Jeremy Hunt delivers a speech during a visit to the Evelina London Children's Hospital on July 5, 2013. Photograph: Getty Images.
Show Hide image

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.

Show Hide image

Will Euroscepticism prove an unbeatable advantage in the Conservative leadership race?

Conservative members who are eager for Brexit are still searching for a heavyweight champion - and they could yet inherit the earth.

Put your money on Liam Fox? The former Defence Secretary has been given a boost by the news that ConservativeHome’s rolling survey of party members preferences for the next Conservative leader. Jeremy Wilson at BusinessInsider and James Millar at the Sunday Post have both tipped Fox for the top job.

Are they right? The expectation among Conservative MPs is that there will be several candidates from the Tory right: Dominic Raab, Priti Patel and potentially Owen Paterson could all be candidates, while Boris Johnson, in the words of one: “rides both horses – is he the candidate of the left, of the right, or both?”

MPs will whittle down the field of candidates to a top two, who will then be voted on by the membership.  (As Graham Brady, chair of the 1922 Committee, notes in his interview with my colleague George Eaton, Conservative MPs could choose to offer a wider field if they so desired, but would be unlikely to surrender more power to party activists.)

The extreme likelihood is that that contest will be between two candidates: George Osborne and not-George Osborne.  “We know that the Chancellor has a bye to the final,” one minister observes, “But once you’re in the final – well, then it’s anyone’s game.”

Could “not-George Osborne” be Liam Fox? Well, the difficulty, as one MP observes, is we don’t really know what the Conservative leadership election is about:

“We don’t even know what the questions are to which the candidates will attempt to present themselves as the answer. Usually, that question would be: who can win us the election? But now that Labour have Corbyn, that question is taken care of.”

So what’s the question that MPs will be asking? We simply don’t know – and it may be that they come to a very different conclusion to their members, just as in 2001, when Ken Clarke won among MPs – before being defeated in a landslide by Conservative activists.

Much depends not only on the outcome of the European referendum, but also on its conduct. If the contest is particularly bruising, it may be that MPs are looking for a candidate who will “heal and settle”, in the words of one. That would disadvantage Fox, who will likely be a combative presence in the European referendum, and could benefit Boris Johnson, who, as one MP put it, “rides both horses” and will be less intimately linked with the referendum and its outcome than Osborne.

But equally, it could be that Euroscepticism proves to be a less powerful card than we currently expect. Ignoring the not inconsiderable organisational hurdles that have to be cleared to beat Theresa May, Boris Johnson, and potentially any or all of the “next generation” of Sajid Javid, Nicky Morgan or Stephen Crabb, we simply don’t know what the reaction of Conservative members to the In-Out referendum will be.

Firstly, there’s a non-trivial possibility that Leave could still win, despite its difficulties at centre-forward. The incentive to “reward” an Outer will be smaller. But if Britain votes to Remain – and if that vote is seen by Conservative members as the result of “dirty tricks” by the Conservative leadership – it could be that many members, far from sticking around for another three to four years to vote in the election, simply decide to leave. The last time that Cameron went against the dearest instincts of many of his party grassroots, the result was victory for the Prime Minister – and an activist base that, as the result of defections to Ukip and cancelled membership fees, is more socially liberal and more sympathetic to Cameron than it was before. Don’t forget that, for all the worry about “entryism” in the Labour leadership, it was “exitism” – of Labour members who supported David Miliband and liked the New Labour years  - that shifted that party towards Jeremy Corbyn.

It could be that if – as Brady predicts in this week’s New Statesman – the final two is an Inner and an Outer, the Eurosceptic candidate finds that the members who might have backed them are simply no longer around.

It comes back to the biggest known unknown in the race to succeed Cameron: Conservative members. For the first time in British political history, a Prime Minister will be chosen, not by MPs with an electoral mandate of their own or by voters at a general election but by an entirelyself-selecting group: party members. And we simply don't know enough about what they feel - yet. 

Stephen Bush is editor of the Staggers, the New Statesman’s political blog. He usually writes about politics.