The Department of Health is headed back to the drawing board over its plans for Lewisham Hospital, after Mr Justice Silber determined that Health Secretary Jeremy Hunt had overstepped his powers when announcing plans for the downgrading of the hospital’s casualty and maternity units.
The headlines will show that the High Court decision is a setback for the Government and Department of Health, a humiliation for Mr Hunt, and the product of a well-prepared case and vociferous campaign by both Lewisham Council and ‘Save Lewisham Hospital’ activists. But lingering in the background is what if any precedent this judgment sets for the reorganisation or rationalisation of NHS services – either in terms of a legal precedent or in lighting a fire under other local campaigns across the UK.
The situation in Lewisham demonstrates how the Department of Health, and Mr Hunt specifically, is between the proverbial rock and a hard place when it comes to the future of acute care services. It is one of the more emotive issues caused by both the Government’s reforms of the health service and the financial difficulties the NHS faces if it does not undertake radical change. Experts including those at the King’s Fund and NHS Confederation make the case that rationalisation of services is an imperative in order to consolidate the NHS’s resources – arguing that larger specialist centres are able to offer a better quality of care and can deliver savings the health service sorely requires. Local populations recoil with horror and fury at the prospect of their local hospital losing its services, which they believe will reduce standards of care. The problem is that the case for rationalisation or the downgrading of services at any one site is yet to be made with sufficient clarity to offset public fears and, with MPs and local councillors not wishing to defy their electorate, what results is procrastination rather than action to either rationalise services or improve the delivery and efficiency of what already exists.
The two big questions then, are if the Lewisham judgement has implications for the rest of the NHS – and if so, what are those implications? No two cases of local service reorganisation will be the same, but if Lewisham encourages activism in other localities the Department of Health and NHS England will either have to make their case far better than at any stage to date, or risk further costly delays to changes in how acute services are delivered. One thing is clear, the High Court judgement will not quell the ferocity of this particular argument.