At a health conference last year I heard Tory elder statesman and current Commons health committee chair Stephen Dorrell approvingly quote one of his party’s more controversial health ministers − as Whitehall called the NHS’s political chief before title-inflation took hold across Britain. His name was Enoch Powell.

I thought of Dorrell’s reference as the row raged over the unbundling of stricken South London Healthcare Trust’s hospitals. The din was noisiest concerning neighbouring Lewisham Hospital, collateral damage in the money-driven reorganisation.

‘Close down costly hospitals and get more mainstream patients treated in the community, Dorrell explained’

This saw Powell’s latest successor, Jeremy Hunt, tweak special administrator Matthew Kershaw’s review recommendations in a bid to square financial imperatives with angry demonstrations.

As a liberal Midlands Tory, old enough to remember Powell’s inflammatory “rivers of blood” speech in 1968, Dorrell has no truck with racism, although Powell’s own view of other races was more nuanced and respectful than that shameful speech suggests. It was immigrant numbers which obsessed the ex-minister, who had actually recruited a lot of Afro-Caribbean nurses in his time.

Dramatic shift in thinking

So it was Powell’s dramatic and progressive decision to start closing the country’s network of old mental hospitals, many of them grim former workhouses (I remember them too), as a humane act of policy that prompted Dorrell’s reference.

“Hospitals are not like pyramids, built to impress some remote posterity,” Powell said in 1961.

Today we need a similar, dramatic paradigm shift to rebalance our thinking, close down costly hospitals and get more mainstream patients treated in the community, Dorrell explained. “It can’t be done by stealth.”

‘MPs privately admit they risk political death by supporting downgrading of a much loved district general’

Well, no. But when we look at recent speeches by the NHS Confederation’s Mike Farrar, calling on elected politicians to back necessary closures or restructuring in their own back yards − echoed by the department’s Sir Bruce Keogh and others − then compare them with the angry reaction of voters, local NHS staff and politicians in Lewisham, and they might all be living on different planets.

Labour’s Andy Burnham, like Dorrell another ex-secretary of state, made some valid points in the Commons. Andrew Lansley’s four-point procedure to legitimise such closures had merely delayed by two years­ at some cost­ much of what Labour had planned to do before the last election.

Half-baked manoeuvres

He may or may not be proved right in predicting that the “back door” reduction of A&E and maternity at blameless Lewisham creates a precedent for similar “half-baked” manoeuvres elsewhere.

But Hunt’s ripostes were telling too. Servicing Labour’s costly private finance initiative projects was part of the legacy that mired the dying trust in £200m of accumulated debt. Labour’s own review procedures had been used in South London. Mr Kershaw, a former chief executive at Salisbury’s modern hospital, had consulted widely.

The truth, as some MPs privately admit, is that they risk political death by supporting downgrading of a much loved district general. Yet it is some years since I first heard Hazel Blears, then a Labour health minister, still MP for Salford, explain that you could take people with you if you explained properly that their babies and stroke victim parents might be safer in a more specialised unit further from home.

To judge from private chats in my own area, where similar restructuring is under way, few usually well informed people yet understand that message in cynical times. It distressed me to drive a sick grandchild past the teaching hospital which treated my own kids because the paediatric unit had moved. But we have to get used to it.

Michael White writes about politics for The Guardian