Last week Sir John Oldham published his long awaited report on health policy for the Labour Party. In his foreword Sir John describes one of the key political challenge of successful reform: " [The] basic principle of health care, free at the point of delivery, with equal access for all, is part of the soul of the nation. However the loyalty inspired by that principle generates an attachment to a model of health and care that might threaten its very future. The preservation of that basic principle demands change." The message for politicians could not be more clear; don't play politics with reconfiguring hospital services.
Yet a week on and a proposed amendment to the law that would give hospital administrators greater powers to recommend changes to local services ignited an intensely political debate on service change in the NHS. Leading the opposition to the reform the Shadow Health Secretary, Andy Burnham, argued, the proposal "creates an entirely new route for hospital reconfiguration - top-down, finance-led." To raise the stakes the Opposition produced a list of over 32 hospitals that were under threat with Andy Burnham adding "no hospital is safe". In the end MPs voted through the change that the Ministers claim will only be used as a "last resort".
However Tuesday's debates hint to the return of the politics that dominated the run up to the 2010 election. On that occasion it was Andy Burnham that was making the difficult case for changing some of England's hospitals. Speaking in 2010 the then Secretary of State argued "Improving the quality, safety and overall patient experience means accepting that services will need to change in this decade...Where difficult decisions have been made, backed by clinicians, they should be supported."
Against the case for change made by an embattled Health Secretary was an Opposition ready to exploit the perennially toxic issue of changing local hospital services. Years ahead of the election David Cameron had promised a "bare knuckle fight with the government over the future of district general hospitals. We believe in them, we want to save them". The Conservative Party produced their own list of 29 hospitals in danger of "cuts". As the election gathered pace the Shadow Health Secretary announced he was "determined to ensure that hospitals are not sacrificed to Labour's NHS cuts, their waste and their obsession with shutting down and centralising hospital services."
The "bare knuckle fight" in Opposition became a moratorium on all planned closures to NHS hospitals once in Government. Despite warnings from former Government advisers to trade union leaders that swathes of the NHS's hospital stock were unsustainable, changes to local services that had been agonised over for years were once again delayed. As the difficult business of reconfiguring hospital services was put on the back burner local NHS services started to feel the pinch. While the NHS budget was "ring fenced" the need to deliver productivity savings meant the tariff of prices for NHS care were cut in cash terms. Many hospitals that had struggled financially in the years of plenty soon found it hard to balance the books. As the next election approaches the size of the problem cannot be avoided. In recent months NHS regulators have warned that between 40 and 50 per cent of NHS hospitals could be in deficit by the end of the financial year.
Under these circumstances any future Government needs to be braced for pushing ahead with hospital closures soon after the election. Tempting as it might be block hospital closures in Opposition political parties won't want to tie their hands in Government.