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.