Jeremy Hunt delivers a speech during a visit to the Evelina London Children's Hospital on July 5, 2013. Photograph: Getty Images.
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Jeremy Hunt's "hospital closure clause" could be a new NHS disaster for the Tories

At least 20 coalition MPs are expected to rebel against Clause 119 today, which would give administrators the power to close down any hospital or A&E without consultation.

After Andrew Lansley's botched NHS reforms, Jeremy Hunt became Health Secretary with a brief to take the service out of the headlines. But he's failed in that mission this week. Later today, MPs will debate what's been branded the "hospital closure clause". Introduced as a hurried amendment to the Care Bill, Clause 119 (formerly known as Clause 118) would give Trust Special Administrators, appointed by Hunt, the power to close or downgrade any hospital or A&E  in the country at just 40 days' notice (allowing no time for proper consultation) if a neighbouring NHS trust is in financial trouble. 

The measure was brought forward after ministers were ruled to have acted illegally by attempting to cut emergency and maternity services at Lewisham hospital after the South London Healthcare trust went into administration. Activists rightly argued that a well-performing and popular local hospital should not be made to pay for the price for failings elsewhere, and the High Court ruled in their favour. But Clause 119 would allow Hunt to overturn this defeat and ensure the government always triumphs in the future. 

The Health Secretary will get his way when parliament votes today, but he will do so in the face of significant resistance, not just from Labour but Lib Dems and Tories too. After revealing that there are 32 communities in England where NHS regulators have major concerns over the finances of trusts (and who could be left voiceless as a result of the measure), Andy Burnham has appealed to MPs to "put constituency before party" and block Hunt's plans. He said: "This Government used to say it wanted to put patients and doctors in charge of the local NHS. Now Jeremy Hunt wants to ride roughshod over local communities and have carte blanche to break up the NHS without anyone else having a say. He must be stopped.

"With more and more hospitals in financial difficulty, this move could hit every community in the land and leave them voiceless in the face of changes to their services.

"Labour is clear: changes to hospitals should be driven by clinical, not financial, reasons with local people involved every step of the way. That is why we believe these plans are dangerous and wrong. It is time for Parliament to stop an arrogant Secretary of State from overstepping the mark."

Burnham's cause is aided by the Coalition Agreement, which committed the government to ending "the centrally dictated closure of A&E and maternity wards, so that people have better access to local services." But the centrally dicated closure of services is precisely what Clause 119 would enable. 

Paul Burstow, the former Lib Dem health minister, who has tabled an amendment that would guarantee consultation rights for local people and give doctors who commission services a veto over any reorganisation, predicts that around 20 coalition MPs (who are increasingly preoccupied with their election chances) could rebel today. He said: "Support for my amendment has been growing. It feels to me that there's a growing disquiet on the Conservative side of the coalition about these plans, plus there are Liberal Democrat MPs who share the concern."

Burstow has won the support of his Lib Dem colleagues Andrew George, Julian Huppert and Mike Thornton, while Tory MPs Nick de Bois and Jeremy Lefroy are also likely to vote against the measure. De Bois, who led the Hands Off Our Hospital campaign against the downgrading of services at Chase Farm hospital in Enfield, said: "My constituents have seen first hand the flawed, unrepresentative consultations on the future of Chase Farm hospital … I have no intention of voting for a clause that reduces further the voice of patients and residents."

For the Tories, the row is a new political headache. Despite a concerted attempt to pin the blame for the Mid-Staffs scandal on Labour (including a lengthy section in David Cameron's conference speech), the opposition retains a double-digit lead on health (37-24 in the most recent YouGov poll). One party source told me that focus groups reacted "particularly strongly" when they were reminded of Cameron's past pledges on the NHS. By again exposing the Tories to the charge of broken promises, Hunt's hospital closure clause is in danger of becoming the new "top-down reorganisation". 

George Eaton is political editor of the New Statesman.

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How English identity politics will shape the 2017 general election

"English" voters are more likely to vote Conservative and Ukip. But the Tories are playing identity politics in Scotland and Wales too. 

Recent polls have challenged some widely shared assumptions about the direction of UK elections. For some time each part of the UK has seemed to be evolving quite distinctly. Different political cultures in each nation were contested by different political parties and with different parties emerging victorious in each.

This view is now being challenged. Early general election surveys that show the Tories leading in Wales and taking up to a third of the vote in Scotland. At first sight, this looks a lot more like 1997 (though less enjoyable for Labour): an increasingly hegemonic mainland party only challenged sporadically and in certain places.

Is this, then, a return to "politics as normal"? Perhaps the Tories are becoming, once again, the Conservative and Unionist Party. Maybe identity politics is getting back into its box post Brexit, the decline of Ukip, and weak support for a second independence referendum. We won’t really know until the election is over. However, I doubt that we’ve seen the back of identity politics. It may actually bite more sharply than ever before.

Although there’s talk about "identity politics" as a new phenomenon, most votes have always been cast on a sense of "who do I identify with?" or "who will stand up for someone like us?" Many voters take little notice of the ideology and policy beloved of activists, often voting against their "objective interests" to support a party they trust. The new "identity politics" simply reflects the breakdown of long-established political identities, which were in turn based on social class and collective experiences. In their place, come new identities based around people, nations and place. Brexit was never really about the technocratic calculation of profit and loss, but about what sort of country we are becoming, and what we want to be. 

Most social democratic parties in Europe are struggling with this change. Labour is no different. At the start of the general election, it faces a perfect storm of changing identities. Its relationship with working-class voters continues to decline. This is not because the working class has disappeared, but because old industries, with their large workplaces, shared communities and strong unions are no longer there to generate a labour identity. 

Labour is badly adrift in England. The English electorate has become increasingly assertive (and increasingly English). The Brexit vote was most strongly endorsed by the voters who felt most intensely English. In the previous year’s general election, it was fear of Scottish National Party influence on a Labour minority government that almost certainly gave the Tories the English seats needed for an overall majority. In that same election, Labour’s support amongst "English only" voters was half its support amongst "British only" voters. The more "English" the voters, the more likely they were to vote Ukip or Conservative. It shouldn’t be a surprise if Ukip voters now go Tory. Those who think that Ukip somehow groomed Labour voters to become Tories are missing the crucial role that identity may be playing.

So strong are these issues that, until recently, it looked as though the next election - whenever it was called - would be an English election - fought almost entirely in English battlegrounds, on English issues, and by a Tory party that was, increasingly, an English National Conservative Party in all but name. Two powerful identity issues are confounding that assumption.

Brexit has brought a distinctly British issue into play. It is enabling the Tories to consolidate support as the Brexit party in England, and at the same time reach many Leave voters in Wales, and maybe Scotland too. This serendipitous consequence of David Cameron’s referendum doesn’t mean the Tories are yet fully transformed. The Conservative Party in England is indeed increasingly focused on England. Its members believe devolution has harmed England and are remarkably sanguine about a break up of the union. But the new ability to appeal to Leave voters outside England is a further problem for Labour. The Brexit issue also cuts both ways. Without a clear appeal cutting through to Leave and Remain voters, Labour will be under pressure from both sides.

North of the border, the Tories seemed to have found - by accident or design - the way to articulate a familial relationship between the party in Scotland and the party in England. Scottish Conservative leader Ruth Davidson appears to combine conservatism, unionism and distance from English politics more successfully than Scottish Labour, which must ride the two horses of "near home rule" and committed unionism. Scottish Labour has a perfectly good call for a reformed union, but it is undermined by the failure of Labour in England to mobilise enough popular support to make the prospect credible.

Identity politics is not, of course, the be all and end all of politics. Plenty of voters do cast their ballots on the traditional tests of leadership, economic competence, and policy. Labour’s campaign will have to make big inroads here too. But, paradoxically, Labour’s best chance of a strong result lies in taking identity politics head on, and not trying to shift the conversation onto bread and butter policy, as the leaked "talking points" seem to suggest. Plenty of voters will worry what Theresa May would do with the untrammelled power she seeks. Challenging her right or ability to speak for the nation, as Keir Starmer has done, is Labour’s best bet.

 

John Denham was a Labour MP from 1992 to 2015, and a Secretary of State 2007 to 2010. He is Director of the Centre for English Identity and Politics at Winchester University

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