Polly Toynbee in her Guardian column of 25th October draws attention to “an emergency extra law …. rushed through the Lords this week to give NHS bankruptcy administrators power over surrounding viable hospitals” (1). This means that the Government , having been told by Mr Justice Silber that the action of its appointed ‘special administrator’ to close the Lewisham A&E department was unlawful, is attempting to change the law to allow special administrators a free hand to close facilities and move services without any real public consultation. This at a time when the Government has been heralding patient and GP involvement and engagement and supposedly bringing about a new era of localism and choice. Already this law has passed through the House of Lords and now all that stands in the way is the agreement of the House of Commons.
This Government was taking no chances. To cover the risk the House of Lords might interpret this action as a petty, vindictive, and contradictory piece of legislation, allowing backdoor reconfiguration of NHS services without going through the messy process of declaring and securing agreement to plans in advance, the Government recently replenished the well-upholstered seats of the House of Lords with a new intake of reliable voting fodder. Thus having restored the House of Lords to its traditional role as a seat of reaction, the last remaining hope is that the House of Commons will restore its reputation by standing up for due process and resisting the over-mighty executive. At least members of the House of Commons, with the prospect of a General Election in little over 18 months time, may be slightly easier to influence than the unaccountable members of the House of Lords. What are the arguments that might be used to sway MPs?
Why it should matter to Conservative MPs
The Conservative plan had been to get the dirty work out of the way early in the parliament and to be re-elected on the back of the turnaround in the economy. It certainly wasn’t to get embroiled in contentious, dubious, top-down decisions by unaccountable administrators having the effect of closing A&E departments all across the land. Even if used judiciously, 10 to 20 of these no-win situations could determine the fate of the next election.
A lot of trouble and parliamentary capital had been expended in devising a system to pass responsibility to GP commissioners not to appointed administrators. Already there were signs that GPs are disenchanted with NHS England and Monitor. This latest manipulation looks like even more top-down direction to them.
And if it is deemed permissible to hustle through legislation to get your way when due process frustrates an inconvenient delay, a dangerous precedent is created. It is all very well using parliamentary procedure to ensure the wishes of Parliament are properly enacted but it is another thing entirely to allow the executive to dictate even more and to overrule views of local GPs, patients and their MPs.
Why it should matter to Labour MPs
Yes it was the Labour Party that established the powers of the administrator within the failure regime, but this was never intended to be a backdoor means of major reconfiguration not possible through normal channels. Labour MPs should consider the risk that most of these administrative manoeuvres may be taken in Labour areas, not having friends in Cabinet. Although fighting the closure of a local hospital may help some Labour MPs be re-elected, will constituents really thank them if they are powerless to stop local services being withdrawn? Labour MPs have a duty to ensure services are defended in the interests of their constituents, and that any changes are thoroughly worked through with local people in support, not to assist NHS England to give carte blanche to help push changes through before the next election.
Why it should matter to Liberal MPs
Liberals are supposed to support localism and consensus decision-making, not to hand power to quasi-liquidators to close down much needed local services because of aberrations in NHS funding systems, struggling to cope with local pressures caused by factors outside the control of local people. For example it now seems clear that problems in South East London were caused by the unfunded consequences of PFI developments there. It may have been completely unnecessary to close the A&E and obstetric departments at Queen Mary’s Sidcup. It would surely be perverse for Liberal Democrat MPs to support an even more top-down decision-making process making it easier to override local wishes and local interests.
Over to you Parliament
The final word should perhaps go to Professors King and Crewe from their recent book “The Blunders of Our Governments”. Summing up the causes of the many blunders of government they put the blame, amongst other things, on the failure of Parliament to do its job. It should not be the job of Parliament to make it easier for government ministers to override local concerns and to foist top-down solutions onto suspicious and sceptical local people. It should be encouraging due process, proper forward-planning and consensus decision-making. It is time Parliament stood up and made itself heard.
Roger Steer
Healthcare Audit Consultants Ltd
1. We found out this week why the government were in such a hurry when the Court of Appeal decisively rejected the appeal from the Secretary of State of the Lewisham decision.