I will make some progress.
The only way to build sustainable services is to have widespread ownership of changes and a robust process of community engagement. The Government’s disfigurement of the TSA process will mean that they have to give no regard to patients’ wishes, and in practice it will mean that they can disregard the views of local commissioners. If the Secretary of State wants to close a hospital, it will be done. It is as simple as that.
In 2003 Labour created the independent reconfiguration panel, a non-departmental body to advise on service change. The IRP’s terms of reference when reconfigurations are proposed state:
“The panel will consider whether the proposals will provide safe, sustainable and accessible services for the local population, taking account of:
1) Clinical and service quality
2) The current or likely impact of patients’ choices and the rigour of public involvement in consultation processes, and
3) The views and future referral needs of local GPs who commission services, the wider configuration of the NHS and other services locally, including likely future plans.”
Why does the Minister think reconfigurations of whole health economies should not be subject to independent scrutiny by the IRP? Why does he think that this should be bypassed without local agreement? Given that quality issues are subject to a number of investigations before a TSA would be appointed, such as Care Quality Commission investigations and being placed in special measures, why cannot a thorough investigation of reconfiguration options be put to the IRP and the public?
If the point of centralising a reconfiguration decision is to provide a quick solution, why are not the Government open to consultation with the public on the future of their local health services during the process of inspection by the CQC or the extended period of time during which a trust is in special measures? Speedy resolution of care failures is essential, but to go along with the Government’s proposals would be to suggest this sense of urgency appears only after months of work trying to address the problem. That is wrong, and it is little wonder that so many hospitals and so many communities believe that this legislation is setting them up to fail.
The Government’s position on this is intellectually dishonest. In reaching the conclusion that the TSA process should be hijacked to provide a back-door reconfiguration tool, they have wilfully ignored professional, legal and medical advice, and have disregarded existing procedure. They have cost the taxpayer hundreds of thousands of pounds in defending their decision in the courts and they have added to the chaos into which they have already plunged the NHS. On Report we offered to work with the Government on a cross-party basis to produce a reconfiguration process and a TSA process that would have commanded broad public and political support. This offer was rejected.
The Opposition’s amendments seek to make a bad law slightly better, but the truth is that more lifeboats on the Titanic would not have stopped it sinking. In case any Government Members ever actually believed the coalition agreement, a vote against our amendments today is a vote against that agreement. At their heart, our amendments are an attempt to help the Government to help themselves, but more importantly, to help all of those communities who expect to have a say in the future commissioning of their local hospital services. The next Labour Government will ensure that their voice is heard.