Saturday, 8 July 2017

STPs in legal limbo: Enter the lawyers

The Lancashire & South Cumbria (L&SC) Sustainability & Transformation Plan (STP) is a collection of documents from the five areas across the L&SC region shown above.  Proposals in the so-called 'plans' involve a complete top-down re-structure of the NHS, along with proposals that attempt to alter the legal framework of the NHS.

The main objective of the 'Five Year Forward View', the blueprint document all STPs are based on, is to introduce models of care founded on the principles of American Health Maintenance Organisations and private insurance policy healthcare plans. After all, the boss of NHS England Simon Stevens, previously worked for UnitedHealth, the largest private healthcare insurer in the states.

One model of care is called an 'Accountable Care Organisation' (ACO), and you guessed it, there's one proposed for Chorley & South Ribble in the L&SC STP (in fact the STP has proposed an ACO for every CCG locality.

Only last week NHS England (NHSE) defined 8 areas they intend rolling-out ACOs, and worryingly, one of them is the Blackpool and Fylde area. NHSE state once the ACO is in full swing they intend implementing it across the Lancashire & South Cumbria footprint, i.e. including Chorley & South Ribble.

The following article, kindly reproduced from Health Campaigns Together, briefly explains the requirement to change legislation if STPs are to evolve into a commercial operation where providers struggling with large deficits, are willing to sell their souls (and assets)  and create a partnership with purchasers (CCGs) to forward NHS privatisation......

As it comes to the difficult question of trying to implement the proposals in STPs, often in the teeth of bitter local opposition, NHS managers are now beginning to wonder about the legality of STPs and the potential Accountable Care Organisations they are hoping to establish.

Legal firm Hempsons has produced some briefing material which underlines these concerns. In their Fit for the future briefing on June 17 they set out an “NHS legislation wish list”, and note in particular the problems created by Andrew Lansley’s health and Social Care Act:

“The current health and social care legislative framework is a brick wall that
STPs and ACSs run into when they try to share decision making and join up
services. It is designed for an inherently non-integrated, competitive quasimarket.
“ […]

“The section 75 partnership regulations (NHS Bodies and Local Authorities Partnership Arrangements Regulations 2000 No. 617) provide limited ability for a CCG to share its commissioning functions with a local authority.”

“NHS foundation trusts simply cannot share decision making. NHS trusts are ham-strung by limited powers to invest in corporate bodies.” In response to this, Hempsons argue the need for new legislation:

“What might be some legislative changes that would enable the NHS and local authorities to integrate services and develop and implement STPs and ACSs? We suggest some below.

“Some may be more controversial than others, but they all recognise the reality that the NHS (steered by NHS England and NHS Improvement) is in many ways already reversing out of a competitive quasi-market back to a centrally directed system where the purchaser-provider split is abolished and foundation trust autonomy offers few if any benefits.”

The Hempsons Seven Steps to accountable care pamphlet, produced jointly with NHS Providers, again stresses that STPs have no legal status or powers: “Key considerations that should be taken into account by STP partners leading on the evolution to accountable care are:
  • STPs currently have no powers to make decisions: their recommendations need to leave partners with real choices on whether to accept the recommendation
  • they are not legal entities; this makes it difficult to hold them accountable, so STP leaderships need to take care to refer back to partner organisations and respect the unique role of boards and well as the liabilities and dutiesof directors
  • STPs are not board-led organisations and will not have a NED [non executive director] majority or built in NED challenge. […]
  • there is a system-wide imperative to make swift progress and a seeming unanimity as to the way forward; in these circumstances leaderships need toguard against group-think
  • the transition from STP to ACS to ACO is clearly difficult to achieve in the current legislative framework. Clarity and simplicity in decision-making are therefore preferable to complexity.”
above article kindly reproduced from July 2017 issue of Health Campaigns Together


Where's the legal basis for STPs?

Tuesday, 6 June 2017

Lancashire hospital board employ controversial private firm in financial rescue plan

Chorley hospital trust board pay private firm who advocate charging NHS patients.

The trust running Chorley & South Ribble hospital and Preston hospital are paying private management consultants 'McKinsey' to draw up a financial rescue plan. 

In their June board report, the  Lancashire Teaching Hospitals NHS Trust, that covers hospitals in Chorley and Preston, claim that if the 'plan' is successful it will deliver a 'stretched' target of £34m to cover additional costs of A&E changes as well as the costs to McKinsey.

In their June (2017) report, the Lancashire hospital trust claim it is experiencing cashflow difficulties and has a 'high' backlog of creditors awaiting payment. They state they have a deficit driven by additional costs associated with Emergency Department (ED) changes and are unable to achieve Sustainability and Transformation Funding (STF). The resulting financial impact is around £5m per month.

Looking outside their organisation, the hospital trust are now seeking a solution to their financial problems from McKinsey, a global consultancy firm who in the past advocated charging NHS patients for treatment.

Private consultancy firms such as McKinsey have been central to the successive government plans to carve up the National Health Service (NHS). One service they provide is supposed “consultation” processes, which end up concocting a financial case for the closure and privatisation of swathes of the NHS and handing it over to their clients in the private sector. They reap rich rewards themselves for services rendered. McKinsey also helped draw up the NHS privatisation bill (H&SC bill 2012)

The undisclosed amount paid by Lancashire teaching hospitals trust to McKinsey could eat into a large part of the hospital boards budget leaving less money available to provide quality services. The trust were recently awarded a score of 'requires improvement' by the Care Quality Commission (CQC) for the second successive time running.

Links/Further Info....
Lancs Teaching Hospital NHS Trust June Board report [PDF]

NHS should charge patients, say McKinsey consultants

McKinsey helped draw up the NHS privatisation bill (H&SC bill 2012)

McKinsey helped draft both the government's £20bn "efficiency" savings and the pro-privatisation health bill (H&SC bill 2012)

McKinsey advises severe cuts – to public spending

The firm that hijacked the NHS: MoS investigation reveals extraordinary extent of international management consultant's role in Lansley's health reforms

Tuesday, 30 May 2017

Naylor Report shows 'Chorley hospital to be demolished' was no idle threat

It's now been confirmed Chorley district hospital and the Royal Preston Hospital would likely be sold-off to the private sector to pay towards a new 'super-hospital' near Lostock Hall.

A new report out called the "Naylor Report" referred to by Theresa May in her interview with Andrew Neil last week is a recommendation to all healthcare trusts in England to sell-off their estate and other assets to release £2bn. And to do this as quickly as possible.

What's this got to do with Chorley district hospital?

The 'option' mentioned in August last year by Lancashire teaching hospitals trust was to sell-off (demolish) C&SR hospital along with the Royal Preston Hospital to make way for a single super hospital over Lostock Hall way.

"the Bamber Bridge/Clayton Brook/Lostock Hall area has been identified as a site for the major new development" (Lancs Evening Post 16.8.16)

Our campaigners questioned at the time "where's the money coming from to pay for a new hospital?

The Naylor report which Theresa May supports gives us the answers in black and white. It involves the sale of assets (mainly estate) and borrowing via PFI.

The very first page  (2nd paragraph) of the Naylor Report says they intend "releasing £2bn of assets for reinvestment and to deliver land for 26,000 new homes".

  • They call it releasing assets for reinvestment.
  • We call it selling off our NHS to the private sector.
Historical intentional underfunding by the Department of Health yields an excuse to justify selling off NHS public property to the private sector.

Trusts blackmailed into selling off assets

In her interview with Andrew Neil Theresa May said she supports the idea of hospital trusts selling off their assets [estate] or face paying an additional 3.5% charge on their capital budget (there's also the mention on the same page 22 of the dreaded PFI if your trust don't comply).

Remember the Tories health & social care act 2012?
As soon as the act became law in 2013 the Tories transferred all NHS estate to a private company. NHS Property Services (NHSPS) is a limited company owned by the Department of Health (DoH), they took over the ownership of around 3,600 National Health Service (NHS) facilities [Estate] in April 2013. NHS Property Services Ltd now manages, maintains and develops the properties on behalf of the DoH.

It's a revolving door for the new CEO of NHSPS who worked previously for BT as well as being the government's Crown Representative for Property and Facilities Management for the Cabinet Office.

Watch Chris Holden's Video summary showing evidence of NHS estate sell-off..


Chorley’s hospital could be demolished to make way for a new ‘super hospital’.

Read more at:
Chorley’s hospital could be demolished to make way for a new ‘super hospital’.

Read more at:
Chorley’s hospital could be demolished to make way for a new ‘super hospital’.

Read more at:

Thursday, 18 May 2017

Why the boss of HealthWatch Lancashire should resign

Our local hospitals have been in crisis for many years, yet the body setup to monitor them have failed to make any difference, and are now refusing to listen to campaigners on spurious radical NHS reforms called STPs.

The so-called 'chief' of Healthwatch Lancashire 'Mike Wedgeworth' upset Chorley hospital campaigners this time last year saying the save Chorley hospital A&E campaign was "deterring specialist doctors from taking up vacant posts at Chorley Hospital.”

In a separate news article (2BR), Wedgeworth said he wasn't going to apologise for what he said since he believed campaigners were criticising the trust and it was having a bad effect because that would put the Trust in a bad light and it might deter people from apply to work there.
What he didn't say, was the trust he spoke of had the worst projected deficit ever seen [2015/16] in the history of the NHS and was still under investigation from NHS Improvement for failing to meet 4 out of 5 core standards after a CQC inspection in 2014 rated them 'requiring improvement.
So much for 'Healthwatch' eh Mike?

Three years on, and after another CQC inspection, the Trust have once again been rated as 'requiring improvement' providing evidence Healthwatch Lancashire have had no impact whatsoever on the outcome for patients requiring secondary healthcare.

Toothless tigers and damp squids, Healthwatch Lancashire, the body setup to question whether people are satisfied with local healthcare provision are actually questioning why NHS campaigners are angry about poor management at the trust which has led to the huge deficit.

Call for resignation

Here's what Mike Wedgeworth said in an interview with 2BR in June 2016...
"I've requested a meeting to discuss the question - I don't feel inclined to resign but if they [campaigners] put to me good reasons to me why I should [resign] then I will consider it".
Wedgeworth and Healthwatch Lancashire have failed on many levels. They've failed to ask simple questions on major NHS reforms called Sustainability & Transformation Plans (STPs) for Lancashire such as how the reforms will be funded, staffed, and where the evidence of the proposed outcomes comes from.

He's failed to make or influence the hospital trust procedures. Worst of all, even though he had teams of volunteers entering hospitals and asking questions, the Hospital trust was once again put in measures of 'requiring improvement' for a second time running after a CQC inspection in 2016.

Healthwatch Lancashire are supposed to be the 'public voice' for health & social care.

"Healthwatch Lancashire will gather intelligence by engaging with residents, listen to comments, compliments and concerns and ensure that these views and experiences are heard by those who run, plan and regulate health and social care services in Lancashire".

Wedgeworth supports the STPs (even though he hasn't a clue how they are to be funded or staffed) saying "My special interest is in ensuring that the public and community groups are aware of the changes being planned in the NHS and local government services and in seeking to influence these changes in their interests".

He claims "I have been a member of the Lancashire Health and Well-being Board since its inception"

Wedgeworth serves on the following Health boards..

  • Chairman Healthwatch Lancashire
  • East Lancashire Clinical Commissioning Group (CCG)  as Healthwatch representative
  • Lancashire County Council Health & Wellbeing Board
His special interests are ensuring that the public and community groups are aware of the changes [STPs] being planned in the NHS and local government services and in seeking to influence these [STPs] changes in their interests.

I think it's time to abolish the useless Healthwatch bodies and we'll start with Mike Wedgeworth's resignation and take it from there...

Related Links

Friday, 12 May 2017

Tory Promise of £10bn extra for NHS was 'pack of lies'


The Conservative governments claim of injecting an “extra £10 billion” into the NHS by 2020 has been 'rubbished' by MPs and proven to be untrue.

The numbers have perhaps been best explained by the Nuffield Trust’s Sally Gainsbury.

She shows that the £8 billion from 2016-2020-21 began at best as a rounding up of an actual £7.6 billion uplift over 5 years. It was only inflated to the mythical £10 billion figure by adding in the money already allocated for the previous year 2015-16.

But it was always a deception: because while alongside some increases to NHS England’s budget, there are simultaneous cuts of over £3 billion being imposed on the rest of the Department of Health budget, which is not ring-fenced against cuts.

So £7.6bn from 2016-2020 turns out to be just £4.5bn extra health spending over the same 5 years. However the £4.5bn “real terms” increase is itself calculated on the basis of general inflation in the economy, not the much higher levels of price increases faced by the NHS in the global market for drugs and equipment.

These threaten cost increases high enough to wipe out another £3.7 billion.
In other words the promised £10 bn “real terms” increase is actually worth less than a tenth of that amount, just £800 million, over the next few years to 2020.
And the comparatively generous financial uplift of 2016-17 is followed by two more years of even more brutal squeeze on spending, which is set to force a massive round of further cuts and desperate so-called efficiency “savings.” These will put local access to hospitals and other health services at risk for millions, most of them older and living in more rural areas.

Devon MP Sarah Wollaston, Chair of the Commons Health Committee, was among the growing ranks of those who openly criticised the government’s deception

Article kindly reproduced from Health Campaigns Together '2017 Election Special' issue available for download as a PDF here.


Saturday, 29 April 2017

Huddersfield hospital closure program, is Chorley hospital next?

The Lancashire hospital trust running Chorley & South Ribble hospital are considering following the same program that proposed closing Huddersfield Royal Infirmary last year.

On the 20th of October last year, Huddersfield Royal Infirmary, run by Calderdale and Huddersfield NHS Foundation Trust, was proposed by the local CCGs to be closed and demolished under their STP program titled 'Right Time Right Care Right Place'. 

Due to similarities, Lancashire Teaching Hospitals (LTH), the trust who run Chorley & South Ribble hospital are now considering following the same program as Calderdale, and are discussing joint communications with the Calderdale & Huddersfield trust. From the LTH board report....
"A slide presentation had also been circulated which provided an outline of a visit that had been undertaken to Calderdale and Huddersfield NHS Foundation Trust to discuss their [STP] programme which was similar in content to the Our Health Our Care programme".
A patient safety risk had been introduced as the Preston Primary Care Centre group were not prepared to support out-of-hours cover at Chorley and the Chorley Medics had relocated from the Chorley and South Ribble Hospital site [to Euxton]. Risks highlighted through loss of income and financial consequences in relation to the urgent care centre service. 


Lancashire Teaching Hospital trusts October 2016 board report states that 78 out of 90 beds had been introduced following the CQC inspection in July 2014 but have now been decommissioned. 
Ironically, the Lancashire Trust now claim there is not enough capacity in acute services which is impacting directly on the delivery of key access targets.
Sustainability & Transformation Plan (STP) related contracts have been brought forward and have now been signed off thus accelerating plans for privatisation before any public consultation periods start. NHS England are basically holding hospital trusts to ransom if the trusts don't meet financial targets by fixed dates.

This will inevitably result in trusts cutting corners resulting in poor quality patient care.

Today (29th April 2017), hundreds of campaigners turned out in Huddersfield to protest against the undemocratic way their hospital had been earmarked for closure. And they are not going to let it go when lives are at risk.
Our NHS campaign here in Chorley has a lot in common with Huddersfield's NHS hospital campaign, and today was the start of a united effort to emphasise just how important our NHS is to us and that services must remain local at all costs.

The NHS is always there when we need it. Now it needs us to prevent it from being sold-off to those who put profit before people. We must never let this happen...

Saturday, 15 April 2017

The Biggest NHS Sell-Off Event Ever!

A 'business-case' for the NHS has now been set, and its the biggest NHS Sell-Off event Ever!

If anyone is in any doubt as to the sheer scale of the privatisation of our NHS, look no further than the Health+Care Conference announced for June.

The conference 28-29 June 2017 | ExCeL London, brings together all STP leads, health trust and CCG chief executives and other delegates from the private sector. The event organisers claim the event is" Europe's largest integrated health and social care event, building relationships between commissioners, providers and suppliers".


The objective of the expo conference is to accelerate 'Transformation' of the NHS by introducing delegates to hundreds of private healthcare sector companies along with other STP leads.

To anyone wishing to retain a universal healthcare system, the Health+Care conference is a shameful collection of people openly betraying the principles of the NHS. Such events would have been taboo 20 years ago, but now the SALE OF OUR NHS is openly broadcast and in public. There's even a 'transformation' awards event for those who so far have managed to cut NHS services and transform them in line with private healthcare sector values.

It's a no holds barred event with Labour and Lib Dem politicians thrown in for good measure...

Here's a brief list of those hosting some of the events with many sessions openly 'sponsored' by private companies..

Opening and Welcome to Health+Care 2017
Chair: Dame Ruth Carnall,
Managing Partner, Carnall Farar Ltd

Cross-Party Debate: NHS and Social Care Funding - is it time to ask the public?
Jonathan Ashworth MP, Labour Shadow Secretary of State for Health

And another Labour Peer...
■ Delivering the £5bn operational productivity challenge
Patrick Carter
, Lord Carter of Coles, founded Westminster Health Care Ltd in1985 which he built into a leading health care provider which he sold in 1999. The Labour peer is a private investor and director of public and private companies in the fields of insurance, healthcare and information technology.

Local Authority Trading Company - The benefits and opportunities and challenges
Alison Waller, Managing Director, Tricuro Limited

Improving quality with creative leadership
Chris Gage, Managing Director, Ladder to the Moon

Dr Al Mulley, Managing Director for Global HealthCare Delivery Science, The Dartmouth Institute

Dr Rupert Dunbar-Rees, Founder and CEO, Outcomes Based Healthcare [research company]

Antony Tiernan, Director of Engagement and Communication, New Care Models Programme – Five Year Forward View

James Sanderson, Director of Personalisation and Choice, NHS England

Sir Bruce Keogh, Medical Director, NHS England

Professor Matthew Cripps, National Director, NHS RightCare

Jacob West, National Care Model Lead – Acute Care Collaboration and Primary and Acute Care
Systems (PACS), New Care Models Programme

The Rt Hon Stephen Dorrell, Chair, NHS Confederation and former Secretary of State for Health

Matthew Swindells, National Director: Operations and Information, NHS England

GP Regulation: Professor Steve Field, Chief Inspector of General Practice, CQC

Challenges facing the NHS provider sector: Chris Hopson, Chief Executive, NHS Providers

Dominique Kent, Chief Operating Officer, The Good Care Group Ltd

The expo conference brags it has over 450 private and public exhibitors....