Clause 119 of the Care Bill

The Care Bill is intended to make the healthcare system in England more transparent and improve quality and safety regulations for healthcare providers. This will be a welcome change, as it is crucial that we learn from the appalling failings that occurred in the Mid-Staffordshire NHS Foundation Trust.

At present, a process of special administration is possible to assist failing NHS trusts or foundation trusts. The government’s recent amendment to the Care Bill, which is now Clause 119, will build on these existing powers in order to strengthen the role of Trust special administrators.

Under the current regime, the Health Secretary can intervene wherever a trust is in danger of becoming clinically unsafe or financially insolvent. The Health Secretary does this by appointing a Trust Special Administrator to take charge. The Administrator then produces a report with recommendations to the Health Secretary about how financial and clinical improvements could be made.

Clause 119 of the Care Bill will firstly give a Trust Special Administrator more time to prepare these draft recommendations by extending the timetable from 45 working days to 60 working days. It will extend the time period for undertaking local consultation on their proposals from 30 working days to 40 working days as well. This will help to ensure that there is sufficient local accountability for any new proposals, contrary to your concern that there will be barely any consultation of local people.

I do recognise, however, that the problems experienced by one health organisation are often affected by the way that neighbouring health organisations may be operating. In a modern, integrated healthcare system, it is unrealistic to expect Trust Special Administrators to deliver sustainable services if they are not able to propose any improvements to neighbouring trusts as well.

In a joint letter to the Department of Health last October, the Foundation Trust Network and NHS Confederation both highlighted that Trust Special Administrators need to be able to look at the wider local health economy when making their recommendations. Clause 119 clarifies that Trust Special Administrators will be able to do so, and that they must seek the approval of all affected health commissioning organisations in the area before making final recommendations.

Clause 119 is not intended for the general reconfiguration of hospitals and other health services, and it is most certainly not about delivering sweeping changes across the NHS to privatise or close down hospitals, or wards. It is instead intended as a measure of last resort, where organisations have failed to make improvements and where urgent intervention from the Health Secretary is needed, so that local health services are not endangered. The government’s reforms will help the government tackle ingrained problems in the health service, turn around failing hospitals, and properly protect the NHS for the long term.

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