Care Bill amendment gives NHS advocates clause for concern

Abstract

A controversial government amendment to the Care Bill will be at the centre of fi erce political debate this week, as the draft legislation reaches the crucial Committee stage of its passage through the House of Commons. If a hospital is identifi ed as failing to provide adequate clinical care or has become insolvent and is placed into special administration, clause 118, dubbed the “closure clause” by its opponents, would grant the Secretary of State for Health sweeping powers to close or downgrade any hospital deemed to fall within the “health economy” of the failing institute, irrespective of its own fi nancial viability or the strength of clinical services. Any changes can be imposed after a public consultation period of 40 days but, under the clause, “the statutory obligations of commissioners to involve and consult patients and the public in planning and making service changes do not apply”, according to health minister and Conservative peer Earl Howe, who guided the bill through the House of Lords last year and tabled the amendment in October. The provision will ensure that “decisive action can be taken to deal with NHS trusts and NHS foundation trusts that are unsustainable in their current form”, says Howe. But there is strong opposition from campaigners who argue that the clause would open the door for wholesale cuts to services with no plans to meet the needs of local populations, no oversight from local authorities, and no requirement to take the opinions of clinical commissioning groups (CCGs) into account. Special administration in its current form has been applied only twice to date. In April, 2013, the regulator Monitor appointed a Trust Special Administrator (TSA) to take over the running of Mid Staffordshire NHS Foundation Trust after serious management failures were identified during an inquiry into poor standards of care. More controversially, in July, 2012, the Secretary of State for Health Jeremy Hunt appointed a TSA to devise a rescue plan for South London Healthcare NHS Trust, which was crippled by debts accrued during a redevelopment funded through a private fi nance initiative. The TSA’s plan involved closing the accident and emergency department and other services at a nearby well-performing trust in Lewisham, and reallocating the money saved to the bankrupt trust.