Redressing the democratic deficit

A Government consultation led to proposals to downgrade the status of Lewisham Hospital. The people of Lewisham took action and set up an Independent Panel of Inquiry. Michael Mansfield QC and Elizabeth Woodcraft explain the role that barristers played.

In 1945 a remarkable vision was forged. People wanted a fresh start and a continued role in shaping their future. This deeply felt belief was in no way daunted by the paucity of resources nor the exhaustion of war. Intrinsic to this revitalised democracy was a foundation built on universal healthcare, education and access to legal welfare.


Incrementally, that vision has been and is being torn apart by successive governments which have eroded democratic authority and accountability – governments riddled with collusive vested interests.

There is an increasing realisation that one of the ways to achieve this is by taking control of the truth and exposing the deceit. In the 1960s, Bertrand Russell recognised this and endeavoured to fill the gap by fostering the idea of an international tribunal of citizens, a court of conscience initiated by civil society, on a voluntary basis, stepping in to utilise the established legal framework, where institutions and governments had failed to shoulder their obligations.

It was this precise motivation that fuelled a ground-breaking step taken by communities in south London centred in Lewisham. The general concern was how the NHS has been systematically undermined, and in particular the threat of closure posed to the community hospital in Lewisham, a successful hospital achieving some of the highest standards of medical excellence in the country, against a background of financial viability. A review ordered by the minister of health was not aimed at Lewisham initially, but at a neighbouring hospital trust losing £1.3 million per week. The trust in financial difficulties has been locked into punishing Private Finance Initiative (PFI) contracts, which involve borrowing money at exorbitant rates from banks, coincidentally bailed out by the public.

The Government proposal

Following ‘consultation’ – later to be the subject of judicial review – the following proposals were announced: that Lewisham would be downgraded from major hospital status; 60% of its estate would be sold off; effective A&E would be closed along with all acute admitting wards, intensive care, emergency and complex surgery; and the obstetric maternity unit would be replaced by a midwife led facility without obstetric or medical back-up. These proposals would have disastrous consequences for training and specialist care.

In Lewisham, a diverse and densely populated part of south London, the people had already made clear what the Government could expect from them when 25,000 took to the streets. The next step was to redress the democratic deficit themselves, to garner evidence enabling the truth about major government policy decisions to be subject to public scrutiny. To provide an opportunity for the whole community to have its voice heard. The people came together and commissioned an independent panel of inquiry.

Setting up a people’s commission of inquiry:

Members of Tooks Chambers have always shared a belief in human rights and fair representation of the most marginalised in society. Some members of chambers had their own experience of Lewisham Hospital, some had been involved in other campaigns around saving the NHS, others simply wanted to be involved in something unique – a people’s commission of inquiry. And the reason we all knew this would be a success was that this truly was a people’s campaign, supported by the community of Lewisham – one of the most economically deprived and culturally diverse areas of the country.

The evidence
The first task was to organise the collecting of evidence. The campaign team’s website already had an enormous amount of information, including news of their campaign, the ongoing correspondence with MPs and requests under the Freedom of Information Act. What was needed for the inquiry was the individual testimony of those with something to say. A member of the team devised a witness template, to be used by the evidence gatherers, but clear enough so that potential witnesses who could not make it to the evidence gathering days could complete it themselves. Three weekends of evidence-taking were arranged. A large health centre in Catford opened its doors to us. Campaign members brought tea, biscuits and fruit, and gradually potential witnesses arrived. Nurses, patients, midwives, GPs, obstetricians and surgeons all waited patiently for their turn to give evidence. We had 50 witnesses and rising, and we had a day for the inquiry.

The witnesses
Witnesses who did not come forward to give evidence were those making the decisions. Letters were sent to Jeremy Hunt MP, the Secretary of State for Health, and Bruce Keogh, one of his advisers, among others. Jeremy Hunt and Bruce Keogh did not reply. It was important that their position was heard and so it was agreed that an actor would read their words – answers they had given in Parliament and letters they had written. Of course had they attended, not only would they have been given time to give evidence, but any points they wanted could have been pursued by the panel or put to other witnesses by counsel briefed to appear on their behalf.

The panel and the place
Mary Warnock and Blake Morrison agreed to sit on the panel with Michael Mansfield QC. The Broadway Theatre in Catford was booked. Arrangements were made to show the witnesses on a large screen at the back of the stage, which would also be the screen for the video evidence of those who were not able to give oral evidence. Technical wizardry meant the inquiry would be live streamed.

As interest in the inquiry grew, there were regular meetings with the campaign, keeping the barristers in touch with the developing views of what was wanted on the day, and what would happen thereafter. We had the agreed terms of reference which was our framework, but given the wealth of evidence which was accruing, our task was to say what we thought was possible from a legal, forensic point of view

It was clear that time restraints meant that most of the evidence that had been collated would not be heard on the day. There was simply not the money to fund a long running inquiry. The panel would garner most information from the papers. Organisation of papers was vital and a group of Tooks members, including pupils, worked with the Lewisham team and photocopied, hole-punched, arranged and collated all the statements into lever arch files. In another file were excerpts from Hansard and the letters of Jeremy Hunt and Bruce Keogh. A running order for the day was prepared. The panel was served with papers and the witness template. The advocates were allotted their witnesses.

The day itself

The day of the inquiry, 29 June 2013, began at 9.30am sharp, with the Mayor making a short opening speech. David [Lord] Owen spoke of his own family’s experiences of Lewisham Hospital and Deion Stephenson, speaking from his wheelchair, commented that Jeremy Hunt needed to get a ‘reality check’.

Then the advocates called their witnesses. Some gave evidence of the financial background to the NHS changes, the debt in the PFI and how a sale of a hospital like Lewisham would pay for it. Doctors and patients spoke of what the changes meant – three buses for a woman in labour, an expensive taxi for a late night sickle cell crisis, the loss of known and trusted teams, creating the need to repeat time and again the details of horrific experiences, the concern that disaffected young people would be lost in the anonymity of distant, overstretched hospitals at the far corners of the borough, the loss of training facilities. The actor read the words of Jeremy Hunt and Bruce Keogh – to howls of outrage. Video clips from doctors, faith leaders and patients brought more evidence. Some 300 people attended the inquiry throughout the day and members of the audience were able to express their own views by writing on a scroll in the foyer of the theatre, tweeting or emailing. Space had been allowed in the timetable for these comments to be read out.

At 5.45pm the inquiry came to a close, when Michael Mansfield gave a brief summing up of the day and the evidence that had particularly touched or troubled the panel.

An interim report was produced 10 days later. Work has now begun on the final report. A transcript of all the evidence given on the day is being prepared, along with a transcript of the video evidence. The report is due to be published this month.

The whole process has restored hope and revitalised the quest for justice.

For more information go to: www.savelewishamhospital.com

Michael Mansfield QC Mansfield Chambers and Elizabeth Woodcraft, Garden Court Chambers

Category: