Friday 17th March 2017
Save Our Hospital Services (SOHS)
- Holsworthy Town Council support their community’s campaign against NHS proposals – Patients do not want medical care in their homes
A meeting of some 500 local residents in Holsworthy Memorial Hall on Wednesday night, is clear evidence of the opposition to North Devon Healthcare Trust’s plan to remove beds from the Holsworthy Community Hospital. It took nearly an hour for the Memorial Hall to fill to capacity and residents were in the mood to have their say. No satisfactory answers were given by Alison Diamond, CEO at NDHT to questions from the floor of the meeting – How long will the ward closure last? – What conditions need to be met to allow re-opening? – Why don’t you show leadership and overturn the decision? Her main response was to blame the decision on the shortage of nurses and low bed occupancy.
Ian Crawford, a campaigner from Save Our Hospital Services (SOHS) said “We congratulate Mayor Jon Hutchings and the Town Council for their support of the campaign to oppose the removal of beds from their local community hospital
Cllr. Barry Parsons made a compassionate plea "Why should we be the ones to suffer?" He emphasised the sense of community and said "I'm terribly disappointed at this decision.
A local GP told Alison Diamond that as a doctor he needed beds for his patients and for convalescence on return from treatment at the main hospital.
Contrary to the NHS England view constantly espoused by Alison Diamond that the plan is to provide medical care in the familiar surroundings of home, previous patients confirmed their preference to receive medical care from professional staff in the safe environment of their local hospital.
These closures of hospitals, removal of beds and plans to provide medical care in the home rather than a hospital are all part of NHS Englands strategy to slim the NHS down for privatisation with the use of agencies on lower wages with little union representation- this is the view of of SOHS campaigners.
Media Liaison – SOHS
07917 123 435
Monday 6th March 2017
- Towns in Cornwall march and protest for the NHS
March 4 was also a major day of mobilisation in Penzance, Truro, Falmouth and other parts of Cornwall where local events were staged in solidarity with the big London demonstration. Local bands played and midnight vigils were staged as Cornish people showed their determination to defend Our NHS.
Full report from the excellent Cornwall Live is here
Read more ...
Tuesday 28th February 2017
SE Cornwall labour Party
- Can't get to London on March 4?
MARCH FOR THE NHS IN TRURO
Saturday 4th March
Assemble 2.15pm at Lemon Quay and march to Truro Cathedral for a rally with speakers
TRANSPORT WILL BE AVAILABLE
Our campaigning has been having an effect. Where Cornwall councillors were refusing to commit even to a proper scrutiny of the Sustainability and Transformation Plan by a vote in full council, that has now been agreed, and many are opposing it outright. NHS funding looks set to be the biggest issue that the local election will be fought on. But we need to keep up the pressure.
Last Friday's Cornish Times reported the 'temporary' closure of St Barnabus' community hospital in Saltash and the transfer of its staff to Liskeard. The closure has not been presented as a cut, but rather a change resulting from a local recruitment crisis in Liskeard. However, the closure is ushering in the STP plans of rationalising and cost-cutting, and may indicate that the community hospital beds in Saltash are earmarked for closure.
Now is the time to stand up for our local health service and act in solidarity with campaigners from all around the country. Health Campaigns and unions in Cornwall have called a march in Truro
to protest about the STP and save our local hospitals; and Labour throughout Cornwall will be supporting the march. It's the same day as the national march in London and saving the NHS will be high on the news agenda. Please come to Truro with us to march behind the SE Cornwall Labour banner!
It's been great to see how many of our members want to show care for our NHS since this campaign began; and we'd like to organise transport to Truro from this area. Can you offer a lift or will you need one? If there is enough interest we may be able to put on a bus... In any case we'll want to organise meeting up in advance so that we can march together. So please reply to this email - or contact your branch secretary - and tell us if you're planning to come.
Look forward to hearing from you,
yours in solidarity,
South-East Cornwall Constituency Labour Party
Thursday 15th December 2016
- SWKONP applauds Warwickshire County Council saying No to Sustainability and Transformation Plan and says government must pay up for health and social care.
Anna Pollert, SWKONP Chair, said
"SWKONP applauds the wise and timely decision of Warwickshire County Council taken Tuesday December 13th declining to sign up to the published 5 Year Sustainability and Transformation Plan for Coventry and Warwickshire.
"We welcome the Council's setting requirements prior to further consideration, including full public engagement, using plain language, an independent chair for the STP, and planning integrated health and care services accessible to all people in Coventry and Warwickshire."
Anna Pollert added
"SWKONP is concerned that NHS England does not try to impose the £267 million which is at the core of the STP, as the contribution of the Coventry and Warwickshire STP ‘Footprint’ (in NHS England jargon) towards the national ‘Five Year Forward View’ target of saving £22 billion by 2020.
"This figure, which is the bulk of so-called £30 billion NHS shortfall by 2020, is a government created shortfall, caused by the underfunding of the NHS. The UK is spending a diminishing percentage of GDP on the NHS, and is now a lowly 13th out of the original 15 EU members in terms of investment.[i]
SWKONP is equally concerned that cuts in social care are scrapped. In September 2016, Warwickshire County Council announced that it had to make cuts of £67 million by 2020, as a result of reductions in government funding, inflation and demographic pressures.[ii]
"Only this week, it was announced that 'Hundreds of jobs could be lost at Warwickshire County Council as part of cuts which will affect some of the most vulnerable across the area...more than 300 people would lose their jobs, including 45 members of staff working in social care and support, 62 people from Warwickshire Fire and Rescue Service along with 54 from community services, 22 from children and family services and 31 from customer services. On top of this, more than £14 million worth of cuts to adult social care have been proposed as part of the authority's new plan to balance its books....' (Leamington Courier, December 9th 2016).
"The government’s starving of social care, as of the NHS, must be challenged. The UK social care system is in deep crisis – a crisis created by the government’s austerity policy, whose failures have been denounced by leading academics.
"Not only is ‘austerity’ a discredited economic strategy' its resulting widening of social inequality in Britain is bad for health and has gone so far that it has prompted the UN to accuse the government of breaching international human rights.[iii]
"£4.6 Billion has been cut from adult social care since 2010, meaning 400,000 fewer people now have publicly funded care.[iv]
"Ministers have been warned they face a "collapse" in social care across the country due to a funding shortfall. While the government offers no more from the budget, it is ‘allowing’ local authorities to find the money by raising council tax. This is not only a cynical ruse, it cannot raise nearly enough.
"The crisis in social care is damaging the NHS as well as society. Patients needing social care cannot be discharged from hospital, leading to delays in admissions and treating other patients. The double crisis in the NHS and social care is bringing both health and social care to breaking point. But it needn’t be so.
"The government has made a political decision to cut public spending, while handing billions to corporations by cutting corporation tax. The UK’s 20% corporation tax is already lower than the average 28.7% of the G20 most powerful economies, yet the government plans to lower this to 17% by 2020. Raising it, closing tax havens, and forcing tax evaders to pay up would easily plug both the NHS and the social care funding shortage.[v]
"Our local councils must demand that the government gives the NHS and social care the funding they so desperately need."
Save Our Hospitals
- Ealing Council stands firm against hospital cuts plan
The NHS has confirmed that despite widespread public opposition, it is pushing ahead with a 10-year plan that will see Ealing and Charing Cross hospitals downgraded.
Last week, the NHS published a £500million business case that sees blue-light ambulances, critical care and potentially all surgery removed from Ealing Hospital by 2022.
After Ealing is downgraded to a ‘local’ hospital, the NHS would then do the same to Charing Cross Hospital – helping it save £1.1billion over the next decade.
Ealing Council has been fervently opposed to hospital reconfiguration plans since they were first announced in June 2012. Under the NHS’ ‘Shaping a Healthier Future’ programme Central Middlesex and Hammersmith hospitals’ A&Es have closed as has maternity and children’s A&E services at Ealing Hospital.
There is widespread public opposition to the plans and numerous protests and marches have taken place across West London.
Ealing Council has confirmed that it will hold a public meeting at Ealing Town Hall on Wednesday, 15 February 2017 at 7pm. Residents are invited to attend to find out more about what it means for local health services including those provided in hospitals as well as planned improvements to primary care. The council will then be responding to the NHS’ public engagement which is starting early in the new year.
Councillor Julian Bell, leader of Ealing Council said: “Despite huge local opposition the NHS is hell bent on carrying out the biggest reconfiguration experiment in its history and using the people of Ealing as its guinea pigs.
“While we want investment in improved out-of-hospital and preventative care, we cannot support the closure of A&Es and the downgrading of Ealing and Charing Cross hospitals. This plan signals the death knell for emergency services in Ealing. It would leave our borough, which has a population the same size as Cardiff, without an A&E. This is not safe.
“To add insult to injury we have also learnt that the investment in the remaining site is being cut with the existing hospital getting a ‘make do and mend’ refurbishment rather than the new hospital being promised.”
Councillor Hitesh Tailor, cabinet member for health and adult services, said: “I would urge as many people as possible to attend our public meeting in February.
“The NHS belongs to all of us and we need to defend vital local health services - once they have gone they will be lost forever.”
Last year Ealing and Hammersmith and Fulham commissioned an independent inquiry led by Michael Mansfield QC that has provided a strong evidence base for why the proposals are wrong.
To find out more about the NHS plans and how you can get involved:
1. Come to the public meeting in Ealing Town Hall on Wednesday, 15 February at 7pm
2. Speak with friends and neighbours to make sure as many people as possible understand what is proposed.
Read more ...
- Camden says no to STP
On December 14 Camden Council refused to endorse the STP (Secret Tory Plan to destroy our NHS) at their cabinet meeting. Well done to everyone who has been campaigning and joined Camden Keep Our NHS Public's lobby and deputation which included Camden Unison and Yannis Gourtsoyannis
from the BMA
Wednesday 14th December 2016
Anna Pollert South Warwickshire KONP
- Warwickshire council rejects STP
Warwickshire County Council at its full council meeting on 13th December passed unanimously a resolution to oppose the Coventry and Warwickshire Sustainability and Transformation Plan.
Councillors are unhappy with the whole approach to develop the STP and won't sign until there has been full public consultation.
The motion was put by Councillor Matt Western (Lab):
Item 4 - Coventry & Warwickshire STP
1. That the Council believes that the approach used to develop the Coventry & Warwickshire Sustainability and Transformation Plan (STP) has been opaque and veiled in secrecy. Given how critical this Plan is to the future provision of Health and Social Care Services and the future of our local hospitals in Warwickshire, the Council urgently requests that more time is allowed for full and proper public consultation and seeks assurances that all plans for the future of the NHS are developed openly and with full involvement of the users of the service.
2. That, consequently, the Council
(i) Agrees that it will not consider signing up to the Coventry and Warwickshire Sustainability and Transformation Plan published on 6th December until:
a) There has been full public engagement
b) It has been co-produced along with the Health and Wellbeing Boards of both Warwickshire CC and Coventry CC
c) It is rewritten in language which is accessible to the public
(ii) Expects that the STP in its next stage moves to a transformational level and that an independent chair is appointed to ensure the necessary challenge.
(iii) Expects that the original intent of the STP around the integration of the health and social care systems is progressed in a way which recognises the crucial role played by social care."
(iv) Expects that the STP workstreams will recognise local and easy access to services by the whole population of Warwickshire and Coventry as a fundamental principle.
(v) Establishes a cross party scrutiny group to consider the STP
Tuesday 29th November 2016
Keep our NHS Public Cornwall
- CORNWALL NHS CHALLENGED OVER “FLAWED” PLAN
“Keep our NHS Public Cornwall” (KONP) a cross-sector campaign group of health professionals, trades unions and community activists/representatives in Cornwall has today challenged Cornwall’s NHS, following the release of the “Sustainability and Transformation Plan” (STP).
KONP has undertaken an initial analysis of the key elements of the proposed plan, released on Monday 28th November. Whilst many of the proposals are desirable, KONP has concluded that it is unrealistic to expect the proposals to be achieved without adequate guaranteed funding. We are also bitterly disappointed that the Chancellor has failed to recognise the crisis in funding of Health and Social Care in his Autumn Statement.
KONP have therefore concluded that without guaranteed funding the proposals are unachievable.
KONP believes that the proposals will inevitably lead to:
· Hospital closures including community beds.
· Further reduction in acute beds
· Inadequate mental health support
· Service cuts
· Outsourcing and privatisation
· Staffing cuts, downgrading and attacks on pay
· Continuing pressure on social care
KONP welcomes proposals to integrate services and to prioritise public health initiatives to improve health and wellbeing. We also support any proposals to pool budgets, to reduce the number of providers and to simplify the commissioning process by reducing the need for competition.
However, KONP maintains that the STP in its current form lacks sufficient practical detail as to how it could work in practice, how any reforms would be funded, and how it would be made sustainable. We believe that the plan lacks credibility and is no more than an idealised wish list.
Rik Evans said following the release of the STP.
“We have grave concerns about this plan. We support many of its aspirations, but without guaranteed funding it is no more than a wish list. Whilst the plan identifies potential underfunding of £264m by 2020, it fails completely to identify what a reformed system would cost.
“The crucial issue is funding .There is currently no evidence that funding will be forthcoming and without it the plan is meaningless”.
Stuart Roden added
“We recognise that there are serious fundamental issues with health and social care in Cornwall that must be tackled urgently. The system is under incredible strain, the fragmentation of the coalition government’s top-down NHS reorganisation and massive funding cuts to Cornwall council have totally failed our local community. The requirements to put services out for competitive bidding have been very costly: increasing privatisation of the NHS and resulting in many expensive failures.
“Having analysed this plan we have come to the conclusion that without a clear financial strategy and guaranteed funding this plan cannot succeed and is fundamentally flawed.”
For further information please contact.
Monday 14th November 2016
posted by Morning Star in Features
- IT’S ALL kicking off in England’s NHS.
It’s not even winter yet, but the squeals of protest are getting louder as the brutal Tory squeeze on NHS spending forces cuts and closures of local services on top of plummeting performance levels and falling quality of care.
What’s new is not the noisy emergence and strengthening of campaigns across the country fighting back, defending rural health services, smaller A&E and other specialist services — although many of these are impressive in size, scope and clout.
The new factor is the squealing from embarrassed, exposed Tory MPs, forced into challenging their own government and the implications of policies many of them have voted unquestioningly to endorse.
In Oxfordshire, Devon, Dorset, Yorkshire, Staffordshire, rural Cambridgeshire, Shropshire and many more areas where local access to services is now at risk, Tory MPs are being forced to challenge Theresa May’s continuation of the austerity policy and her refusal to relax savage spending limits that are forcing the NHS into a monumental crisis.
So serious are the threats to local services that another factor has emerged, undermining NHS England boss Simon Stevens’s drive to force through cuts in hospital services and “reconfiguration” of services through the restructuring of the NHS into 44 “footprint” areas — in which trusts are supposed to collaborate together and with local commissioning groups and local authorities to draw up and implement sustainability and transformation plans (STPs).
This new organisational structure, which seeks to ignore the fragmented market-style system of competition and commissioning imposed by Andrew Lansley’s massive Health and Social Care Act just four years ago, is an attempt to force each “local health economy” to pool resources and share the pain in order to balance the books and deliver a staggering £22 billion in savings by 2020.
But as the public pressure for disclosure of these plans — which have been developed behind closed doors, and were supposed to be kept under wraps until next month — has grown, a succession of council leaders have broken ranks, and published the latest draft of their STP, opening up a new growing storm of protest.
Most of the plans seen so far are two-thirds filled with abstract and hugely optimistic assumptions on the short-term gains from underfunded and endangered public health and community health services, and pages of evasive waffle. But this cannot conceal the fact that many STPs plan to close or downgrade A&E services, maternity services or whole hospitals.
In many cases this poses local communities with journeys of 20 miles or more to access a growing range of hospital care.
In Cumbria and parts of Devon the new journeys could be upwards of 40 miles on twisting rural roads, with little in the way of public transport.
No wonder local politicians, who know they could face the consequences in any future election, are seeking ways to distance themselves from these plans.
Some have gone further. In west London two boroughs, Ealing and Hammersmith & Fulham have defied pressure to sign up in support of an STP which had already been unquestioningly signed off by other north-west London boroughs, in return for vague promises of future funding for social care.
Since then another borough, Sutton, has refused to sign the south-west London STP, while seven West Yorkshire councils have objected to their lack of engagement with the still unpublished STP, and Birmingham has raised major problems with an STP which has been led by its own chief executive.
Stevens has been force to respond to a chorus of legitimate complaints that the STPs are first and foremost about solving NHS problems, with the councils and elected councillors playing second fiddle — and saddled with additional responsibilities.
There is a real problem for the NHS chiefs, whose rhetoric, intended to enable them to skip nimbly around the obstacle to local planning erected by the Lansley Act, includes a notional commitment to “engagement” with local authorities and “stakeholders,” including staff and the local public.
Nothing could be further from the truth of what has been happening as furtive plans (often taking up and pushing forward previous controversial plans for closures under the misleading headings of “centralisation” or “reconfiguration”) have been hatched up under a blanket of secrecy for fear of the anger they will trigger.
The original plan was to leave any pretence of “consultation” or serious “engagement” with staff and the public until after STPs had been vetted and toughened up by NHS England, and binding contracts had been signed: this is now in disarray.
Indeed Health Minister David Mowatt has been reported in the Health Service Journal as effectively giving local councils a veto over STPs in their area, declaring: “STPs should be regarded as incomplete and not go ahead if councils believe they have been marginalised.”
He also promised that STPs which fail “to address the needs of stakeholders, including councils” won’t go ahead.
This promise alone could sound the death knell for a succession of STPs which effectively follow Simon Stevens’s impatient plan to brush aside “local vetoes” — and impose unpopular changes that ignore the needs of local communities.
So the ball is now very much in the councils’ court: some have already stood up and challenged local plans, some, as in west London and Torrington in north Devon, are actively campaigning against local closures.
But most have up to now been tamely roped into signing up for local plans that their voters would not approve — either naively accepting NHS assurances and signing incomplete STP drafts without reading them, or lured in by false promises of partnership working and “integration” of health and social care bringing extra cash in to prop up their services, or bullied by threats that they will be denied any share of the limited pool of “transformation” funding, and left isolated as other boroughs sign up.
Health Campaigns Together meeting at the end of last month identified local government as the weak link of STPs and has urged local campaigners to focus on lobbying council leaders and councillors, as well as MPs, regardless of their party affiliation.
These elected politicians must be called upon to stand up for their local communities, to publish or demand publication of the latest STP Draft in all 44 footprints, to demand a serious period for consultation on every proposed change in the STPs, and to refuse to endorse any STP which threatens local access to services until convincing evidence has been shown that alternative services have been put in place.
This is next to impossible in almost any instance, since the NHS is being starved not only of revenue funding (according to the Nuffield Trust the claimed “extra” £10 billion trumpeted by May turns out to be a miserable £800 million over six years — leaving a growing “gap” between resources and the demands and pressures on the NHS) but also of capital, meaning almost any local plans centred on new buildings are dead in the water.
Campaigners have no interest in drawing up plans for bigger and bigger cuts to bridge a widening gap that has been cynically deepened by six years of frozen funding of the NHS since 2010. We can’t agree to the books being “balanced” in this way at the expense of local services.
Nor can we accept the erosion of the quality and safety of services by the imposition of even more drastic targets for “efficiency savings” by trusts, coupled with limits on nurse staffing levels opening up new dangers of more scandalous failures of care like those in Mid Staffordshire hospitals a decade ago.
Elected politicians of all parties, councillors and MPs, and local newspapers wanting to preserve local services must be called upon in every area to join with campaigners in demanding a change of government policy — a halt to the freeze on funding, a major injection of new money and a return to the growth in spending that saw the NHS transformed and services made sustainable in the decade from 2000.
That, coupled with the NHS Reinstatement Bill to reverse the costly and divisive Health & Social Care Act and renationalise the NHS would be a plan that could win Jeremy Corbyn’s Labour Party support all over the country, while the STPs are emerging as little more than a formula for cuts and chaos.
- John Lister is director of Health Emergency.
Friday 11th November 2016
- Worcestershire's £229 million health funding “black hole” shock
Worcester trade unionists have expressed their horror at a shock £229 million gap in the funding of health services in Herefordshire and Worcestershire. Health chiefs revealed the figure when questioned by Worcester Trades Council secretary Bryn Griffiths at a public meeting in Kidderminster today. To deal with this huge sum, health chiefs have prepared a plan which still they will not make public.
The Sustainability and Transformation Plan has been demanded by the government to “return the system to financial balance”. Mr Griffiths says that health chiefs may be keeping this quiet until Christmas when the public’s attention will be distracted by consultations over changes to the acute hospitals including the planned downgrading of services at Redditch hospital.
“We are fairly sure when the STP plan is published it will be full of cuts dressed up as efficiency savings. In reality hospital services will be diminished and people will have to fend for themselves. The plans will talk grandly about families, neighbours and volunteers looking after the sick but it is really about shifting the costs away from NHS budgets which are massively underfunded.”
The meeting of HealthWatch in Kidderminster heard angry comments from members of the voluntary sector, councillors and campaigners about aspects the plan and the failure to publish it. Plans for Birmingham, Solihull and Shropshire are already in the public domain.
Worcester Trades Union Council calculates the cuts are equivalent to the loss of 6000 health care jobs. Says Mr Griffiths “we do not of course expect the cuts to fall just on jobs but it does show the measure of the problem. The real solution is for our MPs to accept the NHS is massively underfunded and to push the Government to step up to fund it to the level of other European countries.”
Monday 24th October 2016
- NHS plan (STP) submitted - Council Leader's statement
The NHS in the north central London area – which represents Camden, Haringey, Islington, Barnet and Enfield – has submitted a draft Sustainability and Transformation Plan (STP) to NHS England.
This has been developed by a host of NHS organisations with the support of officials from the area’s local authorities to propose changes to the way services are delivered, to make them more effective and efficient.
Councillor Sarah Hayward, Leader of Camden Council, said:
"There is a national crisis in both the health and social care systems - both need to change and we recognise that they could be more efficient. That said, I have serious reservations about the Sustainability and Transformation Plan process so far.
"There has been no political oversight, and minimal public and patient engagement. At present, there is a lack of appropriate focus on adult social care. That lack of public, patient and political involvement is why I am publishing this document on our website
. It is vital that there is full transparency in Camden as this work progresses.
"The next stage is for the bodies involved to respond to this draft plan
and we will be consulting residents and patients on our response over the coming weeks. Local Authorities see first-hand the impact of the profound health inequalities that exist in the north central London area. In the light of this, we’ll be using our role to influence the future quality of local social care and to improve the health and wellbeing of our residents.
"As the provider and commissioner of social care services in Camden we want to be sure that future needs are reflected in this plan. We will be holding a number of public events to gather the views of residents before our response to the draft plan is considered in public by Camden’s cabinet."
Read more ...
Sunday 23rd October 2016
Geoff Barr, Exeter
- Barnstaple: Devon's fightback against Transforming Community Services
Saturday 22nd October saw several thousand people march through Barnstaple to protest against plans to downgrade the North Devon District Hospital. The campaign drew in much of the town and people from all around. It felt like a town on the move.
The protester ranged from the left of politics to the Conservative MP, Peter Heaton-Jones. Heaton-Jones’s speech was determined in tone. However, he was followed by a speaker who pointed out that if he meant what he said he was risking the prospect of a ministerial career and indeed much of a future as a Conservative politician.
The pictures show a lot of red clothing. The theme was based on the so-called “Success Regime” telling us that there are no red lines protecting services from cuts.
The town has a population of a little over 24,000. This gives an idea of the degree of anger in the traditionally conservative areas of rural England. We are at the beginning of a major battle here and this is an early warning to our enemies.
A contingent from Exeter was there. We aim to stop all reductions of NHS services wherever they occur. The cuts in North Devon will impact directly on Exeter as more people who would have gone to Barnstaple appear at the Royal Devon and Exeter Hospital (RD&E) needing treatment, when the RD&E is hard pressed.
Wednesday 12th October 2016
- Shropshire campaigners force CCG to open up meetings
Something which might be relevant when CCGs are looking how they will implement STPs.
The two CCGs in our STP had agreed to set up a joint committee to take decisions on the implementation of the major programme in the STP. The agreed to delegate authority from CCG Governing Bodies to the Committee which meant that decisions would not need to come back for ratification at public meetings of the CCG Governing Bodies. It was intended that this committee would not meet in public.
We challenged the terms of reference at the two CCG Board meetings yesterday and today. We argued that the Joint Committee with delegated authority was subject to the Public Bodies (Admission to Meetings) Act 1960 and could only be closed to the public through a section 1(2) resolution that having a meeting in public would be “prejudicial to the public interest.” We also argued that all papers for the meetings should be published under the “National Health Service (Clinical Commissioning Groups) Regulations 2012”, specifically Regulation 16 on Transparency.
We presented the arguments in legalese – and made them concerned that they would be open to a legal challenge. They obviously took advice overnight and today conceded. Committee meetings will be publicised 7 days in advance, held in public, and all papers will be available on the CCG website.
So we now have 7 days’ notice each time they want to make an important decision on STP implementation – time enough to ensure a large public presence….
I suspect other CCGs will try to set up similar structures, so it’s worth being on the lookout and challenging early.
Saturday 8th October 2016
WORCESTER TRADES UNION COUNCIL
- Secret Plans to Decimate Worcestershire's Local Health Services Discovered
A campaigning group of local trade unionist say it is “astounded” to find that local social and community groups are being consulted behind closed doors over ideas which will fundamentally change how local health services are provided.
The STP presentation document suggests people will have to travel further for health services; that friends, families and neighbours should care for the sick rather than hospitals and seems to encourage patients to move away from care by their GP.2
Worcester Trades Union Council say they have been pressing for months to find out what is to be in the Sustainability and Transformation Plan being worked on for Herefordshire and Worcestershire.
The STP requires all local health authorities to work together and to reduce hospital financial deficits; the Health Services Journal has put this at more than £300 million this year and say the Herefordshire and Worcestershire STP area is “one of the most financially troubled” in England. 1
Worcester Trades Union Secretary Bryn Griffiths says “we have been asking local health bodies and even the County Council’s Health and Wellbeing Board for months what is going on but we have been very politely fobbed off at every turn. They keep saying the public will be “engaged” in due course but the dates change and there is never any detail.”
What has provoked the Trades Council’s immediate concern is an official presentation passed to them by Evesham Labour Party who found it on the website of an organisation Community First.
“This is a staggering document as it presupposes the fundamental rundown of the NHS and suggests people in future will have largely to fend for themselves. It is full of leading questions and loaded political rhetoric.
"It advances the idea of organisational change without suggesting for a moment the problem might be gross underfunding of the NHS.
"It rather looks as if community groups are being drawn in here using pseudo management terms like “co-production” adds Mr Griffiths.
“These groups are even being asked to sign up to ideas suggesting it is somehow wrong to die in hospital rather than at home. Shouldn’t such moral choices be discussed publicly first?”
WTUC Chair: Pete McNally Tel .07761-769412 firstname.lastname@example.org
WTUC Secretary: Bryn Griffiths Tel.07519-817960 email@example.com
1. Health Services Journal 6 October 2016
Worcester Trades Union Council is the official local representative body of the TUC. It is an umbrella organisation of trades’ union branches including ASLEF, NUT, Unison, Unite, NAS/UWT, UCU, and others
Read more ...
Sunday 2nd October 2016
Pete Gillard. Shropshire Defend Our NHS
- 500 defy driving rain to back protest in rural Wellington
We broke the story on Monday that the health bosses had decided to close the A&E in Telford, one of the two serving a population of 650K over an area the size of 3.3 Greater London’s. The health bosses wanted to keep the info secret, but we prevented that. It ran as the lead in the Shropshire Star, our local daily and on both ITV and BBC West Midlands TV, plus a number of radio stations.
We called a demo for today – four day notice, and it was torrential rain today. Five hundred came. Importantly Telford & Wrekin Council supported the demo (which means we didn’t need to worry too much about police permission). The T&W Leader (Labour) made a strong speech arguing for keeping open two A&Es. This was an important shift because there previous line had been, if there has to be only one it should be in Telford. We also had the support of Labour, LibDem and Green Shropshire councillors.
Two short videos. The first, a quick cut from us, and the second is tonight’s BBC report of the demo
Read more ...
Thursday 29th September 2016
John Lister via GP Online
- Former NHS England commissioner lifts the lid on "shameful" rushed STPs
STPs are being forced through at impossible speed by NHS England, resulting in vague plans being submitted filled with "lies" and policies without proof, according to this blistering critique by a former NHS England manager.
Thanks to GPonline for flagging this up.
Read more ...
Wednesday 28th September 2016
Tony O'Sullivan, co-chair KONP
- Greenwich campaigners prompt Scrutiny Panel challenge to Circle contract
Greenwich KONP and Save Lewisham Hospital Campaign have worked hard together to raise awareness of this case - Greenwich CCG has awarded the MSK contract in Greenwich to Circle despite a very well coordinated bid from the NHS providers. It is a 'prime contractor' situation (like Cambridgeshire and like MSK in Bedford) and Circle would hold all the cards, passing on any risks to the NHS providers. The biggest hit would be on Lewisham & Greenwich NHS Trust.
GCCG have cut 10% off the value of the current work. Circle would of course set out to make a profit, resulting effectively in a further cut, and all penalties would be passed on to the providers.
Our raising of awareness with the scrutiny committee and our presence at the panel tonight was welcomed by the chair who invited some of us to speak after councillors' questions. The councillors seemed shocked at the lack of information in the written and verbal answers from GCCG. I pressed them to use their powers not to endorse the contract and to refer the matter to Council and Secretary of State.
The chair of the scrutiny committee, Cherry Parker summed up saying she had been disappointed by the level of detail offered by the CCG:
"In too many cases the answers don't go deep enough, and we are not in a position to endorse this contract award. We would like to scrutinise further and engage other stakeholders. We want to hold on and want the incoming Chief Officer to be accountable for this contract [when in post from mid-October]"
Greenwich CCG's outgoing chief officer Annabelle Burn, clearly shocked, responded in confrontational vein:
"The new chief officer has had full sight of this contract. We will sign the contract as soon as we are ready to. The contract is awarded. The process is going ahead. Our signature is not subject to this process. We will do this in our time."
This did not go down very well with the Council's Scrutiny chair who replied:
"You and I know we have powers to take this further, and we will execute those powers. I say this more through tears."
We don't know how this will end, but Greenwich KONP and Save Lewisham teams were very pleased with the night's outcome, the result of a lot of background work. We have potentially delayed this contract, due to be implemented from 1st December, and have set back this contract award to Circle - whether temporarily or whether we can go further, we will see.
- Secret plans for Oxfordshire still under wraps
The body that has agreed to cut £9.7 million from local health services, but has yet to admit where the axe will fall, now refuses to reveal its involvement in secret government plans that could see further threats to patient care in Oxfordshire.
Oxfordshire Clinical Commissioning Group (OCCG) continues to stall by not answering direct questions put by campaigners Oxfordshire Keep Our NHS Public, and by its repeated delays in responding to an information request from our local Healthwatch, challenging the secrecy of the plans.
And the local Health Scrutiny Committee, which has a public duty to ask searching questions about significant changes to local health services, has once again failed to see this blueprint, officially known as a Sustainability and Transformation Plan (STP), which will impose further drastic cuts on local health and social care.
Leaks of STPs from other parts of the country reveal planned cuts that will see more GP practices closed, community services reduced or removed altogether, hospital wards and whole departments downgraded or axed, beds permanently lost, A&E threatened, and staff terms and conditions weakened.
The tell-tale signs are already visible throughout Oxfordshire, with the downgrading of maternity services at the Horton, GP practice closures in Witney and Bicester, and hospital and community beds no longer available.
Chair of Oxfordshire Keep Our NHS Public, Dr Ken Williamson, said today:
‘That the public is being prevented from seeing these secret plans until the end of the year is shocking. It isn’t good enough to say that the plans have to have government approval before the public can comment on them.
By Christmas, these plans will be a done deal, and any consultation will be a cynical PR exercise, and totally meaningless.
These plans (STPs) are being imposed by central government as part of a massive de-funding of our National Health Service, deliberately starving it of much-needed investment.
Chomsky said that the standard technique of privatisation was: “defund, make sure things don’t work, people get angry, hand it over to private capital”.
They want the NHS to fail. They want people to get angry. All the easier to introduce co-payments and private health insurance.’
Contact: Dr Ken Williamson, Chair of Oxfordshire Keep Our NHS Public, Mobile: 07831 570936
Bill MacKeith, Secretary of Oxfordshire Keep Our NHS Public 01865 558145
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Friday 16th September 2016
- Our Children’s Services in NHS sale: 96% say no
Today we see another GP surgery close, news which comes on top of further disruption and anger in the Patient Transport Service earlier in the week, both the direct effect of the private market in our NHS.
Now it’s the turn of our Children’s Services to be decimated and picked off most likely by a big corporation, further destroying our local NHS and the guarantees that it brings us. The expensive and secretive process to find a new provider has already begun. Brighton people and local campaigners are up in arms about this NHS firesale. A Council meeting on Tuesday will be met by a demonstration against the sale.
The public health commissioners within Brighton Council are in the process of selling off Children’s Services. But nearly 1,000 signatures have already been collected on a petition in only a few weeks by local campaign group Sussex Defend the NHS. They say, “ Giant private companies like Virgin Care (many of them tax-avoiding) are being awarded huge contracts across the country but because they need to make a profit, they reduce their costs by cutting staff and lowering standards and quality of care. We say No to Virgin taking over our Children’s Services. We want to see them properly funded and run, for us, for all of us, by the NHS.”
A team at Brighton University are researching the views of Brighton residents on what they think about who runs our health and social care services. Their current survey has already attracted hundreds of responses including to a question about the current sell-off, Children’s Services. Preliminary analysis of the second survey data shows 96.3% in favour of the services, which include health visiting, school nursing and the Family Nurse Partnership for teenage parents, being retained by the NHS, a mere 0.4% preferring Virgin Care with 3.3% undecided.
Brighton & Hove Council have already this year implemented severe cuts to the service because of the government’s reduction to local funding. Over £1million will be cut over the next 3 years. This has already led to a 10% reduction in health visitor jobs.
Clare Jones, a UNITE the Union representative in Brighton & Hove says, “ Health visitors and school nurses in the city are in shock over the scale of this budget cut and the fact that their services may be provided by a private company like VirginCare. They say there is no place for private profit in children’s health. This decision will have a huge impact on the health and wellbeing of every child in Brighton and Hove – Health Visitors provide the only universal service that visits every family in their home. Health Visitors and school nurses are specialists in children and family health, we are storing up health and social problems for the future, this is such a false economy.”
For further information contact Katrina Miller SDNHS mob 0775 238 0093
Thursday 15th September 2016
- Leading GP warns STPs are little more than “slash and burn”
The last week has seen a flurry of statements and revelations on the state of the NHS and the plans being developed behind closed doors for drastic action to hold back spending and avoid a “gap” of billions of pounds opening up by 2020.
Leading the charge has been Chris Hopson, Chief executive of NHS Providers, representing the trusts and foundation trusts that deliver front line care. He has been writing articles and giving interviews reiterating the point he has made before: that the NHS budget is insufficient to sustain the full range of services in every area.
If there is no relaxation of the rigid freeze in real-terms NHS spending that Tory-led governments have imposed since 2010 while the population increases and costs rise each year, he says, then services will have to be cut back to fit the budget.
Where Hopson’s warnings play into the hands of the right wing is when he calls not for an immediate halt to the spending freeze, but for a public “debate” on the future of the NHS.
We can predict that if any such debate were opened up it would inevitably be hijacked by well-resourced right wing organisations like Reform, and steered by those who seek to undermine the foundations of the NHS and open the way for charging patients for treatment, expansion of private provision and private insurance.
The same danger applies to calls for a parliamentary or other “commission” to debate the future funding of the NHS. For most of us there is no need for a debate, since it’s clear that funding the NHS through general taxation and delivering it free at point of use is the fairest and most efficient way – and this has been repeatedly confirmed by investigations since the 1950s.
But tax funding requires a government that is prepared to raise tax fairly and fund the NHS properly – whereas George Osborne in 2010 used the pretext of the financial crash caused by the bankers to impose a brutal austerity regime of cutting or freezing public spending. This is reversing the ten years of additional investment in the NHS from 2000, and squeezing Britain back down to among the lowest-spending countries on health care.
The problem is not the health care system, but the government and its political choices. And there is no sign Theresa May’s government is taking a different line on the funding of the NHS, although May might prove more reluctant to push through hugely unpopular cuts and closures, especially in key Tory areas, if there is evidence of local resistance.
This is why the plans – many of which include proposals to save money through “reconfiguration” (closing hospitals and ‘centralising’ services) – are being kept so tightly under wraps by NHS England.
Indeed Matthew Swindells, NHS England’s director of for operations and information, has revealed that drafts of all 44 plans were submitted in July, and he has seen them: but up to now only two relatively complete drafts have been published – for NW London and Shropshire.
These plans, along with many of the outline proposals seen by the recent report for 38 Degrees, talk at length about various worthy ambitions to improve public health and tackle inequalities – but in practice centre on achieving drastic efficiency savings, to stave off projected “gaps” between needs and resources, many of them reaching into hundreds of millions of pounds.
While some of these “savings” are expected to flow from a range of “innovative” proposals outlined in Simon Stevens’ 5 Year Forward View, the North West London STP draft makes clear that two thirds of the core savings are to come from old fashioned cuts – closing hospitals, centralising services, squeezing more “productivity” from already hard-pressed hospital staff, and dumping more unpaid tasks onto GPs and primary care services.
In a scathing critique of the emerging plans DrMark Spencer, a Lancashire GP and co-chair of the’ New NHS Alliance’, has argued that the much-vaunted Sustainability and Transformation Plans (STPs) are “more about slash and burn rather than transformation”.
“The more I read about STPs the more it becomes clear to me that many are a mile wide and only an inch deep.” Echoing campaigners’ critiques of plans to make savings by closing hospital wards “or even whole hospitals”, coupled with vague talk of “prevention and self care,” Dr Spencer warns that the plans offer only “sparse detail on the ‘how’ or the ‘who’”.
However he is convinced that the reason for this is “an almost complete lack of primary care input into putting those plans together”.
Again echoing the points made by campaigners, Dr Spencer questions whether huge volumes of additional work can simply be landed onto GPs:
“’GPs will do it’ would seem to be a much-repeated mantra. Really? STPs should be closely examined to determine the extent to which primary care was included.”
He also criticises proposals for new Multi- disciplinary Community Providers:
“Where are they going to come from? Where is the leadership? Where is the local ownership? Where is the buy-in from practices and frontline clinicians? A failure to take the local workforce along this journey will result in stagnation at best and a complete collapse at worst.”
What’s important in Dr Spencer’s partisan rant (as a GP wanting more GP influence over the 5-year plans) is that it emphasises the secrecy and exclusions of the STPs. They don’t just exclude GPs and primary care staff from the process: they also exclude hospital staff, and staff in community health services, and they involve bribing and bullying council leaders to force them into line, and ensure they sign up for plans that pile more pressure on overstretched social care services. And they exclude any engagement at all with affected communities or the wider local public.
Who’s in charge of the STPs? Who are they accountable to? These questions keep coming, as it becomes clear that these new structures have been deliberately created by NHS England to override the complex and fragmented commissioning bodies established by the 2012 Health & Social Care Act, and allow central control to drive through changes.
NHS England boss Simon Stevens has openly talked of STP leaderships as “combined authorities” that will use delegated authority from CCGs, trusts and councils to force through decisions that might otherwise be blocked by one or more of them.
Matthew Swindells has made clear that once the plans have been signed off by NHS England they will be translated into “contracts” and implemented. He makes no mention of any consultation with local communities – indeed he advocates simply ignoring the market system established by the 2012 Act:
“If you have a plan that works, go in it together and don’t let old-style contracting stop you from doing the right thing. We are looking to get all the contracts for the whole of the system signed off by December. …
“…. After that, you have a two-year contract and you have four years’ worth of implementation to deliver the trajectory, during which consultation will need to happen over some of the changes.”
Meanwhile most of the plans remain secret until they have been finalised – meaning that local people will at best be subjected to a pointless token ‘consultation’ on what will be a fait accompli.
That’s why STPs are important, and why they are an urgent issue in every area. That’s why campaigners will be meeting in Birmingham on Saturday at a conference convened by Health Campaigns Together to discuss what we know about STPs, and how best to challenge the process in each of the 44 “footprint” areas they apply.
Among those speaking at the conference will be Shadow Health Secretary Diane Abbott, who has responded to concerns by forcing an opposition debate in the Commons on STPs and the looming cuts. Watch this space: we will be doing everything we can to keep local services and stop short-sighted cuts and privatisation.
Monday 29th August 2016
- NHS bosses tell us things are going to get worse:
Come to our national Conference Challenging the STPs, Birmingham, September 17
A detailed report from NHS Providers, which represents NHS and foundation trusts, has underlined the seriousness of the financial bind that has been created for managers in front-line services by 6 years of virtually frozen funding.
Since 2010, the population has increased rapidly. Falling real-terms pay and tougher working conditions have created predictable staff shortages and forced trusts to use costly agency staff to fill vacancies, and costs have risen as well as demand for emergency and elective care: but real terms funding has barely increased at all. No wonder there is a growing affordability gap, and trusts are running deficits.
Now NHS Providers report that in Quarter 1 of 2016-17:
· the numbers of people waiting for elective treatment has reached a new record of 3.45 million;
· A&E attendances rose to a record 5.34 million, with A&E admissions up 6.4% on the same quarter last year.
· 112,000 patients waited longer than four hours on a trolley for a bed – up over 60% from last year.
· Calls to ambulance services increased by up to 15% -- but ambulance trusts could not meet performance targets for the most serious cases.
. On top of this bed occupancy levels are soaring above 90%: the system is at full stretch.
Trust deficits for Q1 were reduced to £461m, half last year’s record level at this stage – but only after millions were pumped in to the most successful trusts from the £1.8 billion Sustainability and Transformation Fund, which was supposed to pay for investment in longer-term transformation of services.
Once that money is exhausted, the NHS faces the grim reality of even meaner funding in 2017 and 2018, and real-terms cuts until at least 2020.
But NHS Providers warns that the apparent improvement this year is also misleading, since almost half of trust finance directors say they will not be able to keep up the level of savings they achieved in Q1 to meet tough targets and access a share of the £1.8 billion.
Things can only get worse – to reach the worst ever situation. As NHS providers say:
“We anticipate that the level of financial challenge will surpass any that individual providers, and the sector as a whole, has encountered in previous years.”
This results from a political choice, taken initially by George Osborne, and currently enforced by Philip Hammond as Chancellor, to scale down public spending in general, and reverse Labour’s decade of above inflation increases in NHS spending from 2000 that increased health spending towards the EU average.
Six years of avoidable, imposed austerity – along with billions wasted on bureaucracy of a complex and costly competitive market system as a result of Andrew Lansley’s 2012 “reforms” – has left the NHS on its knees. Massive cuts in funding for local government – which through social services is responsible for commissioning social care, from a motley network of under-funded private providers, have also made things massively worse for the NHS.
The key think tanks have been sounding alarms on this, while the right wing fundamentalists of course want charges for care, health insurance and other horrors of a US-style system. Now even prominent Tory MP doctors, Dan Poulter and Sarah Wollaston are urging Theresa May to consider new devices to raise additional tax revenue for the NHS, although any specific “health tax,” especially if raised from National Insurance would begin to undermine the core principle that the NHS is funded in the fairest way, through general taxation.
NHS Providers chief executive Chris Hopson has summed up the situation in stark terms. Even current levels of performance in A&E are now at risk:
“There is now a clear and widening gap between what the NHS is required to deliver and the funding available. There is now a fundamental mismatch between what is being asked of our emergency services and the resources they have at their disposal.”
The same could be said of mental health services, primary care, and community health services: for the NHS to stay within its inadequate budget, something has to give – and NHS England has recognised that to drive this process at local level a further reorganisation has been needed, establishing 44 new local area “footprints”, each of which is required to draw up a 5-year Sustainability and Transformation Plan (STP).
The Nuffield Trust, and now, following a report commissioned by 38 Degrees, the BBC and news media have finally highlighted the importance of this process – which Health Campaigns Together has been flagging up for the last six months. But there is still a lot more to come out: the process has been obsessively secretive.
Even the stolid management voice of the Health Service Journal is now urging NHS England to raise the shutters and publish draft STP plans that have been produced behind locked doors, but it many cases not even shared with the boards of trusts and CCGs or council cabinets.
So far, with speculation rife, only two of the detailed drafts have been published (North West London and Shropshire), while other leaks are either confidential copies, or relatively bland early drafts.
Indeed even the 54-page NW London STP, filled with extensive argument, (much of it in tiny 6-point type), skirts round one of the key proposals to balance the books – cutting beds and services at Ealing and then Charing Cross hospitals, bulldozing the buildings, flogging off part of each site, and replacing each hospital (if funding allows) with a glorified clinic with a few intermediate beds: total loss over 590 beds.
The rapid closure of Ealing is reduced to a footnote, and an added comment, emphasising for the first time that this is a way to save money, not as claimed previously a way of improving services.
All of the STP drafts that have emerged are also remarkably coy about the lack of any capital for investment in alternative services for the hospitals that are to be closed or downgraded; the HSJ recently pointed out this embarrassing weakness undermining the credibility of service “reconfiguration”.
There are plenty more nasty surprises for local people to be revealed as and when NHS England finally relaxes its rigid rule of secrecy. But in many areas it’s already clear that to cover claimed “gaps” between funding and health needs by 2020, STPs are pushing through plans for reconfiguration of hospital services – “centralising” A&Es, reducing local access, putting lives at risk.
Local NHS bosses have been bullied into signing up for cuts, realising they would be sacked if they refused: local councils have been bullied and bribed into compliance by the promise of additional funding for social care – with hefty strings attached – and the threat of losing out on funding if they refuse.
Too few council leaders have been prepared to speak out and stand up for their local communities. Ealing and Hammersmith have been bold exceptions to a miserable rule.
Every part of the country faces a major test this autumn and winter as a result of the ruthless spending squeeze. And with hard information a rare and precious commodity, it’s important for campaigners to collaborate together to build up a clear picture of the state of the NHS, the direction of Tory plans and the best way to fight back.
It’s now less than three weeks to the Health Campaigns Together conference ‘The Challenge of STPs’, in Birmingham on September 17. We called for this in the summer, before many people realised just how big the challenge was going to be.
Now the facts are beginning to emerge, health campaigners wanting to understand what’s involved, compare their problems and share lessons with others, and reach out to trade unions to build more powerful movements in defence of our NHS are urged to join us in Birmingham.
More details and registration HERE.
Wednesday 17th August 2016
Sussex defend the NHS
- ‘Planned failure’ at Royal Sussex claim campaigners
Today’s damning CQC report into standards at the Royal Sussex County Hospital in Brighton, placing the hospital in Special Measures is hardly surprising, say campaigners from Sussex Defend the NHS in Brighton.
The campaign points to years of underfunding, under staffing, low staff morale, cases of racial and sexuality discrimination and serious disconnect between senior staff and front-line clinicians and nurses.
A senior clinician at the Royal Sussex said that staff are working so hard despite government mishandling of reforms which have massively contributed to the crisis, underfunding as well as constant short-term changes at the top of the Trust. The list should include the effects of the government’s refusal to properly and safely modernise the junior doctors’ contract and the lack of effort by hospital management to support them.
Katrina Miller for Sussex Defend the NHS said, ‘Here we are again with a senior manager, Gillian Fairfield, offering heartfelt apologies and little else. Just like with Patient Transport Services, another of these overpaid super managers who should properly acknowledge their own responsibility and the government‘s failure and resign. It’s on her watch we’ve seen a culture of blame, harrassment and bullying develop with understaffing, underpaid and overstretched doctors, nurses and support staff. These are significant failures of management against too high a number of indicators and she should go.
You could think this is planned failure on the part of this government. What’s left of the national health service will be so bad, we’ll all rush off and buy private health insurance. And you can’t help but notice that in the massive and overdue development of the hospital which is being paid for by our taxes, a whole tower of new wards is only going to be available for private patients - Foundation Trusts are going to have to get nearly half of their funding from the private health sector as the government go on reducing their spend.
It’s happening quite stealthily: ‘Special measures‘ means that an ‘Improvement Director’ will be appointed to oversee the required changes to practices in the Trust. Monitor will also appoint one or more appropriate partner organisations to assist with the required planning and actions for improvements.*
We have noticed that even where such appointments appear to be from within the NHS, it turns out that many of these individuals have clear histories and connections with private management corporations, private financial organisations or giant health corporations. You can see which way the winds blowing.’
The campaigners say the crisis comes along with those in GP services, Patient Transport and we are about to see Children’s Services going the same way.
If you’ve had enough of all this and want to join the campaign, Sussex Defend the NHS stall will be at the Brunswick Festival this weekend in Brunswick Square, Brighton.
Monday 15th August 2016
Shropshire Defend Our NHS
- Shropshire’s NHS: Heading for Devastating Cuts
On Wednesday 10th August, the Governing Board of Shropshire Clinical Commissioning Group (CCG) took some shocking decisions. They nodded through NHS cuts that will harm frail elderly people, people with mental health problems, people with profound disabilities, and children with cerebral palsy. They didn’t say ‘cuts’, of course. They’re just ‘realising the potential for disinvestment’.
The planned cuts for this year include:
· axing a voluntary worker who worked on integrating services from health, social care and the voluntary sector;
· closing a crisis house in Ludlow for people with mental health problems;
· withdrawing funding from the handful of children with cerebral palsy who have intensive therapy at the Movement Centre in Oswestry (a recognised centre of excellence);
· closing Enable, a high quality specialist service helping people with mental health problems remain in employment;
· closing beds in a Much Wenlock care home that have been used to avoid hospital admissions;
· ending a service that provides proactive care to frail elderly people in care homes who are most at risk of hospital admission;
· ending a lifestyle physiotherapy service that has run for 8 years, is cost effective and well-used;
· stopping a Home from Hospital service that provides very practical help and personal care for patients following hospital discharge or requiring support to avoid hospital admission;
· ending a Moving and Handling service that provides support to the carers of older people with dementia or mobility problems;
· probably ending most pain management services in Shropshire and hoping that GPs will absorb the work;
· and ending a specialist service at Oak House that provides health assessment and intervention for adults who have profound intellectual and physical disabilities and sensory impairments.
There are also plans to privatise START, a service that provides a short term period of intensive assessment and support to people in their own home thus avoiding residential care.
Several other services associated with the flagship Integrated Community Services (ICS) will end. GP-based counselling services will probably end, although the decision on this has been passed to another committee.
All of these services will now be hastily considered by ‘Task and Finish Groups’, and the CCG wants to bring proposals back for ratification in September if it can. The policy approved by the CCG on Wednesday – a policy being implemented before it was agreed – states that decisions on whether or not there is a need for formal consultation can be made through an informal discussion with the Chair of the Council’s Health Overview and Scrutiny Committee (Councillor Gerald Dakin). Any other ‘engagement’ is deemed non-statutory and a matter for the CCG to determine. They could of course find themselves subject to legal challenge on a failure to consult.
Likely targets for cuts or privatisation next year include community rehabilitation for people who have had a stroke or who have other neurological conditions; the RAID mental health crisis service; and the Bridgnorth and Oswestry provision of DAART, offering multidisciplinary assessment, diagnostic tests and clinical treatments to keep patients out of hospital where possible, with care provided in the community.
The cuts proposed by the CCG are completely at odds with their stated priorities of shifting care out of hospital and providing ‘care closer to home’ instead.
This is crude firefighting, in response to a financial crisis caused by underfunding of our local NHS. Another national priority for the NHS is meant to be that mental health has parity of esteem with physical health – and that’s certainly not happening in Shropshire, given the level of cuts here to mental health provision.
There was almost no discussion in the Board meeting. There was no discussion of the individual services set to be axed, no discussion of the clinical consequences, and no discussion of the impact on the vulnerable people who rely on those services.
The GP members on the Board mostly sat in depressed silence, while senior bureaucrats, few of them with a clinical background, drove forward the cuts agenda. They talked about their deficit – and they forgot about the human beings who will be harmed by their cuts.
A representative of NHS England now attends meetings, because the CCG is one of two in the country under ‘intensive intervention’ because of the scale of its financial deficit. The intensive intervention on Wednesday consisted of telling the Board ‘You have difficult decisions to make over the next few weeks’, and ‘You have got to increase the pace at which you stop spending money’.
The Board members muttered and mumbled their way through the meeting, inaudible much of the time for a meeting that they are required to hold in public. You would think that with 25 or 30 members of the public there, Board members might have had the courtesy to speak up. Sadly not. Repeated reminders from members of the public that we couldn’t hear were simply ignored.
Several members of the public walked out in disgust, seeing little point in remaining. The only possible conclusion is that most Board members didn’t want to be heard.
It’s not possible to know the names of many of those who voted for the cuts, or what their job roles are meant to be. The Shropshire CCG website is hopelessly out of date on Board membership, the Chair is inaudible when he calls people to speak, and Board members don’t bother to introduce themselves (and wouldn’t be audible even if they did).
One member of the public had hoped to at least ask for the website to be updated – but questions from the public were arbitrarily disallowed at the end of the meeting to anyone who had raised earlier concerns on cuts. The grotesque lack of transparency will presumably continue.
The contempt for members of the public was matched only by the contempt for organisations providing the services that will be cut. Astonishingly, there was no advance discussion of cuts with most of these organisations – including Shropshire Community Trust, Shropshire Council, Age UK, and the Movement Centre based at Robert Jones and Agnes Hunt Hospital.
A few had phone calls the day before the meeting. Others found out from Shropshire Defend Our NHS. We’re glad we were able to let them know – but why on earth was the CCG incapable of showing this basic level of decency?
The manager of a threatened GP counselling service attended the meeting. When she spoke as an advocate for her service, her views were dismissed – and she was accused of using ‘emotive language’.
Several organisations, tipped off by us that cuts were on the way, had written to the CCG explaining the impact of proposed cuts on the patients they serve. They asked for the letters to be circulated to Board members, giving them at least some way of being heard. The decision from the Chair? The letters were withheld from the meeting, and will be circulated only with the minutes.
The CCG was already trying to cut services by £12.6m this year. They now want to add an extra £3.6m cuts, and Wednesday’s slash-and-burn exercise amounts to only a small part of this. No NHS service in Shropshire is safe.
The problem is one of funding. The NHS is half way through a decade of the most severe austerity in its existence, receiving far, far less in core funding than it needs. Shropshire faces a triple whammy: our share of national cuts, the discrimination against rural areas that’s built into national funding policy, and the underfunding of areas with an older population. There isn’t enough money coming into Shropshire’s NHS – and that’s why we are now facing devastating cuts.
Whatever the reasons, we can’t allow the most vulnerable members of our community to lose essential services.
Here are three things to do, if you live in Shropshire:
- Email Councillor Gerald Dakin, Chair of the Health and Adult Social Care Committee of Shropshire Council. Ask him to insist on full public consultation on these cuts, rather than letting them go forward unchallenged. His email is: firstname.lastname@example.org
- Email your MP. Point out the impact that these cuts will have on service users. Ask him to insist on proper public consultation – and to take up the catastrophic underfunding of Shropshire’s NHS. You might want to contact your councillor as well. You can find and contact MPs and councillors through the WriteToThem website: writetothem.com
Think about coming along to the next meeting of Shropshire CCG so that these people know that their actions are under scrutiny. We’ll publicise what’s happening in advance. We’re expecting the next meeting to be on the 14th September at the Royal Shrewsbury Hospital; we don’t have a time yet.
Read more ...
Wednesday 10th August 2016
- NW London publishes fuller Draft of STP
The most detailed glimpse yet of what a finished Sustainability & Transformation Plan might look like, a recent draft has been unveiled, raising the question of why the other 43 plans are not yet open to any public scrutiny.
Under pressure from campaigners and from Ealing and Hammersmith & Fulham councils, NHS bodies spanning eight boroughs in North West London, claiming the support of six of the eight borough councils, have finally published what must be at least Version 40 of their STP
An earlier, less complete draft at the end of June which was not published was numbered v 39: several pages left blank in that draft have now been filled with new material in a densely-packed, almost illegible 54-page document, much of it in tiny 7-point type or smaller.
Amid many vague aspirations to miracle public health interventions that almost instantly reduce hospital admissions and save tens of millions of pounds a year, the hard edge is the goal of closing upwards of 590 beds, and achieving savings towards a "gap" between resources and costs of health and social care estimated at £1.2 billion by 2021.
The savings now explicitly centre on the closure of the already part-dismembered Ealing Hospital, where maternity and paediatric services have been largely removed, followed by the closure of Charing Cross Hospital. When the Shaping a Healthier Future plans were first outlined to reconfigure hospital services in NW London, Ealing had 327 beds and Charing Cross 496.
Other documents have revealed that plans for expanding community health services, once depicted as the way in which hospital beds could be safely replaced, are no longer ranked as a priority in NW London. Indeed it is clear from statements from Simon Stevens that there is NO capital available for any major developments of alternative services.
This leaves the massive, unanswered question: how do the commissioners imagine the existing hospital services in Ealing and Hammersmith can be shut down to deliver cash savings between now and 2020 without triggering a massive further deterioration in performance in the remaining NW London hospitals, as took place when two smaller A&E units were closed in NW London in the autumn of 2014?
Nowhere in the 54 pages are there any concrete plans for how any alternative services might be provided, where the staff would come from, how they might be organised and managed, and how it could be paid for while delivering savings.
It's all literally fantastic: a work of wishful thinking rather than a plan. But meanwhile the run-down of Ealing Hospital continues.
- The plans may still be fantasy: but NHS cuts are starting to get real
Theresa May’s government is stepping up George Osborne’s programme of relentless real-terms reductions to NHS spending, to reverse Labour’s decade of expansion. And NHS chiefs are raising the pressure on hospital trusts, GPs and Clinical Commissioning Groups, demanding concrete plans for cuts to tackle monster deficits.
The Health & Social Care Act of 2012 made clear that the Secretary of State has no duty to provide health services: so the cuts and privatisation that are taking shape are being done by ‘remote control’, through Simon Stevens and NHS England, under the approving eye of Jeremy Hunt.
This is why since Christmas Stevens and NHS England have carved England into 44 “Footprint” areas in which the “local health economy” of NHS trusts, CCGs and local authorities are required to work together rather than compete.
However this is no enlightened reintegration to scrap the competitive market. It’s a desperate effort to cut the deficit, balance the books and “transform” services – collaborating in secret, to develop Sustainability and Transformation Plans (STPs), which must all be vetted, and may be changed, by NHS England.
It’s NHS England’s way to assert central control, to speed the implementation of the policies outlined in Stevens’ Five Year Forward View. Alongside the rapid development in each “Footprint” of 5-year plans to bring the NHS back within budget, more tangible, painful cuts are already taking shape.
This very quest for “sustainability” is now threatening services. As a recent report by the King’s Fund on trust deficits argues:
“The scale of the aggregate deficit makes it clear that overspending is largely not attributable to mismanagement in individual organisations – instead it signifies a health system buckling under the strain of huge financial and operational pressures. The recent strategy of driving efficiencies by cutting the tariff has placed disproportionate strain on providers and is no longer sustainable.”
The same report goes on to warn that: “cuts in staffing and reductions in quality of care are inevitable if the government’s priority is to restore financial balance”.
Right on cue Stepping Hill Hospital in Stockport, with a deficit of over £40m, is closing 30 beds, cutting 350 staff and selling off part of the site to cut costs and raise short term cash; trust managers argue that this is in line with plans for other similar trusts.
Just down the road East Cheshire NHS Trust, delivering acute and community services, has declared it is not sustainable in its current form.
And in a nasty echo of the bad old Thatcher era of cuts in spending from 1985, the chief executive of the Care Quality Commission has argued that he prefers cash-strapped trusts to let waiting times increase rather than reduce the quality of care. Not long ago long waiting times were themselves a measure of poor quality.
In another blast from the 1980s St Helens CCG has now resorted to a complete 4-month halt to all non-urgent referrals to local hospitals, reducing services to emergencies only.
Across the country trusts are repeatedly missing targets for prompt treatment of A&E patients – with performance often worst for the more serious Type 1 patients, who need admission to a bed.
However the regulator mis-named ‘NHS Improvement,’ now obsessed with the effort to wipe out deficits, has discarded any pretence of concern for quality of care, and announced that staffing wards at more than the bare minimum of 1 nurse per 8 patients is not affordable, warning that trusts with higher staffing levels may have to cut back as a condition of extra funding.
NHS England, meanwhile, has announced a fresh drive to “reset” the finances. The main components of the “reset” are:
- Pumping in £1.8m of additional cash in a one-off effort to clear deficits;
- Setting tight financial cash limits for every trust and CCG;
- Even tighter controls on use of agency staff;
- national action to implement Lord Carter’s recommendations for savings in procurement and “back office” teams;
- Setting up another team within NHS Improvement to promote efficiency improvement
- Programmes in each STP to increase efficiency through “transforming” services.
But big savings require big cuts. Section 4 of NHS England’s Reset plan argues that hospitals and services which now depend on locums and agency staff need to be closed and centralised in “nearby” larger units.
“By the end of July STPs should have reviewed services which are unsustainable for financial, quality or other reasons […]. They should have developed plans to re-provide these services in collaboration with other providers to secure clinically and financially sustainable services, both for 2016/17 and for future years.”
Despite the fine words about “transformational efficiency” it’s plain that NHS England is primarily resorting to old fashioned cuts to balance the books.
Trusts are being squeezed by CCGs, and in turn have to shed staff and squeeze down on prices they pay to suppliers and agencies.
In many areas – Cumbria, Calderdale, Oxfordshire, Lincolnshire, Devon, North West London, Bedfordshire, Essex, and more – the most vulnerable targets are A&E units, or smaller hospitals that are to be sacrificed on the altar of “sustainability.”
However little has so far emerged from the 44 “Footprint” areas: the details of the STPs have so far been kept firmly under wraps.
The completed documents may have little more of substance to offer than early sketchy drafts. They could yet be a diversion from the actual cuts at trust and workplace level.
The recent publication of at least the 40th version of the North West London STP Plan announces a renewed determination to drive through the closure of Ealing and Charing Cross Hospitals, based on plans debated since 2012 – now openly seen as a way to save money.
However the rest of the 54 densely-packed, chaotically-presented pages in tiny type, indicates that while the volume of paper consumed has increased, management thinking remains stuck in the realm of fantasy.
The same old assertions that have been around for well over 20 years are again embraced by desperate NHS managers –despite the absence of evidence that they can deliver the promised results. The STP shows a semi-religious belief in the effectiveness of prevention programmes to produce rapid improvement in public health. Trendy new apps and digital devices are expected miraculously to keep frail older people out of hospital, and the answer to any problem is seen as paying management consultants to draft another document, or strategy.
It’s a wish-list more than a plan.
However amongst the incantations and pious hopes there is also a commitment in the NW London STP to create “Accountable Care Partnerships” along the lines of the US-style Accountable Care Organisations proposed by the Five Year Forward View.
These would be provider organisations which would work for a fixed budget to cover a defined population. It’s a risky business. In the US private health insurers have homed in on with these, but lost money – despite much higher levels of health spending. Similar NHS “lead provider” projects covering older people’s services in Cambridgeshire and cancer care in Staffordshire have seen private sector bids withdrawn, and the Cambridgeshire plan collapsed for lack of adequate funding.
Nonetheless NHS Improvement have clearly declared their intention to push for much more private sector “partnership” and involvement in local “transformation” plans. The STPs are vehicles to open up contracts for possible privatisation or outsourcing as well as cuts.
With Labour largely silent on this, the only questions seem to be coming from a few local authorities. Councils are being roped into STPs, bribed by pitifully small additional sums towards their meagre social care budgets, then bullied by threats that this could be withheld.
Council leaders are being pressured to sign up in support of STPs without seeing or studying the full document – and many are doing so.
However one or two are standing firm: Hammersmith and Ealing councils in North West London have bravely refused to sign up for an STP which threatens hospitals in their boroughs, and saddles them with even more under-funded responsibilities.
Northamptonshire’s Tory-led county council, facing £60m of cuts, has announced it will cut funding for social care, including support for discharging patients from Northampton and Kettering hospitals.
In Warrington, the chief executive of the Labour-led borough council has spoken out against NHS “naïve” attempts to drive through STP plans without proper consultation, describing them as a “recipe for disaster,” and warning that there was little sign of partnership in the relations between NHS and social care.
Whether it’s STPs, old-fashioned cuts, or the privatisation offensive that is the greatest concern, every part of the country faces a major test in the autumn and winter as a result of the ruthless spending squeeze.
Health campaigners wanting to understand what’s involved, compare their problems and share lessons with others, and reach out to trade unions to build more powerful movements in defence of our NHS are urged to join us at the Health Campaigns Together conference ‘The Challenge of STPs’, in Birmingham on September 17. More details and registration here
Tuesday 19th July 2016
In the post Brexit political free-for all it’s a nightmare scenario for the NHS.
Services were already struggling to cope with rising demand on a budget which falls each year to 2020 in real terms value and as a share of national wealth (GDP).
Nonetheless it seems that – however much rhetoric there may be about the importance of public health – there is no imminent prospect of the extra funding that’s needed either for health care or for the "proactive measures" to improve public health that Simon Stevens keeps on talking about, as things get worse.
Instead there’s just huge economic uncertainty ahead.
The financial squeeze on the NHS flows from the decisions of the Cameron government back in 2010: George Osborne chose the path of austerity and cutting all public spending. He opted to cut the NHS covertly through a 10-year virtual freeze, designed to unpick the previous 10 years of increased spending – while claiming NHS spending was “ringfenced” from outright cuts.
There has never been any sign that the new Prime Minister, Theresa May, in any way dissented from this approach. Nor is there any sign that her chosen Chancellor Philip Hammond, who established a brutal reputation when he was a Treasury minister for driving through cuts, will substantially change Osborne’s approach.
To make matters worse, the Brexit vote is already undermining the ability of NHS employers to recruit health professionals from the EU, who fear that they may not be welcome or secure in the UK.
Since the referendum May herself has refused to guarantee that EU nationals working here would be able to stay following the Brexit vote: that potentially includes the 130,000 or more which Simon Stevens estimates are already working in the NHS, as well as many more in other jobs.
May as Home Secretary was an enthusiastic advocate of tighter limits on immigration: her notion of a ‘one nation’ approach appears to mean excluding people with origins in other nations.
In the midst of her major reshuffle, Health Secretary Jeremy Hunt appears to be almost unique in holding on to his post – despite, or perhaps because of his stand-off with the junior doctors. May’s decision to leave him there signals no retreat from the imposition of a contract which the junior doctors have overwhelmingly rejected.
With continuing fears of recession, there had been talk even from Osborne of freeing up infrastructure spending, but no hint of easing spending limits on health or local government, which is responsible for social care. Hammond is likely to be as mean-spirited.
However it’s not just the health budget feeling the squeeze: social care has been slashed year by year since 2010. With more people living longer with more complex needs, they need social care – and councils are running out of ‘efficiencies’.
The latest survey of all councils in England from the Social Services directors (ADASS) says they have to make further reductions of services of £371m for people needing care – and for their carers. This follows five years of funding reductions totalling £4.6bn, almost one third of real terms net budgets.
The proportion of social care savings expected to be raised from efficiencies has fallen from 75% last year to 55% in 2016/17 whilst outright cuts in services have increased from 18% to 39%.
ADASS argues that there are now “next to no further efficiencies to be made from squeezing provider fees paid, or raising income from fees and charges to customers”.
Half the cuts will come from older people and almost 20% from personal budgets – a scheme dear to the heart of NHS England boss Simon Stevens.
Only a third of social services chiefs were confident they will even be able to meet their statutory duties this year.
All this is bad news for the NHS service users, because most NHS new models of care and hopes for savings through ‘integration’ of services depend on social care: but it’s even worse news for service users.
But big savings are still very much on the agenda on NHS budgets too.
Since just before last Christmas the new mechanism to drive cuts has been Sustainability and Transformation Plans (STPs), which have to be drawn up in each of 44 ‘footprint’ areas across England .
Each STP is required to seek new cuts & “savings” to bridge improbably huge gaps between projected needs and available resources by 2020.
Each plan has to be checked by NHS England, whose boss Simon Stevens has initiated this latest top down reorganisation, hoping to ride roughshod over the structures put in place by the 2012 Health & Social Care Act to impose much more centralised control.
Stevens was reportedly planning to invoke David Cameron’s support in pressing for financial discipline had EU referendum gone against Brexit: but since the vote the central pressure for savings is continuing.
This is made more urgent by the latest revelations that despite extensive “creative accounting” reducing overt deficits by £900 million, the underlying deficit of trusts and foundation trusts last year was £3.7 billion.
Despite hugely ambitious savings targets, the most optimistic forecast for this year is a total trust deficit of £500m. NHS Improvement has responded by demanding trusts implement another £250m cuts.
And as this update is drafted NHS England has called for limits on spending on clinical staff – shocking Royal Colleges. NICE guidelines for safe staffing targets have been effectively discarded, with trusts told they need no longer invest to meet CQC or Royal College guidelines. Struggling trusts which have staffing of more than 1 nurse per 8 patients will be told this can no longer be afforded.
Trusts which appear to be making insufficient savings on “back office” services will be forcibly paired up with other trusts by NHS improvement. The heat is on.
So far there is precious little information on the content of many STP plans. First drafts of all 44 plans – drawn up in secret, with only the blandest generalities published – were apparently submitted to NHS England at the end of June, according to the HSJ, which also reports that it is unclear when – or if – all the plans will be made public.
Behind the scenes there are huge efforts to strong-arm and bribe local authorities to sign up to plans that cut local health care, persuaded by the offer of a token handout of NHS cash to social care budgets.
Many STPs have plenty to keep secret about: they centre on significant, controversial service reorganisation. More and more A&E units and other services are again at risk throughout England, threatening local access for communities.
Plans to axe services at Bedford Hospital for example would mean that the nearest hospital would be 19 miles away: patients are being offered the “choice” of providers up to 50 miles away. STPs offer the chance to override local concerns and impose cuts regardless of opposition.
But the cuts will of course run alongside privatisation: an NHS England director has also promised a conference of the right wing Reform think tank that STPs will offer plenty of opportunities for the private sector to get into contracts for estates management and new models of care.
So the Keep Our NHS Public campaigners that have renamed STPs as “Slash, Trash and Plunder” are spot on, and campaigners need to join with trade unions to address the danger of STPs and coordinate a response wherever possible.
That’s why Health Campaigns Together has established an STP Watch page on its busy website, and organised a national conference in Birmingham on September 17, which will bring together information and experience and attempt to map out solutions.
We need to get together to weather the new, dangerous period for the NHS. I hope readers and their organisations will support HCT, come to the conference, share info on STP Watch – and help us build the strongest possible resistance.
Tuesday 31st May 2016
- STP process will "pool sovereignty" to force through unpopular cutbacks.
NHS England has designated 44 “footprint” areas to cover England, in which for the first time since the 1990s commissioners (purchasers) are required to collaborate with the providers – in drawing up 12-month and 5-year “Sustainability and Transformation Plans” (STPs) to “transform” services and balance the books.
However it’s clear that both concepts – collaboration and balancing the books – have largely lost any currency in key areas of the local health economy. According to the Health Service Journal, NHS England Chief Executive Simon Stevens has also now insisted that within each of these areas trusts have to make much bigger “savings” than some have been planning. They will not be able simply to ignore “control totals” set for them by NHS regulators without incurring financial penalties.
But this may not be enough to force through the scale of changes required to balance the books across the NHS, since it’s clear that current plans are headed for a further deficit in 2016-17, despite huge pressure to find ways to break even.
So in addition Stevens has decreed that where there are controversial decisions to be made (notably over “the disposition of hospital services”) there could be a “pooling of sovereignty” between trusts and CCGs, to establish “combined authorities” with powers to overcome any potential “veto” or resistance to planned cuts or closures.
The purpose of this is much more sinister: this is the old technique of taking controversial decisions as far away from local communities as possible, so that there will be little if any accountability or engagement with communities who face the loss of local access to hospital or other services.
The STPs allow for no public consultation, and sideline both the CCGs and the Trusts, which do have an obligation to consult on changes of service.
This is clearly creating a new mechanism to do unpopular things at great speed with NO local accountability or consultation.
STP plans are to be finalised in the summer and implemented from October – whether local people agree or not. The plans for this are being hatched up now behind closed doors. They will be sent to NHS England by June 20.
But in the “footprint” areas they will be taken forward by a closed cabal of senior figures. This can be seen from documents published by Cambridgeshire CCG, the STP Governance Framework at the May meeting of the CCG Governing Body. This reveals the draconian powers being handed to the STP leadership.
The process will be driven by a newly-created Health and Care Executive (the ‘Executive’), to be made up of the ‘partner’ organisations which are jointly responsible for delivery of the Programme – local CCG(s), Trusts, Foundation Trusts and councils with social service responsibilities.
Since legally decision making remains with each organisation until or unless authority is delegated to the Health and Care Executive, all decision-making across the Programme will therefore be taken under a “Scheme of Delegation” in which the various organisations effectively empower individuals in advance to act on their behalf. But the councils will have no vote, despite being tied in to decisions that are taken.
“The partner organisations will participate in the decision making processes of the Executive to the extent that they are delegated authority by their respective organisations. The Councils participate as non-voting members of the Executive.”
Since this is to be an executive body, able to take decisions binding the various “partners”, attendance at the meetings is ‘mandatory’, and any member of the Health and Care Executive who cannot attend may appoint deputies to represent them at Health and Care Executive meetings. But significantly, in the event a deputy is provided,
“The individual(s) must be fully briefed prior to the meeting and would be expected to have the same delegated authority to commit resources on behalf of their organisation as the named committee member would.”
The element clearly lacking from this new structure is any consultation with the local public – or with staff. The legal basis of this has now been challenged by shadow health minister Justin Madders, writing in a blog that:
“I have asked a number of Parliamentary questions about the footprints and some of the few facts these have revealed include that the footprints and leadership teams do not have legal status or legal duties and will not have the ability to borrow.
“This means that if these bodies do come to the conclusion that certain local services will have to go as part of a blueprint, there may be no public consultation on such decisions and no formal mechanism to challenge them."
It seems that in some areas the possibility of a judicial review of the new arrangements is being considered.
The STP process, forcing hospital closures and cutbacks in services, is undemocratic, unscientific and in many areas unsafe. It must be stopped before it’s too late.
Local MPs, and councillors from all parties should be challenged to take a stand on the plans that are being drawn up and implemented: already one Tory MP has organised a (timid) protest demonstration to oppose a threat to a local A&E service.
Local health unions and professional bodies in every area must also demand a voice on what is being done to the services in which their members work.
Local communities must be alerted, and demand their voice be heard, their access to health care protected, and NHS funding increased to the levels needed to meet the demands of the future.
Simon Stevens seems to believe that if the NHS is driven hard enough in ways that ignore and override the Health & Social Care Act, he can pretty well do as he likes. There is no sign of any ministerial challenge to this view. It’s up to campaigners to prove him wrong.
Tuesday 24th May 2016
- STPs mean express NHS cuts with no consultation
The financial stranglehold of George Osborne’s austerity squeeze – designed to reverse all of Labour’s decade of increases in NHS spending by 2020 – is now tightening on the NHS.
We are in the sixth year with a budget virtually frozen in real terms, and falling in relation to rising pressures since 2010. Trusts are expected to reveal a minimum of £2.7bn deficits from last financial year – and must implement measures this year to drastically rein in spending, and establish “financial balance” next year.
With acute trust deficits averaging a staggering £15m, this level of savings cannot be achieved in most areas without painful cuts: and with key performance targets already being missed, longer waiting times, and a worsening crisis in mental health services, any new spending cuts are likely to further undermine the quality and effectiveness of the NHS.
David Bennett, former chief executive of the regulator Monitor, is only the latest leading figure to highlight the fact that NHS spending is “about two thirds of the average of comparable health services elsewhere.” As a result, the ability of the health service to drive through further savings on the level required is in question. Leading US systems advisor Don Berwick has also pointed out that running a universal service on just 7 percent of GDP is an “experiment”.
Chris Hopson, chief of the trusts’ body NHS Providers has warned that without more money up to 50 hospitals could have to close.
The trusts are indeed expected to carry the vast bulk of the burden of achieving the colossal £22 billion of savings which NHS England chief executive Simon Stevens set as a target by 2020.
NHS England has now declared that up to £15.3 billion of that total is to be squeezed from front-line trusts – with £8.6 billion in increased “productivity”, and £5.7 billion from “demand management” measures that aim to cut trusts’ caseload (and income) by restricting use of services.
Most “demand management” policies are notable for the lack of any evidence of their effectiveness so far – with emergency admissions still increasing in number across the country, despite repeated assurances that they would begin to fall.
However the measures that do restrict demand are the explicit rationing measures and exclusions of some specialist services such as IVF treatment, and ever-tightening restrictions on elective treatment including cataract, joint replacements, hernia and other non life-threatening conditions.
This is designed to push some people with the means to do so to pay for private treatment rather than wait until their condition becomes an emergency, or severe enough for the NHS to take action. This in turn undermines the NHS, promotes inequality and leaves many with the greatest needs unable to access care.
Most of a further £6.7 billion “savings” is expected to come from more years of real-terms pay cuts for long-suffering NHS staff. This has been imposed nationally by the decision of George Osborne, and is one of the factors underlying the junior doctors’ dispute – but has an increasing impact on the ability of trusts to recruit and retain medical, nursing and other professional staff.
Of course where they have gaps in key frontline staff, the trusts are then driven to bring in agency staff – even while NHS England is trying to cap their spending on this and squeeze down agency rates. Meanwhile the staffing crisis remains unresolved.
Balance the books
The “savings” required are truly massive. So the immediate agenda in almost every area is cuts to bring spending back into balance – coupled in some cases with the use of skilled external accountants who will advise on how best to cook the books to minimise reported deficits and maximise apparent income.
A new regime is being imposed to drive this increasingly urgent agenda. NHS England has begun overriding the Health & Social Care Act which established over 200 Clinical Commissioning Groups as the main commissioners of care.
Instead NHS England has imposed a new, unilateral and top down reorganisation, carving England into 44 “footprint” areas, in which for the first time since the 1990s commissioners (purchasers) are required to collaborate with the providers – in drawing up 12-month and 5-year Sustainability and Transformation Plans (STPs) to “transform” services and balance the books.
Simon Stevens has also now insisted that within each of these areas trusts have to make much bigger “savings” than some have been planning.
Forcing through unpopular decisions
In addition he has decreed that where there are controversial decisions to be made (notably over “the disposition of hospital services”) there could be a “pooling of sovereignty” between trusts and CCGs, to establish “combined authorities” with powers to overcome any potential “veto” or resistance.
Older observers, perhaps nostalgic for earlier organisational structures, will see the STPs as a resurrection of the old “Area Health Authorities” established in the 1970s, long before the competitive market and putting services out to tender were even thought about.
But these are not going to be kindly, collaborative bodies.
The purpose is much more sinister: this is the old technique of taking controversial decisions as far away from local communities as possible, so that there will be little if any accountability or engagement with communities who face the loss of local access to hospital or other services.
Footprints = cuts
In practice all 44 “Footprints” and their STPs mean cutbacks and bed closures, as shown by the STP planning to cut 500 beds in North West London – equivalent of at least one of the two hospitals (Ealing and Charing Cross) targeted for closure in long-running controversial plans.
Not every Footprint will focus on bed reductions or hospital closures, but many will. Each STP will vary slightly in form, but each of them will need to make significant changes, and make big reductions in services if budgets are to be balanced by the end of next year.
Some of these reductions involve long and painful journeys. Plans have just been published for the merger of Peterborough & Stamford Hospital, floundering in unpayable PFI debts, with Hinchingbrooke Hospital – which is22 miles away, and still reeling from the deficits left behind after its period disastrously managed by Circle.
There’s fresh talk of reconfiguration of services between Bedford and Milton Keynes Hospitals – 18 miles apart – with discussion of using services up to 58 miles away.
Similar plans for long-distance “reconfiguration” and centralisation of A&E services are being drawn up in many other areas. Chris Hopson has queried the need for separate A&Es “as little as 14 miles apart” – but not explained how patients are supposed to access more distant hospitals.
The STPs – which allow for no public consultation, and sideline both the CCGs and the Trusts, which do have an obligation to consult on changes of service are clearly a mechanism to do unpopular things at great speed with NO local accountability or consultation.
They are to be finalised in the summer and implemented from October, whether local people agree or not.
The plans are being hatched up now behind closed doors. They will be sent to NHS England by June 20.
Opposition – at last
At last we have a vocal challenge to this steamroller of cutbacks from Labour’s ranks with junior shadow health minister Justin Madders writing in a powerful blog that:
“I have asked a number of Parliamentary questions about the footprints and some of the few facts these have revealed include that the footprints and leadership teams do not have legal status or legal duties and will not have the ability to borrow.
“This means that if these bodies do come to the conclusion that certain local services will have to go as part of a blueprint, there may be no public consultation on such decisions and no formal mechanism to challenge them."
The gloves are off: straight after the Referendum, the NHS will become embroiled in a cuts and reconfiguration frenzy that will hit almost every part of the country.
Campaigners need to be ready: threatened hospitals and services that are not actively defended could be axed.
Split the Tories
We need to undermine the government will to drive through the austerity agenda. We have to force more splits in the Tory ranks, to pile pressure on Tory MPs whose local hospitals are under threat.
If promising signs of active Labour Party engagement on this bear fruit, it could mean we can build really strong, united local campaigns: we have to stop these cuts, and demand an end to the austerity squeeze on the NHS.
We must insist that any cost savings are based on scrapping the costly and wasteful market system created by Andrew Lansley, which wastes upwards of £5 billion a year – not on bed closures alongside worthless promises of ‘alternative’ services that are unproven and lack any real resources.
A universal health service like the NHS should be cannot be delivered on Osborne’s meagre funding of 7% of national income (GDP) or less: we must demand a reversal of the cuts that have forced us into this situation, and push spending back up as a share of GDP to at least the level achieved in 2010.
A campaign linking campaigners, unions and the Labour Party could build into a mass movement to defend our NHS and roll back privatisation and the wasteful market. It’s a winner: let’s back it!
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Sussex health campaigners
- Sussex campaigners join together to challenge new quango on health plans
For the first time in their campaigns to save our NHS, health campaigners from across Sussex have joined together to send an open letter to the Chair of the new Sustainability and Transformation Plan group, Mr. Michael Wilson.
The groups, from Brighton & Hove, Worthing and Crawley are planning as much publicity and information as possible across the whole of Sussex about how these plans effect the end of a national health service in England. They would appreciate wide publication of the letter in full :
Dear Michael Wilson,
We are writing to register our major collective concerns about the Sustainability and Transformation plan and the role you have taken up in implementing it in our region.
As you are no doubt aware there is considerable public concern about this Plan. Campaigners nationally find it highly suspicious that the exercise in most parts of the country is veiled in almost total secrecy. This Plan has been imposed by NHS England at the behest of the government with no parliamentary approval and no national or local consultation whatsoever. In West Sussex the issue has been raised so far with Coastal West Sussex CCG and in East Sussex with the HWB and will be raised with Brighton and Hove CCG on the 24th of this month. However despite attempts to elicit information, general ignorance of the true implications is being professed on all sides, although your report presented to the West Sussex HWB is at least open about possible risks and difficulties.
The major upheaval which will be caused by this Sustainability and Transformation plan will be hitting local populations around England by October this year (with detailed Plans and budgets submitted by the end of June). Local residents must not be kept in the dark by lack of public information; we urge you to make details of this plan, and the consequences thereof, available publicly.
We also have very big questions round the finances of this deal. We understand that within the local “footprint” health and social care budgets have to be brought to “aggregate financial balance”. You have made clear in your report to the West Sussex HWB the almost unimaginable enormity of the shortfalls involved - £580 million – with even that “ likely to be an underestimate of the true gap” due in part to decreases in Local Authority funding with consequent cuts to Social Care and Public Health. We note furthermore there is no mention of the regional portion of the “savings” of £22 billion in the NHS by 2020 required by the Carter report nor the budget surplus which all regions have to demonstrate.
You will not be surprised to learn that we intend to publicise these figures as widely as possible. You will be fully aware, as are we, what this order of budget reduction across the ‘footprint’ will entail for NHS and social care services across our region. An honest response by your Trust and all the other Trusts involved and all STP Boards across England would be to say “this simply cannot be done – it can only result in the catastrophic undermining of the National Health and social care services”.
We have a number of specific questions which as citizens very much affected by the outcomes of STP we ask in the spirit of “open, engaging and iterative processes” of consultation which have thus far been shamefully lacking on the parts of all those involved in developing the regional “footprint”.
What is the membership of Sussex and East Surrey Board? How many lay members are there? How many trade union/staff side health workers?
What is the legal status of the Board? As presumably the constitution is available for public view, please provide the electronic link to it.
What is the chain of accountability?
How often does the Board intend to meet? Can you confirm that the meetings will be publicly advertised in advance and there will be public access to them?
Where will the agenda, board papers and minutes be made available to the public?
As Healthwatch has been invited to put forward patient/public views how have you informed the public of this and what measures have been taken to elicit such views?
What impact assessments have been carried out in relation to the operation of the Plan?
We realise that this Plan is the implementation of the government’s massively accelerated devolution agenda which has been forced on to the whole of England with virtually no negotiation and in what, by any standards, is a ludicrously tight timescale. You will be as aware as we are however of the probable consequences for our national health service and the public outcry when the consequences become evident.
Such massive change with such far-reaching negative consequences cannot be ushered in “on the quiet” in the hope no-one will notice as the government, NHS England and all those doing their bidding appear to intend. We, the public need to know and very quickly what STP truly represents and the long-term consequences for all our and our childrens' lives.
With enormous concern,
Sussex Defend the NHS; Coastal West Sussex 38 degrees NHS Group; Crawley and District Keep Our NHS Public (covering Crawley, Horsham, Redhill and Reigate); Don't Cut Us Out (Worthing); Brighton and Hove Trades Council.
Madeleine Dickens from Sussex Defend said, ‘ You have to look at the bigger picture: the government is breaking up the NHS into these financially self-managing regions with impossible targets on debt so that the only way of financing our health services will be a US-style personal insurance system. All the evidence is clear: the US has one of the worst public health systems in the world. These people are collaborating with the wrecking of our NHS which was the best system in the world. They should be ashamed.’
Sussex Defend the NHS are organising a sustained campaign to publicise and expose the Sustainability and Transformation Plan development. There will be a demonstration tomorrow outside Tuesday’s CCG Governing Body meeting from 1230 at the Brighthelm Centre in North Road Brighton. Everyone is urged to come along to make some noise. Sussex Defend campaigners will be asking some challenging questions of the commissioners about the impact of these NHS break-up plans.
The campaign is part of a nation-wide network of campaigns against STP. 38 Degrees have set up an online petition against this break-up and sell-off of the NHS which you can sign here:
Sussex Defend the NHS can be contacted at:
Finally, early alert to Sussex Defend the NHS’ next Public Meeting, Our NHS ... Going, going .... Thursday June 30th 7pm with national speakers and campaign planning. Details shortly.
Join the demonstration at The Brighthelm Centre outside the CCG Governing Body meeting on Tuesday 24th @ 1230.
For more information and interviews contact
- Katrina Miller mob 0775 238 0093
- Madeleine Dickens mob 07875 892 580
- Jan Birtwell Coastal West Sussex 38 degrees NHS Group 07565348647
Monday 23rd May 2016
Sussex Defend the NHS
- Local health services in Sussex: more devastation to come.
Complete re-organisation of health service on its way
Remember when David Cameron promised ‘no top-down re-organisation of the NHS’? All that was made completely untrue by the present government’s 2012 Health & Social Care Act. In Brighton & Hove since then we’ve seen the effects of the break-up and sell-off of our health services from Substance Misuse to Patient Transport Services, GP surgeries to Audiology.
Now, the ‘national’ is finally to be struck from what’s left of our health services as the government implement the next stage of their privatising plans.
These are Sustainability and Transformation Plans being stealthily drawn up in new regions around the country. Brighton & Hove comes under Sussex and East Surrey STP along with West Sussex Coastal and the other CCGs covering the whole of the two counties.
In his presentation to West Sussex Health & Wellbeing Board’s last meeting, Michael Wilson, the Chair of the new STP group drawing up our Plan, exposed the massive £580m shortfall that they are going to have to ‘balance’ in order to achieve the targets set by the government.
On Tuesday next week, 24th, Brighton & Hove CCG Governing Body will be discussing the same framework. If the commissioners collude with this plan, they will be enforcing even more devastating cuts to our health and social services across the city. And only a few people know about the steamrollering of these plans.
Madeleine Dickens of Sussex Defend the NHS and campaign groups in West Sussex have written to Michael Wilson demanding clear democratic involvement in this planning saying, ‘Such massive change with such far-reaching negative consequences cannot be ushered in “on the quiet” in the hope no-one will notice as the government, NHS England and all those doing their bidding appear to intend. We, the public need to know and very quickly what STP truly represents and the long-term consequences in all our and our children’s lives.’
Sussex Defend the NHS are organising a sustained campaign to publicise and expose the Sustainability and Transformation Plan development.
There will be a demonstration outside Tuesday’s CCG Governing Body meeting from 1230 at the Brighthelm Centre in North Road Brighton. Everyone is urged to come along to make some noise. Sussex Defend campaigners will be asking some challenging questions of the commissioners about the impact of these NHS break-up plans.
The campaign is part of a nationwide network of campaigns against STP. 38 Degrees have set up an online petition against this break-up and sell-off of the NHS which you can sign here:
Sussex Defend the NHS can be contacted at:
Finally, early alert to Sussex Defend the NHS’ next Public Meeting, Our NHS ... Going, going .... Thursday June 30th 7pm with national speakers and campaign planning. Details shortly.
Join the demonstration at The Brighthelm Centre outside the CCG Governing Body meeting on Tuesday May 24th @ 1230.
For more information and interviews contact
Katrina Miller mob 0775 238 0093
Madeleine Dickens mob 07875 892 580
Jan Birtwell Coastal West Sussex 38 degrees NHS Group 07565348647
Read more ...
Shropshire, Telford and Wrekin Defend Our NHS