*A shortened version of this article was published on Left Foot Forward on 16 September 2013.
It is now over three weeks since Jeremy Hunt appealed against the High Court’s ruling on Lewisham Hospital and we are still none the wiser as to his grounds of appeal.
It is now over three weeks since Jeremy Hunt appealed against the High Court’s ruling on Lewisham Hospital and we are still none the wiser as to his grounds of appeal.
As I explained in a previous article for Left Foot Forward, the High Court ruled comprehensively in favour of the Save Lewisham Hospital campaign in July, quashing Hunt’s decision because he had no legal power to close or downgrade Lewisham’s A&E and maternity services.
It matters that Hunt has not disclosed his reasons for appeal because he is using public money to pursue a case which he is likely to lose and which, despite his protestations, is not in the public interest. Given that taxpayers are paying for this case, we are effectively the client, whether we want to be or not. Hunt’s failure to disclose his grounds of appeal is therefore akin to a solicitor lodging an appeal on a paying client’s behalf and then refusing to inform that client of the legal basis for the appeal or their chances of success.
Disclosure now would allow scrutiny of Hunt’s case and, if it’s weak, allow public pressure to be exerted on the government to drop the appeal before even more costs are incurred.
It is hard to guess at the legal basis of Hunt’s appeal because the case against him is so strong. The government’s main defence at the High Court stage was one of statutory interpretation – Hunt argued that the Health Act 2009, which established a regime to deal with failing healthcare providers, was intended by Parliament to allow changes to services provided by a failing NHS trust (in this case the South London Health Trust) and changes to services provided by any neighbouring NHS trust (Lewisham).
The judge, Mr Justice Silber, provided at least eight arguments based on an analysis of the legislation and statutory guidance which ‘individually and cumulatively’ showed that the legislation was only intended to permit changes to failing NHS providers.
The only potential basis I could think of for Hunt’s appeal was the possibility that the legislation and the statutory guidance were at odds with what ministers, other MPs and peers thought they were voting for. It is theoretically possible that they believed that the Bill allowed action in neighbouring trusts when in fact it does no such thing.
This would lead to slightly tricky legal arguments about which Hansard debates if any were admissible in court as an aid to interpretation. The current rules, put simply, are that when legislation is ambiguous, unclear or would lead to an absurdity if interpreted literally, then reliance may be placed upon clear statements made by ministers or other promoters of the Bill.
The Health Bill was, somewhat ironically, led by Andy Burnham who was Secretary of State for Health at the time. I have gone through the Hansard reports for every stage of the Bill and can find nothing which suggests that he or any other minister intended the legislation to allow changes to services outside the failing NHS provider in question.
On the contrary, statements by members and peers on both sides show that the debate was proceeding on the basis that the regime only applied to the one failing provider. I have selected some of the most revealing extracts below.
Andy Burnham, second reading : ‘… the Secretary of State would appoint an independent trust specialist administrator to review and consult patients, public and staff on the organisation’s future. Recommendations would be made to the Secretary of State, who would report to Parliament the final decision about the organisation’s future.’
‘The organisation’ is the failing NHS provider. Note the use of the singular – this is repeated throughout the Parliamentary debates. Further, one of the key reasons for the High Court’s ruling was that an administrator appointed to a failing trust is only obliged to consult with parties in that trust before recommending a course of action. The judge said that it would be very strange if Parliament had meant to give the administrator and health secretary identical powers over several trusts but then only require consultation in one of them. The above extract supports this line of argument.
Mike O'Brien (Labour health minister), committee stage: ‘I entirely agree that staff engagement is a central principle of such a regime. When such intervention is triggered, it will understandably be unsettling for staff, so we designed the process to produce a swift resolution while ensuring that staff are engaged throughout.’
The Health Act 2009 accordingly provides that ‘The trust special administrator must hold at least one meeting to seek responses from staff of the trust and from such persons as the trust special administrator may recognise as representing staff of the trust.’ There is no provision to engage staff in any other trust, showing that only changes to the failing trust were intended by ministers.
Lord Darzi of Denham (Labour Parliamentary Under Secretary), House of Lords committee stage : ‘The regime also gives clarity to staff and patients about the process that will be followed, when decisions will be made, and how they can input into the process. Unlike in the insolvency provisions, staff and patient involvement in this process is guaranteed in the legislation.’
The only staff and patient involvement that is guaranteed by the Health Act is that of the staff and patients of the failing trust, again showing that changes to services provided by other trusts were not envisaged.
Conservative Earl Howe expressed concern that the staff of the failing trust were to be consulted once the draft report had been published but not before: ‘No mention is made there of the staff at the trust, and I ask the Minister why that is. No one would deny that the most important people in this equation are the service users—the patients—but we need to remember that there are others with important rights here, and those are the people who work for the trust and provide the services which, in the circumstances envisaged, would be under threat of closure. Those are the people whose jobs are at risk.’
Earl Howe was one of several peers to express concern that the Bill didn’t provide for adequate consultation with those who may be affected. But not once did anyone raise the issue of consultation with patients and staff in other trusts: if anyone had thought that the Bill allowed changes to trusts other than the failing trust, this point would have been raised.
We are therefore no clearer on the grounds for Hunt’s appeal but even more certain that the legislation was only intended to allow changes to failing healthcare providers.
But we shouldn’t be forced to guess reasons, we should be told. And soon.