Care Bill [Lords]

Written evidence submitted from Unite the Union (CB 26)

Re. Chapter 4, Clause 118 of the Care Bill

I am writing to you to raise urgent concerns about regulations Chapter 4, Clause 118 of the Care Bill.

Clause 118 appears to have been inserted into the Bill as a way to make it possible, easier and faster to close or privatise any viable hospitals. The Government will be allowed to close or downgrade any hospital in the country, with little consultation with local people or regard to clinical need, clinical infrastructure, local clinical expertise or decision making if there is another Trust in financial difficulties anywhere nearby. Given the reorganisations, cuts, and disruption currently being imposed on the NHS, there will be very few hospitals in the country that are not near a hospital that is experiencing financial challenges.

Unite is extremely concerned about the clinical risk caused by these changes and the lack of local control and clinical decision making that will result.

Currently the law allows these fast-track closures to happen only at hospitals that are in such serious financial or clinical difficulties that they are taken into ‘Administration’. Clause 118 however extends the powers of Trust Special Administrator (TSA) that take over struggling Trusts. Crucially these will now be able to take decisions to fast-track the closure of hospitals in another area - no matter how ‘successful’ those hospitals are at addressing the clinical needs of the local population - using the 'unsustainable provider' legislation that was designed only for insolvent Trusts. If it becomes law, this Clause means that no hospital will be safe, no matter how successful, and officials that are distant from the needs of local populations making decisions over the heads of local clinical experts

Unite believes that this is a dangerous move which will put thousands of lives at risk, by removing local clinical decision making about local NHS provision. Fundamental to the planning of NHS services must be regard to the clinical needs of the communities that are served. Government is not in a position to arbitrarily make these decisions, and must seek proper consultation from local clinicians and the local population

As it stands it appears that the Government is planning to use the fast track ‘failure regime’ as a tool to reconfigure hospital provision more generally. This is totally inappropriate. If services need redesigning the law must ensure this is with proper and extensive consultation with local people and that decisions are based on clinical needs not political interference.

Evidence demonstrates that clinical reorganisation has a bearing on the immediate and wider population, and ensuring that the distribution of clinical specialisms is a matter of local and regional clinical interest, for example the London Stroke Plan. It is also essential that any reorganisation doesn’t just focus on acute services, but there is also an impact assessment on primary care.

Unite is also extremely concerned about the motivation for introducing this clause, as it appears to be solely aimed at overturning the outcome of the affective local campaign to defend Lewisham Hospital in South London. This campaign successfully took a legal challenge against the Secretary of State to prevent the fast-track closure of Lewisham’s A&E and maternity services, in order to redirect patients (and money) to a different Hospital Trust that had large Private Finance Initiative debts to pay off to the banks.

The clinical evidence demonstrated that these reforms would have been detrimental to the local population and would have put lives at risk. The capacity of neighbouring hospitals was also severely challenged at being able to deliver safe, timely and appropriate services, including in the field of emergency medicine.

After losing both the judicial review and the appeal, the Secretary of State has responded by inserting Clause 118 into the Care Bill as an amendment. It has no relation to any of the other issues covered by the substantive Bill.

Unite believes that this will drastically reduce the rights of the public to have a say in decisions about our local hospital and health provision. These changes make a mockery of the Government promise that in the NHS there would be ‘no decision about me, without me’ and the localism agenda.

Unite urges the committee to urgently move to remove this clause in its entirety from the Care Bill as it offers no benefit to our health service, communities or governance. Unite recognises the need for proper debate on clinical reorganisation to improve the effectiveness of clinical care and to improve the life chances of local populations, however Unite believes that this needs a far greater debate and must be clinically led.

January 2014