Intended for healthcare professionals


Planning for closure: the role of special administrators in reducing NHS hospital services in England

BMJ 2013; 347 doi: (Published 13 December 2013) Cite this as: BMJ 2013;347:f7322
  1. Allyson M Pollock, professor ,
  2. David Price, senior research fellow ,
  3. Elias Kondilis, senior lecturer ,
  4. Andreas Freitag, research assistant,
  5. Louisa Harding-Edgar, research assistant
  1. 1Centre for Primary Care and Public Health, Queen Mary, University of London, London E1 4NS, UK
  1. Correspondence to: A M Pollock a.pollock{at}

A proposed amendment to the law will give special administrators powers to reconfigure health services well beyond those provided by the trusts they are administering. Allyson Pollock and colleagues argue that this will undermine equal access to care in England

One of the effects of the Health and Social Care Act 2012 was to remove the organisations that used to plan health services for geographical areas in England on the basis of need. Instead market forces are to have more influence, with competition among providers leading to more innovative and patient focused services.1

A recent legal judgment has made the government realise that it may have lost too much control and it is proposing to amend the law in order to restore a partial planning function. A proposed amendment to a bill going through parliament (tabled in October 2013 and currently awaiting a second reading in the House of Commons) would provide trust special administrators (who are sent in to manage trusts that have large deficits) with the power to reconfigure neighbouring services as well as those of the trust that is in trouble.2 However, the special administrators would have no complementary duty to plan health services for the population of that area on the basis of need; their responsibility is simply to ensure that trusts can pay their debts.

We explain why the government is making this amendment and how such an ostensibly obscure provision could undermine equity of access and the provision of a comprehensive health service to some populations in England.

Lewisham: a reconfiguration too far

The idea that market forces not public planning should shape the English NHS has been a cornerstone of government strategy since Labour’s NHS Plan in 2000. The approach was taken further by the current government, culminating in the controversial Health and Social Act 2012, …

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