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Hospital closure clause: the toxic addition to the Care Bill

From Matt Dykes at Touchstone:

As the Care Bill enters the Commons for its final stages next week, attention will be grabbed unfortunately by Clause 119 - more popularly known as the Hospital Closure Clause.

Inserted as a government amendment in the House of Lords, the clause provides new powers to the Trust Special Administrator (TSA) appointed to take over a financially failing NHS trust or foundation trust to make recommendations for the reconfiguration of services that affect providers across the whole region.

That could mean making proposals to close financially healthy and outstanding hospital services simply because they neighbour another Trust that’s in financial distress.

If this clause becomes law, hospitals will be at risk of having services shut down without their agreement, without proper consultation with clinical staff, patients and the public, and without even any agreement from the new GP commissioners.

The Bill got through the Committee Stage with some minor amendments. In the face of concerted opposition, the government has extended limited consultation rights to staff and representatives of neighbouring Trusts.

But the amendments do nothing to alter the fact that we will have a new regime in place across the NHS that will enable the fast-track closure of hospital services with a consultation process that is just not fit for purpose for reconfigurations of this potential scale.

This is something that that neither Conservative nor Lib Dem MPs at the Committee Stage of the Bill seemed to grasp. The line repeatedly taken by coalition representatives in the Committee debate was that service configurations must take into account whole health economies and can’t be isolated to individual hospitals and that the TSA regime is in place only for a minority of extreme cases.

Neither argument stands up to scrutiny.

First, of course it is recognised that the NHS is a joined up system and, as such, changes to services must surely have implications for delivery across a whole area. No-one is arguing against the reconfiguration of services that is informed by clinical opinion and consultation with staff, patients and local communities.

But these will largely be closures based on financial imperatives, these will be decisions arrived at by Trust Special Administrators attempting to solve local funding crises, not necessarily on improve clinical outcomes. Moreover, the proposed consultation requirement of 40 days and “at least one meeting” of the staff and public affected is simply insufficient to deal with what might be a complex and far reaching change to services across a region, including potential closures of local hospitals.

The Nuffield Trust states that these consultation requirements remain “far fewer and far shorter” than what is typically required. As we continue to say, this regime is not fit for purpose for the task in hand.

Second, while it is true that Trust Special Administrators have only been brought in on two previous occasions, the startling state of NHS finances suggest that we’re likely to see their increasing use.

The NHS Trust 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 forecasting a similar position. As the number of trusts in financial difficulties increases, there will be an increasing use of TSAs and therefore an exponential increase in the number of other hospitals affected.

Neither point has been addressed by coalition representatives in parliamentary debate. As such, Clause 119 remains a toxic addition to the Care Bill as it enters the Commons for the last time. This legislation is an attack on our NHS and affront to the principles of local democracy and patient voice that was supposed to underpin the government’s reforms of the NHS.

The TUC is calling on MPs to oppose the clause during the Report Stage and 3rd Reading scheduled for the week beginning 10th March. We particularly want to target Lib Dem MPs who, let’s not forget, premised their support for the government’s dismantling of the NHS on the platform of local democracy.

Please email your MP, using the TUC’s Going to Work site, and help spread the word about this threat to our local NHS hospitals.


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