Monday, 20 November 2017

Chorley A&E must not go the same way as Burnley

At the October health scrutiny meeting  I note there were no 'matters arising' from the previous health scrutiny meeting held in September. Why aren't councillors raising questions about the STPs and querying why we're still waiting for doctors to re-open Chorley & South Ribble A&E full time?

The Lancashire Teaching hospital NHS trust didn't attend Octobers health scrutiny meeting since apparently NHS Improvement had a very important meeting with them. I think we can all guess what that was all about - all queries on a postcard to the LTHT trust since they don't allow the public to speak at their meetings. I wonder what's to hide?

Watching the 'webcast' (link below) for October's Health scrutiny meeting I couldn't help but notice the North West Ambulance Service (NWAS) representative mention the 999 call-centre advisors are occasionally obliged to remain on the phone and this was taking up valuable time. The thought occurred the reason for this is because many A&E's/Hospitals are running over-capacity resulting in ambulance crews being unable to get back on the road and attend other incidents? It's not rocket science is it?

Handover breaches are a 'clear indication' of a failed system

The figures for last year show a huge increase in serious Ambulance handover breaches (> 60mins) when Chorley A&E closed. Patients had to be taken to the Royal Preston hospital and any hospital nearby. Wigan saw a huge increase in patients arriving by Ambulance of almost 500% when Chorley & South Ribble hospital A&E shut it's doors in April 2016.
The ambulance handover times trebled and as the table above shows there was a huge increase in serious ambulance handover breaches resulting in patients lives' being put at risk.

To my horror however, the CCG had received instructions from NHS England and NHS Improvement not to penalise hospital trusts as they were going through a period of transition. *NWAS aren't penalised for waiting, the trust are supposed to pay but they've been told there's no recourse for breaching 4 hour and 12 hour targets. disgraceful!

And the problems of overcrowding at acute/A&E hospitals resulting in poor quality patient care haven't just 'gone away' either. In fact, they are getting much worse. Royal Blackburn Hospital (RBH) was on code 5 black alert over the weekend and today at RBH every single ambulance bay was full (image above) with some having to park.... on the CAR PARK!
Note here that Burnley's A&E was closed/downgraded in 2007 and moved to Blackburn resulting in one hospital in East Lancashire to cater for over 540,000 people. It's been crisis management ever since over at the Hospital in Blackburn, and patients as always pay the price for the politically motivated upheaval.
We're still waiting for a small number of mid-grade doctors to come to Chorley A&E and save the day and re-open services 24/7. Yet the longer this fiasco continues, the more suspicion arises that something else is planned for our A&E services.  Something so devious that even a hospital trust board avoiding a council health scrutiny meeting pales into insignificance in the overall scheme of things.

But we're not going away, we have a duty to ensure we keep what's rightfully ours in a 24 hour A&E service and that it remains in place for our children, and our children's children.

Finance is not the issue here, deception and betrayal of our NHS is...


Webcast Health scrutiny committee Oct 31st 2017

Wednesday, 8 November 2017


Are the NHS reform plans based on New Labour's' 2006 white paper? and what's a Labour peer doing heading up an STP scheme then praising Lancashire teaching hospitals NHS trust? Are all 3 main political parties in favour of a private-public NHS partnership? What the hell is going on?

The current boss of NHS England 'Simon Stevens' is a turncoat and entered government with New Labour (he was previously a Labour councillor for Brixton and former advisor to Labour PM TONY BLAIR).

Stevens was previously vice president for Unitedhealth, the largest private healthcare insurer in the U.S.A. He will sell his soul for fame and fortune and has U.S Accountable Care Organisations (ACOs') ready for privatisation in England as his goal. The reason he is head of NHS England is because NHS England were set up by the real privateer (the current health secretary) 'Jeremy Hunt' with no input from the NHS or those who use it.
It appears Stevens has simply expanded on New Labours 'Our Health Our Care Our Say' white paper from 2006 and added American style ACOs into the integrated part of the Sustainability & Transformation Partnership (STP).
STP = Straight To Pocket (private sector pocket)
*Labour's 2006 white paper is said to be the blue print for the 'five year forward view' which in turn is the blueprint document for all STPs. So not only has Stevens expanded on Labour's 2006 white paper, but he's handed it over to the Tories and it appears to be supported by Labour Peer Lord Pat Carter. 

The Labour Peer Lord Carter, like Tony Blair, seems to be just another Tory in disguise. Carter (real name Patrick Robert Carter) is heading up the Slash Trash & Privatise care home scheme, he visited Lancashire county council in late July along with the Lancashire Teaching hospital trust who closed the A&E department 24/7 at Chorley & South Ribble Hospital in April 2016. So what's a Labour peer doing promoting the STP privatisation plans? 

  • New Labour's 'Tony Blair' appointed Carter as a Labour peer in 2004.
  • Lord Carter co-founded private nursing home company 'Westminster Health Care' in 1985 with Martin Bradford. He's been lobbying for the private care-home sector to take on more patients from over-stretched NHS hospitals ever since Simon Stevens revealed the STP plans for England.
  • Carter was also previously president of Mckesson enterprise ltd international operations group (business portfolio holder), Mckesson specialise in orthopedic imaging/consultancy private sector work.
  • In 1985, Lord Carter founded Westminster Health Care which he built into a leading health care provider and subsequently sold in 1999. Carter is now a private investor and director of public and private companies in the fields of insurance, healthcare and information technology.
Previously many Labour politicians have made full use of the 'revolving door' between industry and government. Alan Milburn and Patricia Hewitt are among the ten previous health ministers who have taken lucrative consultancies with private health care companies.

More links below...

Is this the blueprint for the STPs five year forward view?
New Labour's 2006 white paper 'Our Health Our Care Our Say': a new direction for community services

Lord Carter visits Lancashire Teaching Hospitals July 201

Lobbying for transparency

Co-operation & Competition panel for NHS funded services

Are STPs based on New Labour's white paper from 2006?

Chorley A&E closure, super-hospitals, & NHS Privatisation

Wednesday, 1 November 2017

STPs demand Hospital service closures in Chorley & Preston

In early 2015 Lancashire Teaching Hospitals NHS trust were granted planning permission to build a multi-storey carpark at Royal Preston Hospital.

But shortly after came the general election along with news that the NHS was to undergo yet another top-down reorganisation based on privatisation plans known as a 'five year forward view' [5YFV]. The chief executive of NHS England appointed to roll-out these plans was no other than 'Simon Stevens', ex vice president of UnitedHealth, the largest private healthcare provider in the united states.

This drew suspicion from NHS campaigners: that NHS privatisation in England was on the cards and the 5YFV was a template for the introduction of American-style healthcare. The suspicion was made worse when it was discovered the man who appointed Stevens in post was no other than the health secretary 'Jeremy Hunt', an MP  renown for his political parties position on wishing to privatise the long-serving publicly provided NHS.

Under these regional plans, called Sustainability & Transformation Plans or 'STPs', health providers in Lancashire were to merge with those in South Cumbria to share resources and aid roll-out of the transformation from a 'National' healthcare system to a localised U.S. based healthcare system now known as an 'Accountable Care Organisation' (ACO) sometimes referred to as an Accountable Care System (ACS).

*The Tories Health & social care act (H&SCA) that came into effect in 2013 handed National responsibility for healthcare provision down to localised private GP-led groups called 'clinical commissioning groups or CCGs for short. The 'National' element had been removed from the NHS leaving NHS services wide-open to commercial ventures, including take-over of the more lucrative hospital services, that under STP plans, were to be relocated from hospitals into private-public partnership community clinics operated by the ACO.


One idea in the STPs was to close many hospital services and move them into what the plans call 'multi-specialty community provider clinics, or MCP clinics for short. The H&SCA allowed 'Any Qualified Provider' (AQP) to bid on, and win NHS contracts. CCGs soon set to work tendering out NHS contracts and over in Chorley hospital (and Preston hospital) urgent care centre services were handed over to a private provider for an apparently meager sum, leaving one Preston doctor to question if the services could be provided on such a small budget (the advice was £44m for a 5 year contract but the contract went for £30m allegedly).
The latest proposal from the STP Solutions Design Team are to close 80% of outpatients services at Chorley & Preston hospitals and move them into the community under the 'care closer to home' scheme.
With less and less money going into the NHS it was soon realised other NHS services were becoming unstable, none more so than A&E and other acute services.

Lancashire Teaching Hospitals NHS Trust (LTHT) who run hospitals in Chorley and Preston were told to drop the multi-storey car park plans for Preston Hospital since it was anticipated the transformation of the NHS would result in many fewer hospital attendances. The five year forward view had divided England into 44 'footprint' areas with each allocated a 'sustainability & transformation plan [STP] of its own'. The STP plans were bad news for the NHS, but good news for the private healthcare sector who in 2013 had been given statutory rights to bid on ANY NHS service contract (under the Tories 2012 Health & social care act).

Having shelved the multi-storey car park plan, the Lancashire hospital trust reported: "Since then we have been working on a new plan to improve how we provide and organise our hospital services so that we can ..remain viable for the future.  Major building work, including the multi-storey, has been put on hold whilst the transformation programme [STP] is progressing to make sure we don’t make any significant investments before our future plan is finalised".

Yet things appeared to be going wrong for those rolling out the STPs. The local plans for Chorley & South Ribble were questioned by the borough council resulting in a unanimous vote that Chorley council write to the health secretary and that the STP be ceased and remodelled so that it  "seeks to protect health and social care services, ensure they retain their local identity and strengthen local democratic accountability".

I don't recall any reply from Jeremy Hunt to the council's tabled motion on the issue but that's not surprising given Hunt's track record of ignorance.

So where are we up to at present with the STPs?

Since their inception via the 5YFV, without any indication to the public, STPs have mutated into 'Sustainability & Transformation Partnerships' instructed to form Accountable Care Organisations (ACOs).

These ACOs attempt to prevent ill-health by 'demand managing' (rationing) medications and treatment. They use a 'capitated payment' system and are financially driven to ensure an end of year surplus is passed backed to shareholders in the ACO. The ACO are a spin-off of the failed Obamacare and introduce a two-tier healthcare system into England. They will see the demise of the NHS if implemented nation wide.

The first ACO for Lancashire & South Cumbria is being trialled over in the Fylde, and if all goes well, they are proposed to be rolled out in Chorley, South Ribble, Preston and beyond.

So there we have it, we need not worry about car parking at hospitals soon, because there won't be hospitals left (with the exception of a trauma/A&E centre in the middle of beyond).

We won't need to worry about hospital car parking, since we'll all have a private clinic on the street corner run by Circle, Virgin, or Care UK Ltd.  The NHS will be a thing of the past and we'll all be making co-payments under the local ACO insurers for surgery or that medicine that is no longer on prescription.

Or we can stand up and say NO!

We are no longer under any doubt as to the intentions of the STPs and the two-tier privatised system they represent. We can no longer sit on the fence claiming we are in the dark about these sordid plans.
As campaigners to retain publicly provided health services we inform others and gain their support.

After all, we all know what happens to people who stay in the middle of the road, they get run over.[Nye Bevan]


Multi-storey car park plans for Preston Hospital halted

Chorley council return STP plans for remodelling

Monday, 23 October 2017

NHS Privatisation, where's the scrutiny?

Lancashire's Health scrutiny committee need to stop being hoodwinked and properly scrutinise STPs before it's too late. It's time to start asking questions, no decision about us without us.

At the previous Lancashire Health scrutiny committee on the 19th September, councillors were given a presentation by the 'Healthier Lancashire and South Cumbria - STP Team*' on 'progress' made since the Next Steps on the NHS Five Year Forward View published in March 2017 including the Sustainability Transformation Partnership (STP) for Lancashire and South Cumbria.

Councillors were informed that a 'board' called "the STP Board" had been established but this board was not a statutory body but merely consisted of several organisations such as the hospital trust, GP federation, mental healthcare trust, social services, clinical commissioning groups voluntary and private sector.

All these existing organisations are to be merged into a single partnership organisation. The merged healthcare bodies form an organisation imported from the U.S.A called an 'Accountable Care System' (aka Accountable Care Organisation or 'ACO' in the United states).

Ironically, the boss of NHS England 'Simon Stevens' is ex vice-president of UnitedHealth Group, the largest private healthcare insurer in the United States. Steven's now wants to bring the U.S. multinational private healthcare market to the U.K. with UnitedHealth group taking a slice of the NHS cake...

Among the companies taking on NHS work were privately owned businesses such as VirginCare and Care UK as well as stock market listed multinationals including UnitedHealth Group, Acadia Healthcare, Circle, Capita and Interserve.

Councillors at the health scrutiny meeting on the 19th were told these organisations on the STP board had no statutory mandate but that each organisation had signed up to it and volunteered to agree to work together to forward the NHS England STP plans. The STP board deals with the STP target finances and approves the transformation plans (its own plans). Yet the STP board has no accountability and is merely 'acting out' roles that are neither democratic, lawful, nor representative of the people who pay for the services they provide as individual organisations.
The STP board is in effect a QUANGO set up by NHS England in an attempt to bypass local democracy and enforce a private-public accountable care system (ACS) upon the peoples without their consent.
Those who've followed the disgraceful overruling by this government of the county objections to fracking know only too well the strategy here.

The 2012 Health & Social Care Act handed most of the NHS budget over to private GP practice commissioning groups (CCGs) handsomely rewarding those GPs with business acumen to start the NHS privatisation process in motion. Since its inception in April 2013, CCGs have tendered over a third of NHS services to the private sector, and are rationing more medicines and hospital surgery treatment every week.

Forming 'Accountable Care Systems' will only legitimise and expand on the existing rationing of healthcare treatment and services (what an ACS calls 'demand management' ) and fragment what's left of our public healthcare system into a two-tier private-public partnership accountable only to it's shareholders - the collection of healthcare organisations mentioned above.

Health Insurers & Accountable Care Systems (ACS)

In effect, CCGs will act as micro-insurers in the ACS with the prime incentive for the whole organisation to ensure an end-of-year surplus (profit) is made. To do this it uses a fixed capitated budget and 'demand management' to ration and withhold medicines and treatment.

Or as puts it...

ACOs/STPs don’t explain that this mean-spirited restriction of treatments and patient numbers is based on an American health insurance system variously called  managed care, health maintenance organisations or accountable care organisations. An Accountable Care Organisation (or System now also called in 2017) is accountable to the health insurance company that holds the budgets for treatments available to the population that is covered by the ACO . This is usually around 50K people - compare this with the 2k-6K population that is usually registered with a UK GP surgery. Don't be fooled by the word 'accountable' in this contect. It means counting money not BEING accountable to the public.

The health insurance company specifies what treatments are available (managed care) and which patients can access them (the ones who are cheapest to treat and who offer the best chance of financial recovery), as well as setting the overall annual population budget that the ACO has to stick to.

If the ACO comes in under budget it can keep what it hasn’t spent so there is incentive there to restrict treatment in order to maximise profit. The spin from NHS England is that this incentivises efficiency. The reality is it leads to cherry picking patients and restrictions and denial of care.  This is called ‘demand management.’ STPs and ACOs are ALL ABOUT 'Demand Management'.

By imposing managed care pathways - ie telling doctors what treatments they can provide and how to provide them -  Accountable Care Organisations de-professionalise doctors and other health workers and destroy the individual patient- health worker relationship.This is clearly not the NHS as a publicly owned, funded and run comprehensive health service, or as an empathetic, person-centred health service... is correct, here in Chorley & South Ribble we're already seeing CCGs telling doctors which medicines and treatments they should or shouldn't provide. Only last week Clinical Commissioning groups in Chorley and Preston introduced draconian policies that stopped certain surgical surgery such as some hernia operations leaving many to suffer.

All Councillors need to be aware, this is what STP leaders and other 'boards' who meet in secret haven't told you. It's happening in front of your very eyes, with very few councillors and members of the public aware of the sheer scale of NHS healthcare privatisation that's coming.

Let this be a warning. One by one you will see larger private clinics (called Hubs) being built/established in Preston and Chorley/South Ribble to house services that have been moved from hospitals. Gradually, the likes of Virgin care who already have the Musculo-Skeletal (MSK) contract, will takeover more of the lucrative NHS services thus destabalising the remaining NHS services.

For Chorley, South Ribble, and Preston, the STP solution designs team have already stated they wish to see almost ALL outpatient hospital services CLOSED and moved into a community setting - thus paving the way for more private contractors to take over NHS services.

Emergency care cannot survive without these services and Chorley District Hospital will become nothing more than a shadow of its former self; re-labelled as a 'community hospital' (private providers already have a specially built building at the hospital and hold a 7 year urgent care contract in the bargain).

The threat of the closure of both Preston and Chorley hospitals is still hanging over us, that's why week in and week out we stand outside Chorley & South Ribble hospital. Shortage of mid-grade staff or not, questions need to be asked about what these unelected 'STP boards' are really up to.

There is no money to roll-out these plans, there is a serious lack of staff, and there is no evidence that the plans will work in practice. So what are we waiting for? If STPs were planning applications they'd be thrown out of county hall.

I suggest the same treatment is given to STPs, or we'll be heading back to the dark ages where only those who can afford to pay get treated. Think on, be prepared, ask the questions. I guarantee you will not get any straight honest answers. Stop the STPs before it's too late....

Next Health Scrutiny Committee
Tuesday, 31st October, 2017 10.30 am
Venue: Cabinet Room 'C' - The Duke of Lancaster Room, County Hall, Preston

Agenda page here:


*Healthier Lancashire and South Cumbria (STP Team):  Dr Amanda Doyle OBE, GP and STP Lead; Neil Greaves, Communications and Engagement Manager Gary Raphael, Finance Director; and From Morecambe Bay CCG:  Andrew Bennett, Chief Officer

Tuesday, 12 September 2017

Chorley Hospital could lose 80% of it's outpatient services under STPs

ACOs, an issue nobody wants to talk about, but I'm going to anyway...
Well, I've just got back from the STP public debate organised by Healthwatch Lancashire in Leyland. Healthwatch invited clinical leaders working on the STP to the event so the 'leaders' could explain what the Sustainability & Transformation Partnerships (STPs) were all about and what the STP plans involved and how they 'might' work.

I asked why the name was changed from ST 'Plans' to ST 'Partnerships' since when the public were taking part in the engagment events they commented on plans, not partnerships. The answer was the plans are now partnerships and all healthcare providers now intend working together. Not really a justification is it? Ah, so this is the Accountable Care Organisation (ACO) Partnerships I offered.

So we all sat patiently waiting for how these ACO partnerships were going to work, how they would be funded, where staff would come from, and see some evidence of an ACO being beneficial to patients. It never came.

In fact, around 70 minutes into the 2 hour session I had to ask the STP lead doing most of the talking 'Dr Amanda Doyle' why she or her team hadn't mentioned the ACOs (which is what all STPs are to become), and only then got a brief mumble about working together etc,, no mention that ACOs work on capitated budgets and 'demand management' (restricting demand to treatment and medicines by limiting access to healthcare).

But what really plagued my mind was what Dr Doyle said in response to a question from a member of the public about the NHS being privatised. She came out with the old chestnut that the NHS already has private practice GPs and have done so for many years. No problem with that since the GPs work for the NHS indirectly via their contracts. But on closer thought consider this......
Here we have the lead organisor of the Lancashire STP (also Blackpool CCG) Dr Amanda Doyle, a PRIVATE practice GP. Rolling out plans that were put together by the boss of NHS England 'Simon Stevens' the ex vice-president of the largest PRIVATE healthcare company in the U.S. (UnitedHealth), who in turn was appointed by the Health Secretary 'Jeremy Hunt' who openly stated in a policy pamphlet the NHS was an arcahaic institution and called for it to be 'denationailised' (privatised).

The in-depth issue of ACOs and how they work were seemingly avoided by the panel at all costs. But I think you get the picture, and of course one of the reasons the Tories wanted private practice GPs to sit on Clinical Commissioning Groups (CCGs) and be put in charge of the biggest chunk of the NHS budget.

There has been no asessment on the impact the 'challenging' changes will have on patient care, only talk of improvements in services and care closer to home. Again no answers to where the funding is coming from, where the staff are coming from, or where the evidence is that care pathways such as 'preventive/self care' will reduce the financial burden. Although Dr Doyle claimed IF it did work it would reduce the NHS budget by a big chunk. It's been tried before and never worked, and no evidence was provided tonight. But one thing is for sure....


They are willing to role the ACOs out on a 'trial basis' (suck it and see), STP leads and clinicians have been told it's OK to fail but "we must get on and do something" and to be less risk averse [take risks] and not [be] afraid to try something new [1].

The risks in such partnership plans are very high, and many patients will suffer if anything goes wrong, yet those implementing the STPs have been told to go ahead and do it anyway.

What they plan to do..

The Solution Design Event Team in July 2017 made some proposals based on feedback from 3 public engagement events (called 'Our Health Our Care) to meet the out of hospital strategy (effectively denying hospital care to patients).

  • Transfer services into communities (this is what I call 'Primary priming' ready for the privatisation or the take-over of primary and community services).
  • CLOSE at least 80% of Hospital outpatient services and move them into clinics (this is decoupling of services from the hospital ready for take-over by the likes of Virgin care - this will be a PPP 'Private-Public Partnership to start with).

If the GPs don't agree to be part of the GP federation (i.e. one of the ACO partners), then the ST Plan could fail. Same with other proposed 'partners' such as social care (Better Care Fund). And if any one of the partners refused to join the ST Partnership ACO? or what if a partner decides to leave? or Who's running the show (governance structure?).. Again, no answers to these questions from the panel at the public meeting in Leyland.

When faced with the reality of what could happen (what if scenarios).
When faced with questions they couldn't answer, the questions were seemingly avoided and a reply of how lovely it would be IF it all did work.

So there are no answers. ACOs are a spin-off from Obamacare and are simply an extension of Health Maintenance Organisations that are demand led, capitated (restricted) budgets, and have never been trialled in a system where taxpayers money would be thrown at it (the U.S.A. medicaid ensures customers make co-payments if they exceed a certain treatment cost).

There are always two sides to a debate but unfortunately, when the reality of what could happen is ignored the inevitable happens. It's time to wake up everyone about what's happening, before it's too late....

[1] 'Solution Design Events' July 2017 proposals

Related Links

STP Lead Dr Amanda Doyle claims STPs are meaningless to public

Sunday, 3 September 2017

Americanisation of the NHS in England

Americanisation - multi-national corporations have been eyeing up the NHS for many years. All they need is an inroad, and that's just what the health secretary Jeremy Hunt has given them. Video above - Jeremy Hunt moving forward to kaiser permanente...

In the USA, "United Health" deliver healthcare through Accountable Care Organisations (ACO). Simon Stevens the current CEO of NHS England worked there for 10 years and they are one of NHS England’s preferred contractors for supplying support services to clinical commissioning groups.

and the £1bn contract that went to Capita in June?

In June, Capita Ltd won a £1bn contract to supply administrative support to the NHS as England’s state-funded healthcare service increasingly seeks to use the private sector in its pursuit of savings. The seven-to-10 year contract will see Capita provide NHS primary care providers such as GPs, opticians, pharmacists and dentists with a range of back office services, including payments administration and the management of clinical records

Capturing back office positions is key to the ongoing Americanisation of the NHS. It is about promoting the US model - one of the most costly and inefficient health systems in the world.

Monday, 28 August 2017

Cover ups, increased waiting times, and NHS contract sell-offs

During the general election campaign Healthwatch bodies were told they could not publish factual financial information that showed the true scale of NHS deficits, indicating another “cover up” to deny the public the true picture of the NHS. [1]

The head of the NHS and previous vice president of the largest private healthcare insurer in the U.S. 'Simon Stevens' was accused of abandoning waiting times targets after he said some patients would have to wait longer for treatment.
  • 3.78 million patients are now waiting longer for NHS treatment - a rise of more than 50 per cent since 2012.
  •  1,573 patients are now waiting more than a YEAR for planned operations, compared with 886 just a year ago - a rise of 78 per cent.
  • 382,000 patients are now waiting longer than 18 weeks for routine surgery, the largest since September 2008
  • Over the past three years, the number of patients waiting more than 26 weeks for treatment has increased from 60,402 in April 2014 to 136,030 in April 2017 [2].
  • Touchscreen advertising within NHS GP practices are now offering patients facing waits of almost a month a same-day appointment for £39. Evidence that the NHS is moving towards a “two-tier” system, where only those who can pay upfront could get the care needed.
  • Senior NHS managers have been told to “think the unthinkable” as part of a national programme to cap costs. This 'capped expenditure process' could be seen to be forcing many trusts to bypass public consultation and implement draconian cuts, downgrades, and service contract handovers to the private healthcare sector.
Closing wards and surgical theatres, cutting back on staff, and systematically lengthening waiting times for operations are among the moves being discussed between NHS England, health trusts. and some management consultancy firms such as McKinsey and Deloitte.

Fourteen areas are under particular pressure to make swingeing cuts because they are on course to miss agreed “overdraft limits” so have been told to follow the capped expenditure process (CEP) [3]. This includes 'Morecambe Bay' which is in the same STP footprint as Chorley & South Ribble.

CCGs to sell off more NHS services affecting Chorley & South Ribble

■ Midlands and Lancashire Commissioning Support Unit (CSU) are working on behalf of Chorley & South Ribble and Greater Preston CCGs and in December 2016 put four more NHS services out to tender to the estimated value of £12,751,970.00 per year. These are: Musculoskeletal [MSK], Physiotherapy, Pain Management and Rheumatology Services.[4]

Considering the Lancashire Teaching hospital trusts current deficit the above four services are likely to go to the private sector but as yet the tender is still open. The MSK contract is currently held by Virgin Care so it's unknown if the CCGs are renewing this or holding out for split bids (Lots) along with the other services (Physiotherapy, Pain Management and Rheumatology) .