New research by MHP Health Mandate has revealed that 21 struggling NHS trusts will be located in marginal constituencies at the next election following the Boundary Commission’s review. Of these 12 are located in ‘super-marginals’ with a notional majority of less than 1,000 after proposed boundary changes come into effect. You can read about the research in the Guardian.
This could have a significant impact on the future shape of the NHS. There is a growing acceptance that a number of hospital trusts will be forced to close or downgrade services in order for the NHS to survive the slowdown in spending which has created an “unprecedented financial challenge". There is also a strong clinical case for rationalising some services, particularly in London. The Secretary of State has already taken the politically difficult decision to back plans to downgrade Chase Farm (a perennial on the sick list, saved for years by its proximity to marginals), but the political pain will not end there if widespread changes are to be delivered. And delivering these changes will be made harder by the impact that such decisions could have on key battleground constituencies.
Nothing strikes more fear into the heart of a politician that the prospect of a closure of all or part of a local hospital. Much to the frustration of many NHS managers, the public is often wedded to the bricks and mortar of venerable old local institutions and is fearful of any change that could threaten this. The 2001 result in Wyre Forest, where voters turfed out Labour’s David Lock in favour of Richard Taylor, a local consultant who stood on a platform of ‘saving’ Kidderminster Hospital, is etched on the minds of many politicians with majorities which are smaller than they would like.
So who stands to benefit or lose from the looming battle over hospital closures? Based on the new boundaries, the Conservatives hold a notional majority in 13 constituencies in which a hospital yet to achieve Foundation Trust status is located, whereas Labour hold nine and the Liberal Democrats five. Both the Conservatives and Labour could also be beneficiaries of local rows about closures, with 11 marginals being targets for the Conservatives and 13 for Labour. The Liberal Democrats are the nearest challenger in only three marginals.
MPs whose marginal seats will be influenced by debates over the future of these trusts include Health Minister Paul Burstow (Sutton and Cheam), former Health Secretary Alan Johnson (Kingston upon Hull West and Hessle), Labour Shadow Health Minister Liz Kendall (Leicester West) and leading Health and Social Care Bill advocate Nick de Bois (Enfield North).
Following the Secretary of State’s recent warning about the financial risks posed by PFI schemes to the long term health of some trusts, it is interesting to note that, of the 21 trusts identified in this analysis, a third have been identified by the Department of Health as being ‘at risk’ as a result of a PFI scheme.
If closing hospital services is part of the answer to the NHS’ efficiency challenge, then this was never going to be politically easy. Yet this analysis shows quite how difficult it could be. With the polls remaining close, the fate of hospitals in these 27 constituencies could determine the outcome of the next general election.
If you are an MP in a marginal constituency looking nervously over your shoulder, or you are just interested in how the battle for health will shape the next election, you can read the full list of marginals affected here.