Guest editorial 4 October 2011: Nick de Bois MP on why the Chase Farm A&E and maternity closure is wrong

This guest editorial from Nick de Bois, MP for Enfield North,  sets out his case as to why the decision to close the A&E and maternity services at Chase Farm is unjustified.

De Bois recently wrote this letter of complaint to the Prime Minister about the decision.

I do not expect to be consulted over what instruments are used if I require heart surgery; but I do expect a choice over whether to undertake the surgery or not.

Similarly, I do not expect to be consulted over the specific designs of a maternity ward; but I do expect a say over where my children are born.


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This is because while I have a healthy respect for medical expertise, I expect a level of choice in the health service for which my tax pays. Where to draw the line between this patient choice and medical prerogative is becoming a central test to the Government’s commitment to localism and open public services.

The location of this line has been made very apparent to me in recent weeks.

Resolving disagreement
The central issue this Government will have to confront is what action to take if medical professionals signal in one direction and local residents and GPs another. It is worth stating that their goal is one and the same: an accessible and high-quality local health service.

However, when conflicts of these kinds occur, it is the Government and, more specifically, the Health Secretary that will be expected to mediate, eliminating the supremacy of the patient voice.

This is exactly what has happened in my constituency in the case of Chase Farm Hospital. In what was an incredibly long and drawn-out process, the PCT recommended downgrading the A&E and maternity departments of the hospital in 2008.

After this decision, Chase Farm was handicapped by the awarding of a poorly-negotiated PFI investment to its neighbouring hospital, North Middlesex (again with no local consultation).

The decision to downgrade was challenged by the local council, but then upheld by an Independent Review Panel. Conservative leader David Cameron visited the hospital and stated that under a Conservative Government, the forced downgrade would not continue.

Recently, after extensive consultation, another IRP endorsed the original proposals - and the Health Secretary has accepted their recommendation. We are back in the same situation we had under the Labour Government, with justified local outrage.

No decision about us without us?
The question I have been forced to ask, as an MP who has fought against these plans for the best part of the last decade, is how has this occurred?

How has this decision been allowed to go forward despite the opposition of many local GPs and members of the public, when we promised that after all this time, they would be allowed to make the decisions?

The answer I keep coming back to is that we simply haven’t got far enough in the transfer of power and accountability. The buck still doesn’t stop with GPs, councillors or patients: they are still only consulted as part of central decision-making.

No more top-down reorganisation
When this issue raised its head, the local council were allowed to dodge the decision and simply ask for more money, and when it came to an ultimate decision, all heads turned to the Secretary of State.

This is a culture that needs to be broken if the localism agenda is going to be fully realised. The fact remains that public services too often look to the centre.

The Health and Social Care Bill originally severed this link, and ambitiously shifted power away from the Secretary of State and towards the front line. Under a great deal of pressure from politicians who profess to support localism and individual freedom, this was watered down and, as far as NHS reconfigurations are concerned, the status quo remains. The difference being now that local stakeholders will only turn to the Health Secretary and IRP if they cannot agree.

Therefore in order to learn the lessons of Chase Farm and avoid the Labour legacy of forced closures, we need to hand budgets, responsibility and accountability to the lowest level manageable in order to ensure that people get what they want, rather than settling for what is given to them.

It pains me that one year after promising the Big Society, I am having to write a letter to the Prime Minister to intervene in order to keep my local hospital open, as opposed to meeting with GP commissioners.

The Conservatives said before the general election that we’d bring about real people power. Now we just need the courage of our convictions to bring that about and see this through.

Nick de Bois, MP for Enfield North