Sunlight is the best disinfectant. So says Jeremy Hunt, keen to ferret out bad treatment, if only for nefarious political purposes. "No decision about me without me," pledged his predecessor, Andrew Lansley, while uprooting the NHS with no one's by-your-leave. Both upheld the NHS constitution to "put patients at the heart of everything the NHS does" and to be "accountable to the public, communities and patients". But all that will be overridden by clause 118, hastily tacked onto the care bill, which returns to parliament this week.
Maybe such pieties were never realistic in a rationed NHS (or any private system)that can offer only what available funds can buy. Money is at the heart of decisions about what's best for patients, although politicians pretend otherwise. Better by far to be open about this eternal truth and conduct honest public debates about tough priorities. But clause 118 will shut down public involvement. What's more, it uproots Lansley's chaotic reorganisation by giving absolute power to trust special administrators (TSAs), free to close, merge or privatise hospitals regardless of doctors, patients or the public.
The NHS Trusts Development Authority says half its trusts are in financial trouble, along with many foundation trusts: all risk falling into the hands of these TSA dictators to fix their fate. Forget new clinical commissioning groups, theoretically led by GPs to commission what they think best: they will be ignored – unless the House of Lords throws out this explosive clause.
Far from opening up to public scrutiny, the NHS, under acute financial pressure, is clamping down on public involvement. Let's start with whistleblowing. After the Mid Staffs scandal, you might expect the eyes and ears of all staff to be recruited to speak out whenever they see things going wrong. But the case of Charlotte Monro sends out a warning to staff to keep their mouths shut on pain of losing their jobs. Yesterday, her dismissal from Barts NHS Trustfor "serious misconduct" was upheld by the hospital's appeals panel.
A Unison rep, Monro worked for 26 years as an occupational therapist at Whipps Cross hospital in east London, recently merged with the Royal London and Barts. Barts, with a famously catastrophic PFI debt, needs to save money fast: 1000 jobs are to go, with many staff downgraded. One saving is to merge two stroke wards, losing nearly a third of beds and a small specialist gym, vital to get stroke patients on the move. Monro, representing staff, addressed the local Waltham Forest council's health scrutiny committee to explain why this plan was inadequate. Local authorities are supposed to play a part in NHS accountability, responsible for public health and for integrating social services for returning patients to the community. But her appearance caused Barts managers to fire her for bringing the trust into disrepute with inaccurate information. "Inaccurate" is a matter of opinion: there are two sides in any reorganisation dispute.
Surely, councillors protested, NHS staff have the right to speak to their local scrutiny committee? Managers searched for other reasons to bolster Monro's dismissal and came up with a complaint that, four months previously, she had consulted some of her members on what they claimed was a confidential plan. But most preposterous, they uncovered an ancient conviction for assaulting a policeman related to a demonstration back in 1979, claiming she had never registered it. Now they have upheld her dismissal on these old issues, but conceded she did have the right to speak to the scrutiny committee, although that's what triggered the disciplinary action.
I have no idea if the staff are right about cuts to the stroke unit, but what's plain is that their view should be heard – and under the Trade Union Act, no representative should suffer personal detriment for union duties. Monro is devastated at losing her job, despite what the disciplinary panel call her "unblemished record" and good work with patients. She had years of good relations with Whipps Cross managers before the merger: she won an award for outstanding service in 2009. What this achieves is the silencing of any staff wishing to express a view, as cuts come thick and fast. Journalists know how afraid NHS staff are, less whistleblowers than nervous whisperers. Hunt may want them to denounce bad NHS care – but certainly not to question management or political decisions that determine resources for care. Monro plans to take her case to an employment tribunal, which may untangle the unjust original cause for her dismissal from the excavated charges used to justify it.
Clause 118 is to be voted on in February. It springs from the government's frustration at losing a court case brought by Lewisham hospital protesters to stop their services being cannibalised to shore up the finances of nearby south London hospitals, bankrupted by a PFI. If the clause passes, protesters, MPs, doctors and commissioning groups are set aside. A TSA can impose closures and mergers within 40 days.
The NHS never could be a democracy: everyone wants more. But it runs only with the reasonable consultation and consent of its staff and local community. Managers must manage finite resources, but successful reconfigurations happen when doctors are convinced of clinical value for money and they, in turn, persuade others. Clause 118 rides roughshod over that, heralding a new climate of diktat: whistleblowers beware. By voting down clause 118, Liberal Democrat peers who sold out the NHS last year could repair some of that damage.