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.

Getty Images.
Show Hide image

How will Theresa May meet her commitment to low-earners?

The Prime Minister will soon need to translate generalities into specifics. 

The curtailed Conservative leadership contest (which would not have finished yet) meant that Theresa May had little chance to define her agenda. But of the statements she has made since becoming prime minister, the most notable remains her commitment to lead a government "driven not by the interests of the privileged few, but by yours." 

When parliament returns on 5 September, and the autumn political season begins, May will need to translate this generality into specifics. The defining opportunity to do so will be the Autumn Statement. Originally intended by George Osborne to be a banal update of economic forecasts, this set-piece more often resembled a second Budget. Following the momentous Brexit vote, it certainly will under Philip Hammond. 

The first priority will be to demonstrate how the government will counter the threat of recession. Osborne's target of a budget surplus by 2020 has wisely been abandoned, granting the new Chancellor the freedom to invest more in infrastructure (though insiders make it clear not to expect a Keynesian splurge).

As well as stimulating growth, Hammond will need to reflect May's commitment to those "just managing" rather than the "privileged few". In her speech upon becoming prime minister, she vowed that "when it comes to taxes, we’ll prioritise not the wealthy, but you". A natural means of doing so would be to reduce VAT, which was increased to a record high of 20 per cent in 2010 and hits low-earners hardest. Others will look for the freeze on benefit increases to be lifted (with inflation forecast to rise to 3 per cent next year). May's team are keenly aware of the regressive effect of loose monetary policy (low interest rates and quantitative easing), which benefits wealthy asset-owners, and vow that those who lose out will be "compensated" elsewhere. 

A notable intervention has come from Andrew Tyrie, the Conservative chair of the Treasury select committee. He has called for the government to revive the publication of distributional analyses following Budgets and Autumn Statements, which was ended by George Osborne last year (having been introduced by the coalition in 2010). 

In a letter to Hammond, Tyrie wrote: "I would be grateful for an assurance that you will reinstate the distributional analysis of the effects of the budget and autumn statement measures on household incomes, recently and mistakenly discontinued by your predecessor." He added: "The new prime minister is committing her government to making Britain a country that works 'not for a privileged few, but for every one of us'. A high level of transparency about the effects of tax and welfare policy on households across the income distribution would seem to be a logical, perhaps essential starting point." 

Whether the government meets this demand will be an early test of how explicit it intends to be in reducing disparities. 

George Eaton is political editor of the New Statesman.