In a rushed vote on a provision added to the Care Bill at the last minute, on Monday 21st October, the House of Lords has voted to extend the powers of unelected Special Administrators appointed to fix failing trusts to reconfigure services at neighbouring trusts without extensive consultation. The Care Bill will return to the House opf Commons for final approval, probably in early November. This appears to be the death knell of "no decision about me, without me". It follows the defeat of the Special Administrator's plan to reconfigure services at Lewisham Hospital by local campaigners through Judicial Review. The regulator Monitor regards separate trusts as competitors which must be absolutely forbidden from cooperating or merging, But Health Minister Lord Howe said in the parliamentary debate on these provisions, "Where severe and prolonged problems exist, it is surely the case that the special administrator must be able to propose a viable solution. This clarification on the scope of the administrator does not constitute a change of policy, it is not retrospective and it is intended only to remove any uncertainty for the future. NHS trusts, foundations trusts and other providers dont exist in isolation from each other. They are part of a complex, inter-dependent local healthcare economy. Issues of clinical and financial sustainability nearly always cross organisational boundaries."