-making.

In the face of concerted opposition by the public to the government’s efforts to use Trust Special Administrators (TSA) to reconfigure health services, including a decision by the High Court that efforts to downgrade Lewisham Hospital would not go ahead, the government introduced the clause in the House of Lords as an amendment.

The clause, if it passes, would enable TSAs appointed to a failing NHS trust to have the power to take decisions that go wider than the trust under consideration – so to reconfigure services from other trusts (such as in the case of Lewisham).

The amendment also makes clear that requirements to consult with patients and the public over planning and changing services do not apply – there will be a 40 day period with ‘at least one meeting’ of the staff and public affected.

During the committee stage of the Bill, Conservative and Lib Dem MPs repeatedly made the argument that service changes must take into account ‘whole health economies’, not isolated to specific hospitals and that the TSA powers will only be used in a minority of cases.

The NHS Development Authority has reported that around 30 per cent (of 102) non-foundation trusts are planning a deficit for this financial year, and Monitor reports that around 11 per cent (of 147) foundation trusts are planning similarly.

With this increase in mind, it is very likely that TSAs will be used ever more readily, with so-called service reconfigurations taking place based largely on financial imperatives, and with very little in the way of staff and service user engagement.

We recognise that the NHS is a joined-up system and changes to services must have implications for delivery across a whole area. We believe however that changes to services must be informed by clinical opinion and consultation with staff, patients and local communities.

Clause 119 does not provide for such consultation – 40 days is not enough time to reconfigure services that affect a whole area. The Nuffield Trust have noted that the consultation requirements remain “far fewer and far shorter” than what is typically required.

The TUC recommends MPs vote for amendment 30, which has support from Labour MPs, and calls for the removal of clause 119 from the Bill.

In the event that this amendment is not passed, the TUC recommends that MPs support amendment NC16 , supported by cross-party MPs, which redresses the balance of power by giving ultimate decision making powers to local commissioners and, where CCGs do choose to consult with patients and public, this will be under the more rigorous requirements of the NHS Act 2006.

The TUC do have reservations about amendment NC16, as there remain questions over what happens to public consultation where commissioners choose not to engage with the public and patients.

Lib Dem MPs have supported NHS reform under the rubric of promoting local democracy, and it is clear that clause 119 stands in clear contrast to participation in decision-making by local communities, staff and service-users.

This vote will be an opportunity to see whether they will defend such principles or opt for a model of service delivery and decision-making that allows little space for improving service quality, participation or local decision-making.

The TUC is calling on MPs to abide by their commitment to put patients and clinical staff at the heart of decision-making within the NHS and oppose the government’s ill-thought out hospital closure clause.

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