Victory for campaigners fighting to keep children’s heart surgery unit in Leeds. The headlines last week trumpeted a win for people power over the politicians and accountants. The decision to transfer the specialist unit was ruled by the courts to have been flawed.
‘The courts have said public sector organisations have a duty to protect the public purse’
Does this mean that local protesters have won and the unit will stay in Leeds? No, it means the process of consulting on the proposal will have to be re-run to ensure all those with an interest have the full facts at their disposal before the decision is made.
Does this mean that a different conclusion will be reached at the end of the re-run process? Unlikely, as the business case will remain the same. The business case is that it is more efficient and safer to transfer the service as part of centralising expertise and making economies of scale. It’s a classic example of “the people vs the business case”.
Financial pressure on local authorities and the realisation that residential care for older people could be bought much more cheaply in the private sector led local councils to propose the closure of many, most and in some cases all of their council-run homes.
The financial argument was irrefutable: council homes were a lot more expensive to run than those in the private sector. The same amount of money spent in the private sector would buy a lot more care. This was a genuine efficiency in a period of austerity.
‘Local MPs have probably supported protesters while at the same time voting in favour of the government strategy’
But what of the human cost? Closing homes would mean frail and confused elderly people having to transfer to another home. This was their home; they did want to move. Their relatives didn’t want them to move, they were happy with the care provided, their parent was “settled”, the trauma of a move away from staff they knew and friends they had made would be distressing and detrimental to their health. Why should they be put through this upset just so the council could save money? They banded together and with the help of sympathetic lawyers took their objections to the courts.
But the courts have said public sector organisations have a duty to protect the public purse, so they can chose to provide services in a different, more cost-effective and efficient way as long as they meet their statutory responsibilities.
However, in arriving at their decisions organisations have to ensure a rigorous consultation process is undertaken and all relevant information is made available, and the decision making process and reasons for arriving at their decision are transparent.
What judicial reviews do is decide if the consultation process was flawed, therefore bringing the conclusions into question. The outcome is further consultation. In most cases the same decisions are arrived at with perhaps a few concessions on timing and phasing.
So does this mean the business case will always win in the end and what does this say for local democracy? Well you can always use your vote in the next council election to express your disapproval and since council elections are more frequent than national elections a protest vote could see a change in the leadership.
But the NHS is not subject to local democratic accountability − local MPs have probably supported the protesters while at the same time voting in favour of the government strategy for reorganising the service.
So if you want to have more say in what happens to your local hospital maybe you should be advocating the transfer along with public health to local government. But the real change would be to argue that health and care services should be practise-led, not finance driven.