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Posts Tagged ‘Save our NHS’

Poll Results: Hospital Closure Clause

April 10th, 2014 by

It’s been a few weeks since MPs debated the hospital closure clause. Here’s a quick recap of what happened: Lib Dem MP and former health minister Paul Burstow tabled an amendment which aimed to remove the worst parts of the clause. The amendment was drafted by lawyers funded by 38 Degrees members. But Burstow decided to withdraw his support for the amendment at the last minute after the government offered some concessions.

Since then, the 38 Degrees office team have been speaking to experts to decide how meaningful the government concessions were, and whether Paul Burstow was right not to push for a vote. And it’s worrying news. The government’s concessions did not go far enough.

They committed to consult local people about any proposed hospital closures. They also said that local doctors should be consulted. But lawyers have said that while some of the concessions are a step forward, our hospitals still aren’t safe.

It’s disappointing that we didn’t make as much progress as we hoped. But the hospital closure clause is not law yet. It returns to the House of Lords on the 7th May. So, last week, 38 Degrees members voted to decide our next move.

The results are in! 38 Degrees members have decided that we want to keep campaigning on this issue, and to shout about the fact that no hospital will be safe under the current proposed bill. (The red shows 38 Degrees members who ranked it as their top priority, and green and dark blue show members who support it as an option, and light blue are those who want to stop campaigning on this issue).

So, it looks like we’ll be keeping on campaigning. Watch this space for our next move… more information in the next couple of days.

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Poll Results: March 29th 2014

March 31st, 2014 by

Every week a random (but representative!) sample of 38 Degrees members vote on which issues our movement should prioritise and which campaigns to get behind. Here are the results for March 29th 2014.

The blue represents people answering ‘a lot’ to the question of whether 38 Degrees members should spend time on each issue, the red represents people answering ‘a little’, and the green is ‘not at all’.

Protecting the NHS by stopping the government’s dangerous plans like privatisation and closing A&E departments has come top this week! See here for a campaign to uncover links between NHS England – the body in charge of privatisation contracts in the NHS in England – and big business.

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Poll results: March 22nd 2014

March 24th, 2014 by

Every week a random (but representative!) sample of 38 Degrees members vote on which issues our movement should prioritise and which campaigns to get behind. Here are the results for March 22nd 2014.

The blue represents people answering ‘a lot’ to the question of whether 38 Degrees members should spend time on each issue, the red represents people answering ‘a little’, and the green is ‘not at all’.

Protecting our NHS from privatisation has come top this week! See here for a campaign to uncover links between NHS England – the body in charge of privatisation contracts in the NHS in England – and big business.

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Hospital Closure Clause: what do you think?

March 11th, 2014 by

Late this afternoon, MPs debated the Hospital Closure Clause. Since then, the office team has been trying to work out what to make of how it went. It’s quite complicated, and there’s still quite a lot of analysis to be done.

Here’s some questions 38 Degrees members will need to consider together over the next few days:

- how far has the government moved to meet our concerns?

- the government says the changes needed can be written into guidance which is prepared after the law is passed. Is this true, or do we need to amend the law further when it returns to the House of Lords?

- what other things could we be doing, together, to keep our local hospitals safe?

Please comment below with your thoughts.

Here’s what Paul Burstow MP thinks:

I want to thank 38 Degrees members in my constituency and across the country for raising concerns about the changes the Government was proposing to the way in which a hospital in serious financial or clinical trouble is handled in the NHS.  Trust special administration (TSA) as it is known was introduced by Labour in 2009.  It is a blunt process that should only ever be used in exceptional circumstances.

For me the starting point must be that decisions about the future of local health services are grounded in clinical evidence, supported by local clinicians and drawn up with the active involvement of local people. In the last few days with the support of emails from 38 Degree members to MPs and the 159,000 signatures we have got the Government to make some important concessions.  The amendment played a vital part in getting Ministers attention.

Today Ministers gave Parliament the assurance that everything possible will be done to help any potentially failing hospital to sort out their difficulties so that a TSA is only ever used in rare and extreme circumstances. Following my lobbying Ministers have amended the Bill to strengthen public and patient involvement by the inclusion of local Healthwatch.  In addition local councils are being added for the first time too.  In the Lewisham case the local Council played a vital role in standing up for local people.

Also as a result of today TSAs will have to consult with NHS Trusts and their staff and with commissioners (CCGs) of any affected NHS organisations.  And as a result of the amendment Ministers have conceded that equal weight must be given to views of each involved Trust, staff  and commissioners.  Finally Ministers confirmed in response to my amendment that any TSA plan must have the agreement of ALL relevant commissioners.

When it came to pushing the amendment to the vote I had to make a fine judgement.  Having secured important changes and commitments from the Government I took the view that pushing the amendment to a vote ran the risk of defeat and sacrificing what the Government had offered.

That is not the end of the matter.  A cross party committee of MPs and Peers will be set up to agree the guidance to TSAs.  I will be chairing that Committee and I am keen to engage with 38 Degree members as we draw up the rules to make sure the views of local clinicians and local people are heard.

And here’s a response from Jamie Reed MP, Shadow Health Minister:

I read Paul Burstow’s blog to 38 degrees members and to give him credit he was right about one thing – the amendment certainly got Ministers’ attention. So much so I had Tory MPs coming up to me last night saying that George Osborne was dragged in at the last minute to heed off any potential rebellion in the Commons.

Looking at the voting figures, the real tragedy is that if Paul had pushed our amendment to a vote, and brought with him the Lib-Dems, we could have won that vote last night. Instead only one Lib-Dem ended up voting for Paul Burstow’s amendment. And it wasn’t Paul Burstow.

The truth is no meaningful improvements to the hospital closure clause have been secured and it would be delusional to believe that they had.

But let’s have a look at the “important concessions” the Lib-Dems claim they won.

The first concession is a new job for Paul chairing a committee of MPs and Lords which will look at the guidance on how the legislation will be used in future. I’m not holding my breath.

The second concession is that Healthwatch will have a say in any decisions made. That’s the same Healthwatch who under the Health and Social Care Act is barred from criticising Government policy. And that’s the same Healthwatch who has just had its funding cut by £10m.

The final concession is that the Trust Special Administrator will now have to ‘consult’ with NHS staff affected by the changes, but crucially they will be under no obligation to take their advice, and, unbelievably, they will not be required to consult with local people.

I’m afraid Paul has sold out thousands of people who signed the 38 Degrees petition for some pretty meaningless public relations designed to let Jeremy Hunt get his way and save the face of the Lib-Dems.

We knew this was always likely to be the case.

The truth is that – from the widely hated Heath & Social Care Act onwards – the Lib-Dems have enabled the Conservative Party’s vandalism of the NHS. 38 Degrees members came under attack from Conservative MPs during yesterday’s debate – and not for the first time. Let’s not forget it was your donations that paid for the legal advice that drafted the amendment that Paul refused to push to a vote.

Instead it was left to Labour to ensure that the voices of the 159,000 petition signatories – and millions more in the country at large – were heard in Parliament.

Reading Paul’s justification for his actions, I was reminded of Ricky Gervais’ David Brent character breaking the news of redundancies to his staff after promising them there would be none: “The bad news is there will be redundancies. The good news is, I’ve been promoted…”

But it’s not all bad news. It turns out that the job offered to Paul in the chamber of the House of Commons in return for not moving the amendment is not remunerated. That’s bad luck – at least Judas was paid.

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Roundup of what 38 Degrees members have done to scrap the Hospital Closure Clause

March 11th, 2014 by

MPs are set to vote on the crucial amendment which would scrap the Hospital Closure Clause and replace the clause with new wording at 6pm this evening.  The vote is on a knife’s edge and the media are reporting a growing rebellion from coalition MPs.

In the meantime, here’s a quick roundup of what 38 Degrees members have done to get us this far:

Nov 2013: 38 Degrees member, GP and chair of the Save Lewisham Hospital campaign, Louise Irvine, launches a petition on Campaigns By You calling on Jeremy Hunt to axe the Hospital Closure Clause. It gets over 100,000 signatures in a couple of days.

23rd Feb 2014: 38 Degrees members vote overwhelmingly to launch a massive campaign to stop the Hospital Closure Clause.

26th Feb 2014: The huge people powered petition to scrap the Hospital closure clause is launched, it gathers 100,000 signatures in less than 24 hours!

27th Feb 2014: Campaigners gather outside Downing Street to hand in Campaigns By You petition.

March 1st 2014: 38 Degrees members and local hospital campaigners meet their local Lib Dem MP and ex health minister, Paul Burstow. They leave him in no doubt that they want him to do everything in their power to scrap the hospital closure clause. To find out more about what happened in the meeting click here. 

March 3rd 2014: Award winning filmmakers worked at break-neck speed to pull together a hard-hitting video about the hospital closure clause. The video was paid for by donations from 38 Degrees members. Thousands of people shared it and watched it. The aim was to show just why Jeremy Hunt’s plans needed to be stopped.

Here’s the link to the video.

March 4th 2014: The lawyers who represented the Save Lewisham Hospital Campaign drafted amendments to Clause 119, paid for by donations from 38 Degrees members, which Paul Burstow MP tables.

March 7th 2014: Tens of thousands of 38 Degrees members email their MPs asking them to support the Burstow amendment.

March 7th: Local hospital campaigners across the country got in touch with their MPs and local press about the hospital closure clause to ramp up the pressure locally. Special mention to REACH and Save the Alex campaign, who even made the Today programme.

March 10th 2014: Thousands of 38 Degrees members phone their MPs asking them to support the Paul Burstow amendments.

March 10th 2014: Our massive people powered petition is handed in to Paul Burstow MP, who presents it at the debate.

March 11th 2014:  Thousands of 38 Degrees members tweet their MPs asking them to support the Burstow papers.

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NHS: tweet MPs about the Hospital Closure Clause

March 11th, 2014 by

NHS - Locked gates image

Urgent: Today MPs will vote on the hospital closure clause. They have a choice. They could vote the law through, making it dangerously easy for the government to close our local hospitals without any real consultation.

Or, they can scrap the hospital closure clause and make sure that local people and doctors are properly involved in any decisions about changes to hospitals. All they’d need to do is vote for changes to the law laid down by Paul Burstow MP, amendment NC16.

We only have hours left before MPs start voting. And the one thing MPs always have with them is their phone. Let’s keep the pressure up until the last minute via Twitter.

Can you tweet your MP now? It takes 30 seconds and you’ll find some suggested text. Click here.

Support for the amendment is snowballing. More and more MPs – including Conservative and Liberal Democrats – are signing up to the amendment. That’s down to everything 38 Degrees members have done together.

Over the last three weeks 38 Degrees members have built a 180,000-strong petition, sent over 80,000 emails to their MPs and placed hundreds of calls to MPs’ offices. There are signs that a rebellion against the government’s plans is growing, but the parliamentary maths is still tight.

Lots of MPs could still go either way – so let’s give them a nudge in the right direction. Every time they glance down at their phones, they need to see more of us asking them to vote for the amendment.

Amendment NC16 will see off a huge threat to our local hospitals. MPs need to vote for it today.

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NHS: phone MPs about the hospital closure clause

March 10th, 2014 by

Closed hospital
Tomorrow, MPs will be voting on the hospital closure clause. If it passes, the clause would give the government the power to quickly close hospitals, without properly consulting local people and doctors.

But there’s a chance to stop it. Liberal Democrat, Paul Burstow MP, a former health minister, has put forward an amendment to replace the clause with new wording, giving local people a final say in changes to their NHS services.

MPs will be voting on this amendment tomorrow. Many MPs – including Conservative, Liberal Democrats and Labour – have already said they’ll be voting against the government, and standing up for their local hospital. So we have a real chance to win the vote tomorrow if enough of them hear directly from us about how important this is.

Can you call your MP’s office now and ask them to vote for Paul Burstow’s amendment? You don’t need to be an expert to call your MP. It’s just about saying what you think, as their constituent. It’ll only take a few minutes, but it could make all the difference to how MPs votes. Click here to call your MP.

If MPs phones are ringing off the hook before the vote, it’ll create a real buzz around Parliament. Phone calls will make sure MPs remember to turn up to the vote, and they could be the tipping point in getting more of them to vote the right way.

MPs have already received thousands of emails from 38 Degrees members asking them to vote for the solution to the hospital closure clause. But we need to make sure that they’re hearing from their voters wherever they turn. An avalanche of phone calls to their office today could be the thing that persuades them.



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The TSA process, the Lewisham case, clause 119 of the Care Bill and the new amendments

March 7th, 2014 by

You can also read this blog post on the Open Democracy website here:

The debate about clause 119 of the Care Bill, which seeks to make amendments to Chapter 5A of the NHS Act, is an example of the government trying to use a screwdriver to undo a bolt. The government have a real problem but clause 119 is the wrong tool to try to solve it.

There is a remarkable consensus across informed professionals who care about NHS services that, in order to deliver high quality care and direct money and staff to patients such as the frail elderly who need community services, the NHS needs to make substantial changes to its footprint of local hospitals right across the NHS. But the NHS is a taxpayer funded service and making changes to the footprint of NHS buildings, let alone closing hospitals, is bad politics. I should know more than anyone because if changes to hospital services in Kidderminster had not been so controversial, I might still be a serving MP!

The problem is that the NHS needs a much better way to take these difficult decisions. But the present amendments to the TSA process are just about the worst possible way to do this. The scheme brought forward by the government is both legally ineffective and is potentially politically incendiary. Even if it worked as a legal scheme (which it does not) it is the wrong solution to a real problem for numerous reasons.

The amendments to be moved by Paul Burstow MP will ameliorate the worst parts of the scheme. This will at least deliver a scheme that is legally effective, but it’s an inelegant compromise where a more comprehensive approach is needed.

The TSA regime was brought in to deal with the exceptional case where an NHS Trust or an NHS Foundation Trust got into serious financial trouble. But no Trust is an island and where there are such serious problems at an NHS Trust that a TSA is a realistic prospect, there will almost certainly be other problems. There may be a dysfunctional relationship with commissioners or there may simply be too many NHS acute hospitals competing for too few patients, with the result that none of them is able to survive financially.

The patient population to support an acute hospital is probably now about 450,000. Hence an area of 400,000 people cannot viably support 2 full, 24 hour acute hospitals, as for example Gloucestershire residents had to accept when deciding whether both Cheltenham and Gloucester could stay open as full acute centres. That was a controversial decision that was made locally after full patient consultation with all the options being examined. For present purposes it does not matter whether the local NHS decision makers were right or wrong. The decision was made locally after a local engagement exercise and thus had a measure of local credibility.

Using the TSA process to impose structural changes across a health economy over the heads of local NHS commissioners and providers is misguided for many reasons. It is a spectacularly wrong solution to a real problem.

First, this is not what the TSA process was brought in to deliver. Chapter 5A brought in the TSA process to solve an exceptional financial crisis in a single trust. Making changes to NHS hospital services across a health economy is not exceptional. Facing up to these difficult decisions is now a routine part of the work of the NHS throughout the country. It is wrong in principle to use exceptional powers to solve routine problems.

Secondly, if the government uses the TSA process to impose changes on a reluctant local health economy it politicises a decision that can only be successfully taken and implemented if it is de-politicised. The government that tries to use a TSA process to impose sweeping change without proper local public engagement will face a unity of political opposition. Nothing unites a community more than having their hospital services removed but imagine the uproar if they are removed for purely financial reasons by unaccountable bureaucrats over the heads of local GPs. Conservative and Liberal Democrat MPs might as well give up now because their government will be held responsible for giving the power to an unaccountable bureaucrat to close down their local A & E and they will be punished at the next election.

Thirdly, the TSA scheme, as proposed by the government, is unfair because it gives NHS commissioners of services at hospitals run by the failing trust a privileged position. Those commissioners have a veto on the extent of changes to their hospitals, whereas the commissioners of services at successful trusts have no such right. Thus those in the NHS who have worked hard to create viable, constructive relationships between commissioners and providers will have services removed. A cynic might say that this was an example of the dysfunctional parts of the health economy being entitled to write the rules to disadvantage the functional parts.

Fourthly, the proposed TSA process cuts across the mantra of the present government that commissioning decisions should be clinically led and should be made locally. Under the TSA process these are not local decisions and they are not made by clinicians. On the day after he came into office in May 2010 Andrew Lansley, wrote as follows in a national newspaper:

Bureaucracy and a top-down approach have undermined the health service ….. Patients and clinicians must be put in control. …. It is time we recognised that the real headquarters of the NHS is not on Whitehall, it’s wherever there are patients, it’s the doctors and nurses whom we register with at our local practice. These are the people whom we rely on and trust. They should be the ones making the decisions about the management of our services as well. That is how we will create a service that is centred on the needs and the wishes of patients.

Less than 4 years later we see the government abandoning this approach as it tries to introduce far more centralising powers than Labour ever did. These powers are inconsistent with a clinically led commissioning.

Finally, the TSA process is a failure because of the lack of public engagement. NHS England’s own recent document on public engagement had a telling part which said:

“Evidence suggests that engaging and involving communities in the planning, design and delivery of health and care services can lead to a more joined-up, co-ordinated and efficient services that are more responsive to local community needs. Public participation can also help to build partnerships with communities and identify areas for service improvement. ….

Insight gathered from the public helps to improve services and outcomes as well as potentially helping to spot failures. Listening to and using the voice of patients and the public were never more forcefully presented than in the Francis report”

So why is one part of the NHS suggesting curtailing public engagement when another part of the NHS says that the lesson is that full public engagement is essential to getting these difficult decisions right? The NHS is thus pulling in different directions.

The Burstow amendments will put all commissioners on an equal footing. They prevent the TSA, Monitor or the Secretary of State being the decision maker where changes are proposed in a TSA Report outside the Trust in administration and thus restores the principle of local, clinically led commissioning. It also brings back proper patient engagement before decisions are put into effect outside the Trust in administration. It is not a perfect solution but paradoxically it is one that is consistent with lots of other strands of government policy.


David Lock QC was MP for Wyre Forest (Kidderminster) from 1997 to 2001. He was counsel for the Campaign in the Lewisham Hospital case in the High Court and Court of Appeal and was instructed by 38 Degrees to draft amendments to the Care Bill. These are his personal views and should not be attributed to 38 Degrees.

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More information about the “Paul Burstow amendment”

March 7th, 2014 by

What’s the amendment about?

Amendment NC16 to the Care Bill seeks to add a further clause which will change the effect of clause 119 (commonly known as the “hospital closure clause”).

This new clause seeks to address the widespread concerns that have been raised by a variety of groups about the original “hospital closures clause”. It aims to ensure that:

· Where a Trust Special Administrator (“TSA”) is appointed, the TSA will treat all commissioners of NHS services equally. The clause removes the unfair preferential position of the commissioners of NHS services of the Trust which is in administration.

· That where the TSA recommends that changes are made at financially and clinically viable hospitals (i.e. other than hospitals run by the Trust which is in administration), those decisions will continue to be taken by NHS commissioners who are locally accountable to their communities. It takes away the right of the TSA to impose changes at hospitals other than the Trust which is in administration

· It ensures that, where changes are proposed for financially and clinically viable hospitals, these changes will only take effect after proper patient and public engagement.

Who’s behind this amendment?

Paul Burstow MP has tabled the amendment (Amendment NC16) to the Care Bill. This amendment was drafted with the assistance of the barrister who acted for the Save Lewisham Hospital campaign in their landmark victory over Jeremy Hunt. The QC’s time was paid for by donations from 38 Degrees members.

Several MPs from different parties have now added their name in support of this amendment. These include:

  • Andy Burnham (Labour)
  • Caroline Lucas (Green)
  • Andrew George (LibDem)

How does the original hospital closure clause work?

The original “hospital closure clause” makes changes to the TSA process which is used when an NHS Trust gets into serious financial difficulty and the government is entitled to appoint an administrator – the TSA – to take over the Trust and produce a report recommending changes to local NHS services.

The TSA is only supposed to recommend changes to the Trust in administration but in the case of South London Healthcare NHS Trust, the TSA recommended shutting the A&E and maternity services at an adjoining hospital, Lewisham, despite the fact that Lewisham hospital was highly rated and not in financial difficulties. Lewisham hospital was earmarked to be downgraded because of problems at a neighbouring hospital, despite the opposition of local doctors and the local community.

Local campaigners, supported by 38 Degrees members, paid to launch a legal challenge against this decision. The judge ruled that the TSA had exceeded his powers, because he couldn’t try to impose changes at neighbouring hospitals. He only had power to recommend changes at the hospitals run by the Trust which was in financial difficulty.

The original Hospital Closure Clause tried to change the law to give the TSA extensive powers over any other hospitals that were linked to the financial problems of the Trust which was in financial difficulty. This meant that NHS services could be subject to widespread reconfiguration by the back door, without the support of local commissioners and without proper public consultation.

The powers opened up the possibility that the government would use these new powers to change or cut services at NHS hospitals without local people, doctors, or decision-makers having a proper say.

What does the amendment do?

The amendment seeks to change the “failure regime” to make it clear that local doctors and patients must have a real say.

It does this by firstly requiring GP commissioners (local doctors who have the power to decide what health services you are able to access and who provides them) from across the whole area affected by any proposed changes to have the final say in what services are provided by local hospitals. The original hospital closure clause only gave this right to GPs in the area of the hospital with the financial difficulties that triggered the “failure regime”.

Secondly it makes it clear that if the TSA recommends changes at a neighbouring trust which is not in special administration (as happened with Lewisham), the final decision maker should be local doctors in that area – not the TSA or the government. So in the case of Lewisham, proposals to shut the maternity and A&E unit could only go through with the support of Lewisham clinical commissioning group.

It also provides that where the local Clinical Commissioning Group are considering adopting changes recommended by the TSA, they must go through proper consultation with the local community, local authority and local medical professionals before any changes can be agreed.

Is this a perfect solution?

Almost certainly not! But it provides a far better balance between local and national decision making than the original clause.

There are many things that lead to a hospital getting into serious financial difficulties including disastrous PFI deals. These deals can rip off the taxpayer and harm the NHS. If changes are needed to local NHS services, those decisions must be made locally by those with the best interests of local patients and only after a proper process which gives local people a say in how decisions should be taken.

Is it better than the original hospital closure clause?

Definitely yes – this new clause puts in new safeguards to ensure patients and doctors get a say in their local NHS. It prevents them being overruled by the government using a “failure regime” in a neighbouring area.

Is getting this new clause passed better than simply stopping the hospital closure clause going through?

Yes! The new clause makes it clear that local doctors and patients have a right to have a say before changes are made to their NHS.

It should avoid us having to rely on the courts to protect these rights, as we did in the case of the campaign to protect Lewisham hospital.

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Jeremy Hunt is trying to change the law

December 3rd, 2013 by

38 Degrees members are passionate about defending the NHS. When Jeremy Hunt tried to close the A&E at Lewisham hospital, thousands of us came together, chipped in and took him to court. We won, he appealed, then we won again.

But having been told twice that he acted illegally, he’s trying to change the law! [2] He wants to bring in a “hospital closure clause” to give him new legal powers to shut A&Es like Lewisham. If he gets this through, none of our hospitals will be safe from his meddling or closure.

The hospital closure clause will soon be voted on by MPs. We need to persuade enough of them to vote against it. A huge petition will show MPs that the public don’t want them to give Jeremy Hunt new powers to shut hospitals.

38 Degrees member Louise Irvine, who is chair of the Save Lewisham Hospital campaign, started a petition on the 38 Degrees website. Please can you sign it today, before MPs vote?

It’s a pretty cynical way to respond to our campaign, isn’t it? After losing in court, Jeremy Hunt’s trying to sneak a change into a law to allow him “to dismantle hospital services arbitrarily.” Even the very best hospitals wouldn’t be safe. This sinister clause is hidden within a much bigger piece of law – presumably he’s hoping that it will go through unnoticed.

A big petition can help stop this happening. When the bill is next debated, we can prove that thousands of us are coming together against these plans. Every signature helps sound the alarm. Every signature is a blow to Jeremy Hunt’s reputation, an extra voice against him getting new powers to shut hospitals.

Jeremy Hunt saw the public outcry the last time the government changed the law to damage the NHS. He saw his predecessor, Andrew Lansley, lose his job. The last thing Jeremy Hunt will want to see is 38 Degrees members coming together again to stand up for NHS.

So let’s get signing this petition now and together, once again, we can stop Jeremy Hunt!

(Louise is running this petition on Campaigns By You, the part of 38 Degrees that allows members to campaign on the issues that matter to them. If you’d like to set up your own campaign, please click here and get started .)

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