MPs approve greater powers for UK government to close hospitals, but with a CCG veto.

MPs have voted for a change in the law that will give the government more power to close well performing hospitals that are in the same area as poorer performing neighbours. However, last minute concessions were made to give clinical commissioning groups the power to stop any moves that might use successful hospitals to help solve problems at failing trusts. MPs in the House of Commons debated an amendment (clause 119) to the Care Bill on 10 and 11 March, which could allow services at well performing trusts to be shut or downgraded as part of a wider plan to reconfigure health services across a whole region on the recommendation of a government appointed trust special administrator at a nearby failing trust. After a lengthy debate held over two days 297 MPs voted for the amendment to be included, and 239 voted against it. The government introduced the amendment after a court decided last year that Jeremy Hunt, the health secretary, had acted illegally when he tried to downgrade emergency services at Lewisham Hospital in southeast London. Hunt’s downgrade attempt had followed recommendations by the trust special administrator for the neighbouring former South London Healthcare NHS Trust. The amendment means that such a situation cannot happen again, and it will allow a special administrator to make changes to hospitals that are close to those with problems. Critics of the change said that such recommendations would be made without sufficient consultation with patients and the public or the approval of local clinical commissioning groups, but ministers denied this. During the debate Andy Burnham, the shadow health secretary, said, “Clause 119 allows a hospital to be closed or downgraded simply because it happens to be near a failing one. “It creates an entirely new route for hospital reconfiguration—top-down and finance led. It subverts the established process in the NHS, which requires that any changes to hospitals should first and foremost be about saving lives, rather than saving money. It puts management consultants, not medical consultants or GPs, in the driving seat.” Daniel Poulter, health minister, said, “TSAs [trust special administrators] are for rare and extreme cases of failure. This is not a power to be used to reconfigure services routinely. This is a system of last resort, and other actions will of course be taken first to address the problems of trusts in difficulty. “We believe in locally led commissioning and in listening to patients locally. This clause is not to be conflated with normal procedures for designing and arranging local hospital services.” During the debate, Paul Burstow, Liberal Democrat MP for Sutton and Cheam, sought to withdraw an amendment that he had originally proposed, which would have curtailed clause 119. Burstow had had concerns about the clause but was reassured by Poulter, who said that clinical commissioning groups that sent patients to successful hospitals would have the power to block that hospital being used to help solve a problem elsewhere, if the group disagreed. Burstow will chair a committee of MPs and peers that will oversee the drafting of new guidance on the role of clinical commissioning groups in such situations. Grahame Morris, Labour MP for Easington, said, “Despite the assurances given by . . . government frontbenchers, the potential remains for this mechanism to be used as a backdoor route to making changes and closures at hospitals. “Potentially, clause 119 could take control of every NHS trust and foundation trust away from the public, leaving no hospital bed in the country safe.” Stephen Dorrell, Conservative MP for Charnwood and health select committee chairman, said, “Are we really going to say that a trust special administrator can only look at the circumstances of an institution that has been proved to be unviable? Or are we going to allow him to look outside those circumstances, in order to deliver better care for patients?”