Not feeling so courageous, eh, minister?

William Hague is not the first MP to put loyalty to a local hospital before government policy, and h

The Sun reports today that William Hague is lined up to speak at a rally in opposition to the downgrading of a maternity unit at a small hospital in his Yorkshire constituency. A spokesman for the Foreign Secretary is quoted as saying this has nothing to do with the health reforms contained in besieged legislation currently causing tumult in parliament.

In technical terms, that might just about be true. The Health and Social Care Bill isn't on the statute books so it cannot directly have led to changes on the ground to which Hague is opposed. But politically the two cannot be separated. Partly, it just looks ridiculous. People conflate 'reform' and 'cuts' (the Sun's copy certainly does) and generally blame the government for everything bad that happens in the NHS so will wonder whose side the Foreign Secretary thinks he's on.

But the Hague conundrum also points to a more subtle, long-term problem. There is something approaching consensus in health policy circles that, eventually, for the sake of cost efficiency and coordination of care, specialist services need to be concentrated in centres of excellence, while routine procedures can be done more locally. What this means in practice is that the medium-sized district general hospital is an endangered species. There will be clinics, often based around GP practices, for the small stuff, and then fancy regional centres for the high-tech, complicated stuff. This dynamic appears to be what is behind the removal of certain services from Hague's constituency. Routine baby deliveries will stay; inpatient paediatric care is moving off 22 miles away to Middlesborough.

The problem with this trajectory - although it might make commercial and clinical sense on paper - is that it makes for atrocious politics. It always means stories of sick patients being forced to travel miles by taxi or ambulance when what they really want is just to stay local. Every constituency has an old-fashioned general hospital and every MP feels obliged to stand by it on the barricades. (Remember Hazel Blears getting into much the same pickle?)

Lansley's reforms are going to replicate this situation in constituencies up and down the country. The new GP-led commissioning structures and enhanced competition to provide care will, it is guaranteed, accelerate the process of 'rationalisation' away from general hospitals. That is partly the point of the reforms, albeit not one the government boasts about. Local surgeries will pick off the work that doesn't need in-patient beds, while specialist hospitals will be the obvious suppliers of more complex procedures. Plenty of Tory and Lib Dem MPs are worried about the dilemma this will create for them. It is a courageous politician indeed who turns up at a local town hall meeting to say 'actually,in the interests of overall NHS efficiency and in support of government policy, I'm here to defend the closure of our casualty/maternity ward.'

Hague isn't planning on doing it. The rest will follow his lead. This is just one of many reasons why Andrew Lansley's reforms are a political disaster. He can't seem to sell them to the public and no one else with a seat to defend containing a cherished local hospital is going to dare do it for him.

Rafael Behr is political columnist at the Guardian and former political editor of the New Statesman

Grant Shapps on the campaign trail. Photo: Getty
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Grant Shapps resigns over Tory youth wing bullying scandal

The minister, formerly party chairman, has resigned over allegations of bullying and blackmail made against a Tory activist. 

Grant Shapps, who was a key figure in the Tory general election campaign, has resigned following allegations about a bullying scandal among Conservative activists.

Shapps was formerly party chairman, but was demoted to international development minister after May. His formal statement is expected shortly.

The resignation follows lurid claims about bullying and blackmail among Tory activists. One, Mark Clarke, has been accused of putting pressure on a fellow activist who complained about his behaviour to withdraw the allegation. The complainant, Elliot Johnson, later killed himself.

The junior Treasury minister Robert Halfon also revealed that he had an affair with a young activist after being warned that Clarke planned to blackmail him over the relationship. Former Tory chair Sayeedi Warsi says that she was targeted by Clarke on Twitter, where he tried to portray her as an anti-semite. 

Shapps appointed Mark Clarke to run RoadTrip 2015, where young Tory activists toured key marginals on a bus before the general election. 

Today, the Guardian published an emotional interview with the parents of 21-year-old Elliot Johnson, the activist who killed himself, in which they called for Shapps to consider his position. Ray Johnson also spoke to BBC's Newsnight:


The Johnson family claimed that Shapps and co-chair Andrew Feldman had failed to act on complaints made against Clarke. Feldman says he did not hear of the bullying claims until August. 

Asked about the case at a conference in Malta, David Cameron pointedly refused to offer Shapps his full backing, saying a statement would be released. “I think it is important that on the tragic case that took place that the coroner’s inquiry is allowed to proceed properly," he added. “I feel deeply for his parents, It is an appalling loss to suffer and that is why it is so important there is a proper coroner’s inquiry. In terms of what the Conservative party should do, there should be and there is a proper inquiry that asks all the questions as people come forward. That will take place. It is a tragic loss of a talented young life and it is not something any parent should go through and I feel for them deeply.” 

Mark Clarke denies any wrongdoing.

Helen Lewis is deputy editor of the New Statesman. She has presented BBC Radio 4’s Week in Westminster and is a regular panellist on BBC1’s Sunday Politics.