Clause 118 would leave no hospital in England safe

The new regulation would allow Jeremy Hunt to close any hospital or department in Britain and rob the public of their right to protest.

Rules are pesky things when you’re trying to get things done. Especially when it comes to health care and you’re making such big changes that they can be “seen from space”. But for Jeremy Hunt et al, they’re more of a bore, not real obstacles. If the rule book tells them they can’t do exactly what they like, it’s very simple: they just rewrite it. It’s a luxury of the rich and powerful when irritations like Lewisham happen. The public claimed a victory, Hunt feigned defeat. But it was only a simpering type of defeat; he knew he’d be back. 

Hunt’s costly setback at Lewisham – costly for the taxpayer of course – said a lot about the government’s plans for the NHS in general. The way he has responded since, contriving to stack the law in his favour, says even more. It speaks volumes for the sheer determination he and the rest of the cabinet have in seeing their plans through, and the powerful means they have to back it up.

Means like Clause 118 of the Care Bill. Or as it’s known in some circles, the "Hospital Closure Clause". Another obscurity in the legislative blur, its purpose is nonetheless stark. If it is nodded through in the next few weeks, another checkpoint on the road to private health in the UK will be passed.

In short, Clause 118 will allow Jeremy Hunt and any future health secretary to close any hospital or department in England with very little trouble at all. No consent from the clinical commissioning group (CCG) which runs it (despite the new "autonomy" they’ve been granted), no sound financial basis for the decision, nor true democratic approval required. Only a tedious consultation process with the local yokels to sit through and you’re done.

It might be wilfully obscure but Dr David Wrigley, GP, BMA GP Committee member and anti-privatisation campaigner, is in no doubt about Clause 118’s menacing potential. He says: "It means no hospital in England is safe. It allows the closure of hospitals if it suits the higher powers and the main reasons may well be financial when it should be a clinically based decision. It’s effectively a hospital closure clause; it’s an affront to democracy." Wrigley has set up an online petition to fight Clause 118 and is urging the public to contact their MP in protest against it.

Why does all this matter? Well, it doesn’t. Not if you can afford your own healthcare. But for the rest of us who don’t have such luxuries, it means a hell of a lot. With hospital budgets under pressure and departments in crisis, private companies lurk in the shadows waiting to take over services under the NHS banner, like wolves in sheep’s clothing. Every time a nationalised service is closed, vital care will be pushed physically and financially further away from us.

With the rule book rewritten, this time leaving no room for little hiccups like Lewisham, the public will be cut out of the democratic process and robbed of their rights to protest closures. But perhaps the most nauseating part of it all is the double-standards. David Cameron gave a solemn promise that there would be no more "tiresome, meddlesome, top-down re-structures". Jeremy Hunt has said time and time again that CCGs should hold their own keys, that primary care should be delivered "in exactly the way CCGs want in their area", that by empowering and consulting with local clinicians and handing over responsibility for commissioning to the doctors on the ground, the NHS would be liberated.

For many, Clause 118 is proof, were it needed, that this was nothing but lip service. Unite’s head of health Rachael Maskell says: "This is going flat in the face of Jeremy Hunt’s previous rhetoric, and very much pushing along the line of centralist diktat about local services. It doesn’t bring in the CCGs at all; it doesn’t involve patients or staff."

Countless doctors, nurses, surgeons, managers, unions, patients, politicians, economists and dozens of campaign groups are pleading with the government to rethink the way it is "reforming" the NHS. Yet it presses ahead Thatcher-like, wilfully ignorant, skipping around every tiresome obstacle, using new tools like Clause 118 to take more power and control away from the people who have paid for the NHS and who need it the most.

For a party which received only 36.1 per cent of the vote in 2010 and is now squirming away in an uncomfortable coalition, ignoring the wishes of the medical profession, its own CCGs and the general public to bring in more centralised control and a privatised system that the majority of the public opposes, might just seem like arrogance.

But the history books, like the rule books, are written by the winners. With Clause 118 due to be sealed in the next few weeks the government might well be justified in a little swagger, knowing the book is nearly closed on the NHS once and for all.

Jeremy Hunt waits to deliver a speech during his visit with David Cameron to the Evelina London Children's Hospital on July 5, 2013. Photograph: Getty Images.

Benedict Cooper is a freelance journalist who covers medical politics and the NHS. He tweets @Ben_JS_Cooper.

Photo: Getty
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The rise of the green mayor – Sadiq Khan and the politics of clean energy

At an event at Tate Modern, Sadiq Khan pledged to clean up London's act.

On Thursday night, deep in the bowls of Tate Modern’s turbine hall, London Mayor Sadiq Khan renewed his promise to make the capital a world leader in clean energy and air. Yet his focus was as much on people as power plants – in particular, the need for local authorities to lead where central governments will not.

Khan was there to introduce the screening of a new documentary, From the Ashes, about the demise of the American coal industry. As he noted, Britain continues to battle against the legacy of fossil fuels: “In London today we burn very little coal but we are facing new air pollution challenges brought about for different reasons." 

At a time when the world's leaders are struggling to keep international agreements on climate change afloat, what can mayors do? Khan has pledged to buy only hybrid and zero-emissions buses from next year, and is working towards London becoming a zero carbon city.

Khan has, of course, also gained heroic status for being a bête noire of climate-change-denier-in-chief Donald Trump. On the US president's withdrawal from the Paris Agreement, Khan quipped: “If only he had withdrawn from Twitter.” He had more favourable things to say about the former mayor of New York and climate change activist Michael Bloomberg, who Khan said hailed from “the second greatest city in the world.”

Yet behind his humour was a serious point. Local authorities are having to pick up where both countries' central governments are leaving a void – in improving our air and supporting renewable technology and jobs. Most concerning of all, perhaps, is the way that interest groups representing business are slashing away at the regulations which protect public health, and claiming it as a virtue.

In the UK, documents leaked to Greenpeace’s energy desk show that a government-backed initiative considered proposals for reducing EU rules on fire-safety on the very day of the Grenfell Tower fire. The director of this Red Tape Initiative, Nick Tyrone, told the Guardian that these proposals were rejected. Yet government attempts to water down other EU regulations, such as the energy efficiency directive, still stand.

In America, this blame-game is even more highly charged. Republicans have sworn to replace what they describe as Obama’s “war on coal” with a war on regulation. “I am taking historic steps to lift the restrictions on American energy, to reverse government intrusion, and to cancel job-killing regulations,” Trump announced in March. While he has vowed “to promote clean air and clear water,” he has almost simultaneously signed an order to unravel the Clean Water Rule.

This rhetoric is hurting the very people it claims to protect: miners. From the Ashes shows the many ways that the industry harms wider public health, from water contamination, to air pollution. It also makes a strong case that the American coal industry is in terminal decline, regardless of possibile interventions from government or carbon capture.

Charities like Bloomberg can only do so much to pick up the pieces. The foundation, which helped fund the film, now not only helps support job training programs in coal communities after the Trump administration pulled their funding, but in recent weeks it also promised $15m to UN efforts to tackle climate change – again to help cover Trump's withdrawal from Paris Agreement. “I'm a bit worried about how many cards we're going to have to keep adding to the end of the film”, joked Antha Williams, a Bloomberg representative at the screening, with gallows humour.

Hope also lies with local governments and mayors. The publication of the mayor’s own environment strategy is coming “soon”. Speaking in panel discussion after the film, his deputy mayor for environment and energy, Shirley Rodrigues, described the move to a cleaner future as "an inevitable transition".

Confronting the troubled legacies of our fossil fuel past will not be easy. "We have our own experiences here of our coal mining communities being devastated by the closure of their mines," said Khan. But clean air begins with clean politics; maintaining old ways at the price of health is not one any government must pay. 

'From The Ashes' will premiere on National Geograhpic in the United Kingdom at 9pm on Tuesday, June 27th.

India Bourke is an environment writer and editorial assistant at the New Statesman.

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