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Clause 118 could mean the end of independent GP commissioning

The NHS in England is faced with the prospect of wholesale reorganisation from above with virtually no accountability to CCGs or local people.

The Government have added Clause 118 to the Care Bill: this will give a Trust Special Administrator (TSA), called in for a failing Trust, new powers to reconfigure services across a whole health economy.

It allows fast-track closures – or privatisations – to happen to any hospital, however high quality, popular and solvent, if it has a more struggling hospital nearby.

The Bill is going through Parliament now and the amendments, including this clause will probably be voted on in January or February.

The current legislation was designed to enable the Secretary of State to make fast decisions about a Trust that is failing financially. It was tried out for the first time last year in the South London Healthcare Trust: a Trust Special Administrator (TSA) was appointed who developed plans that affected hospitals across the whole of south east London and included Lewisham Hospital, a thriving district general hospital.

But the inclusion of Lewisham was challenged in the courts by the council and the Save Lewisham Hospital Campaign, and was conclusively shown to be illegal – at the moment the legislation only applies to the failing Trust itself, not neighbouring Trusts.

In response, the Government intends to change the law to ensure that a TSA has the power to make changes beyond the challenged hospital, including Trusts and other providers. It is doing this by attaching Clause 118 to the Care Bill which is currently going through Parliament. The amendments, including this clause, will probably be voted on in January or February.

So far as accountability is concerned, the Clause makes clear that:

  • Local Authorities can’t scrutinise new proposals.
  • The time for consultation is increased to 40 days.
  • CCGs do not have to consult their populations about the proposed changes.
  • Even if CCGs in the affected area disagree, a final decision can be made by NHS England.

How this affects you

CCG independence is threatened. With a wider geographic area potentially affected, there is a requirement for all affected CCGs to be consulted. However, even if they disagree (which is highly likely, as we found) NHS England will still be able to make an overruling decision. So this means that CCGs’ ability to have any real say in services for their patients virtually disappears. And even if the Bill goes through, it may not even be possible to implement the TSA’s recommendations.

There is vanishingly little consultation with the public – 40 days, hardly time to fix meetings. Local people will be confused. It will be very difficult for Healthwatch across a number of boroughs and Trusts to coordinate to discuss proposals which will affect a large area in complex and often unpredictable ways. GPs up and down the country are likely to be dragged into arguments and frustrations as solutions are imposed.

Our experience in Lewisham is that GPs engaged vigorously with the TSA process. We quickly became disillusioned as we realised what was being suggested and how that would reduce patient safety and make our clinical work more difficult. On the other hand, GPs in Bexley were pleased with the TSA’s solutions.

How it affected me

The TSA process seems to me to be dangerous and flawed. I live and work in Lewisham and I am part of the Save Lewisham Hospital Campaign. A totally new reconfiguration was proposed beyond any previous suggestions, which made it difficult to explain and respond.

It was inaccurately and inadequately described: it left out any mention of the major impacts on paediatric and mental health services. It distorted evidence and statistics. It did not follow agreed procedure – for example it omitted an equalities impact assessment.

And next time, it could be you facing down the TSA. We did not expect this in Lewisham – we have a thriving and financially solvent Trust. We became the fall-guys to solve the finances of a Trust in another area. There are plenty of Trusts out there over which the TSA process is hovering.

If this worries you, you can raise this with your CCG and the BMA. You could also write to your MP and demand that they vote against Clause 118 of the Care Bill (here is an example of a letter and here are suggestions to include if you want to construct a letter of your own).  Ask your MP to sign the Early Day Motion 656 ‘Closure of NHS services’ which has been laid down, and already signed by a MPs from different parties – including Labour front benchers.

Dr Brian Fisher is a semi-retired GP in New Cross, south London, and patient and public involvement lead for the NHS Alliance.