Michael White: The cross-party assault on Hunt's clause 119

It’s a rash columnist who predicts the outcome of a parliamentary vote which takes place after his or her deadline, but whose outcome will be known to the readers.

But let’s live dangerously and assert that Jeremy Hunt will have survived the cross-party assault on clause 119 of his care bill by the time this reaches you.

• A bland euphemism which hides a dangerous lack of planning

The ‘Lewisham amendment’

The clause is what we might call the “Lewisham amendment”, belatedly inserted into the department’s largely unrelated “Winterbourne/Mid Staffs legislation”, this in response to the High Court ruling that the trust special administrator who cannibalised bits of Lewisham’s district general hospital to prop up the larger local health economy exceeded the powers granted him under Labour’s 2006 NHS Act.

Mr Hunt responded as ministers in all parties often do, with a move to change the law and let TSAs do what they deem necessary to resolve trust bankruptcies. So many loom, we keep being told.

‘Despite shroud-waving tactics I have some sympathy with ministers who carry burdens that judges and lawyers do not’

Despite shroud-waving tactics I have some sympathy with ministers who carry burdens that judges and lawyers (on strike over their own pay this month) do not. Nor do pontificating journalists.

Even if greedy bankers (who still don’t get it) had not bust the system in 2008 and the Tory-dominated coalition not imposed its cuts package in 2010, we would face most of the current pressures on hospital, primary and social care for reasons we all know.

Yes, coalition choices have made some problems worse: primary care reforms and budget cuts were bound to mean trouble in A&E.

But where I parted company long ago with coalition ministers over the foolish promises Andrew Lansley made (and David Cameron still makes) over prior local consultation before reconfiguration decisions.

By raising expectations they were building up trouble. Stung by the Chase Farm photo-ops-and-let-down, Enfield Tory MP Nick du Bois was one of last night’s promised rebels.

Clause 119 might just sneak through

Even with a good case rebel numbers rarely stack up. With 306 Tory MPs and 57 Lib Dems the coalition has an overall majority of 76 over all other parties, even before we discount 22 assorted nationalists, some pretty semi-detached on English health matters.

It’s hard to overturn, especially when some coalition rebels merely abstain, which amounts to half the value of a No vote. Rebels held out hope that new clause 16, which addresses the “collateral damage” weakness in clause 119, might just sneak through.

On Monday MPs spent six hours on the closing report stage of the protracted bill, more on Tuesday. Wasted time? Certainly not.

Former care minister Paul Burstow moved several amendments (as a “convert”, Labour allies noted) to strengthen patient protection.

They included a last, doomed attempt to ensure that private care contractors become liable for the same human rights obligations that lie on the public local authority which pays them.

‘The government has tweaked the sweeping extra powers it is giving to special administrators’

As is often the case, it fell to his successor, fellow-Lib Dem Norman Lamb, to bat away most of his proposals, albeit with promises of further examination and explanations of ministerial intent, which may guide judges in future.

Under protest and pressure, the government has tweaked the sweeping extra powers it is giving to TSAs to strengthen consultation procedures.

Ministers don’t want a local pre-election crisis ahead of an election, do they?

Less popular perhaps, but fair, they have also strengthened the appeal process for NHS managers deemed not to be a “fit and proper person”. Every tweak may make a difference.

Labour’s Andy Burnham says “hospitals must change” but baulks at outright closures. Tory veteran Stephen Dorrell pleads the big picture, which requires some to close so that more care can take place in the community, as lip service always says it should.

Michael White writes about politics for The Guardian