Election 2010: fight for marginal puts hospitals in the hot seat

In June 2006, as NHS organisations were buffeted between deficit crises and reconfiguration rows, the Department of Health was forced to disclose an embarrassing set of “heat maps” it had produced to guide ministers on where the most political pain was being felt.

Most controversially, those maps were not always used to aid ministers to steer around the pain – or to provide that elusive and euphemistic “political cover” often sought by NHS managers. Instead it seemed at times that ministers – most notably John Reid, Ivan Lewis and Hazel Blears – used the maps to direct themselves to the nearest protest line against “cuts” imposed by “NHS bureaucrats”.

Four years on, as the NHS finds itself in the middle of an election campaign, hospital access and reconfiguration lag behind cancer drugs and services in the political heat stakes. That may change.

So, as a guide to NHS managers, HSJ has now produced its own “heat map”. While the 2006 DH maps centred on organisations with the most radical and contested reconfiguration plans or deficits, HSJ’s map reveals the acute hospitals sited amid the most politically contested parliamentary constituencies.

The map has been produced with the help of the respected website electoralcalculus.co.uk, which uses a series of national polling data to produce monthly predictions about the outcome of a general election in each constituency. By matching the location of acute hospital sites to the most marginal English constituencies, HSJ has identified the 10 acute trusts in the hottest seats – those with the smallest absolute margin between the incumbent party and its nearest opponent.

See the map

Trusts feeling the heat

• 1 Ipswich Hospital Trust: Labour are tipped to lose their Ipswich seats to the Conservatives by a margin of 0.43 per cent, putting the trust in the fifth most marginal hospital seat. The trust has been at the centre of a row over the location of primary angioplasty centres in the region. The trust has not been scheduled to have a centre, leading to concerns about travel times for heart attack patients in the rural area. Local Conservative candidate Ben Gummer has leapt to the cause with a “Save Ipswich Hospital” campaign and has accused the government and local NHS of selling Ipswich “down the river”.
• 2 South Warwickshire Foundation Trust: polling data in the month before the launch of the election on 12 April suggested Labour will hold the Warwick and Leamington constituency which hosts Warwick Hospital. But the Conservative candidate has everything to play for at just 0.2 per cent behind in the polls. The hospital has had its share of controversy. In 2006 it was flagged to lose some trauma, maternity and paediatric care services in a consultation proposing to centralise specialist care at University Hospitals Coventry and Warwickshire Trust – in the neighbouring safe Labour seat of Coventry North East.
• 3 The same proposals affected George Eliot Hospital Trust. The 2006 Coventry and Warwickshire acute services review proposed the closure of the hospital’s special care baby unit. This is now “deferred for the time being”.
• 4 Mid-Cheshire Hospitals Foundation Trust: the trust has two main hospital sites. One is in shadow health minister Stephen O’Brien’s safe seat of Eddisbury. The other – the Victoria Infirmary – is in Weaver Vale, which Labour is expected to lose to the Conservatives by 0.42 per cent. The hospital has previously been threatened with downgrading, but the foundation trust insists those concerns are no longer valid. Despite this, it was given fresh impetus last month when the local press suggested a planned ward refurbishment could become more permanent.
• 5 Northumbria Healthcare Foundation Trust: the trust has three general hospitals, 10 sites and spans six constituencies, but only North Tyneside General Hospital is in a marginal seat – Tynemouth, which is predicted to change from Labour to Conservative. The Conservative candidate has suggested the trust’s recent decision to invest in a development in a neighbouring constituency tipped to stay Labour may be “playing politics”.
• 6 St George’s Healthcare Trust: the Conservatives hope to snatch the previously “safe Labour seat” of Tooting in south London and are predicted to succeed – if only at a margin of 1.12 per cent. The Conservative candidate has evoked an undersized maternity unit and raised concerns about cuts if Labour win.
• 7 County Durham and Darlington Foundation Trust: it has a number of sites, but only its University Hospital of North Durham sits in the Durham City constituency which the incumbent Labour party is predicted to lose to the Liberal Democrats by the closest margin for our hot seat trusts: just 0.05 per cent. With seemingly everything to play for, the local Labour party kicked off its Durham campaign by celebrating the “state of the art £91m hospital” opened at the site in 2001. They contrasted that with longer waiting times under the past Conservative government and the allegation that “top Lib Dems want to break up our NHS and replace it with an insurance based system putting those unable to pay at risk”. Durham Liberal Democrats did not rise to the bait of that reference to an idea in the 2004 Orange Book – published independently of the Liberal Democrat party but with a contribution from current leader Nick Clegg. Instead they responded by “revealing” that as £60m of the new hospital was paid for through the private finance initiative, the site would eventually “cost the taxpayer more than half a billion pounds”.
• 8 University Hospitals of Morecambe Bay Trust: possibly the least fortunate in the political stakes – the trust has five hospital sites spanning four constituencies, all with margins of under 4 per cent. Three are expected to change hands. But earlier this month Shadow health secretary Andrew Lansley was reported in the local press saying the hospital “could close” if Labour stayed in power.
• 9 Hereford Hospitals Trust: the Liberal Democrats are predicted to lose the Hereford and South Herefordshire seat to the Conservatives, by a margin of 0.4 per cent. The district general hospital is a single site hospital and unlike neighbouring  Worcestershire and Wyre Forest – the latter predicted to stay with independent Kidderminster Hospital and Health Concern candidate Dr Richard Taylor –  has so far avoided controversial reconfiguration plans. That has not stopped candidates finding some controversy. But the trust might be thankful its political heat so far seems to have been confined to the location of a GP led health centre. Liberal Democrat candidate Sarah Carr complained in September this was not needed as “we already have good availability of GPs”. But her stronger criticism was saved for the original planned location of the centre – a garden used by the trust’s mental health facility. On that point, Ms Carr was joined in November by Conservative candidate Jesse Norman, who celebrated a change of heart from the trust.
• 10 South Devon Healthcare Foundation Trust: the trust’s Torbay Hospital has managed to stay out of the heat, although the incumbent Liberal Democrats have complained about parking for residents living near the site.