Health campaigners in south-east London had good reason to celebrate on 29 October. They had inflicted a second legal defeat on health secretary Jeremy Hunt, who had moved to close Lewisham Hospital A&E and downgrade its maternity services as part of an NHS debt-management exercise, all with minimal public consultation.
But their victory may be short-lived, as the Coalition government has amended the Care Bill now before Parliament to give the health secretary powers to fast-track hospital closures or downgrades, regardless of clinical or financial performance. Under current law, this can only be done if a trust is insolvent and has been taken into administration.
Campaigners claim the Coalition is trying to rush the changes through on the quiet, and are calling for the new provisions to be defeated or removed. A petition against the clause can be found at 38degrees, with further advice on opposing the bill at OpenDemocracy.
Lewisham hospital’s A&E and maternity unit are a financial success, but the neighbouring South London Healthcare NHS Trust (SLHT) had accumulated debts of £150m, and was losing £1.3m each week.
SLHT was the first to be given the new ‘unsustainable providers’ treatment, with Matthew Kershaw, a government-appointed special administrator, called in to make recommendations. He proposed that other providers take over SLHT’s services.
In addition, Kershaw urged a major reorganisation of emergency and maternity services across south-east London and Kent, which would have involved fast-tracking a merger of Lewisham and Queen Elizabeth hospital in Woolwich.
The proposals were very unpopular locally. Lewisham consultant physician Dr John O’Donoghue was reported at the time saying that the plan would set a “disturbing precedent”, adding: “If services at a successful and well-run hospital like Lewisham are closed due to problems at a neighbouring trust, then no hospital in the country is safe. These plans are a travesty.”
Jeremy Hunt approved the plans in early spring, and SLHT has since been wound up and its services transferred. However, the closure of Lewisham’s A&E department and the downgrading of its maternity service were put on hold pending legal challenges.
In June, the high court declared Hunt’s decision to downgrade services at a major hospital as unlawful, claiming he had breached provisions of the National Health Services Act 2006. The appeal court upheld this decision on 29 October.
But the whole affair suggests that the government is intent on closing or downgrading important and popular public services as it sees fit, regardless of their quality or cost-effectiveness – and without necessarily having any democratic mandate to do so.
This is the flip side of the government’s money-creation extravaganza that is quantitative easing, in which £375bn has effectively so far been given, interest-free, to the major banks to do with as they wish. How long can public services be starved of cash, while the very financial institutions which led us into the 2008 crash are rewarded with billions of pounds?