Friday, 18 August 2017

STPs lack any legal status or powers

Hackney shows the weakness of STPs: time to follow suit

City & Hackney Clinical Commissioning Group has finally been the one to state openly that the STP emperor has no clothes – by insisting, with the support of legal advice that STPs lack any legal status or powers to compel CCGs or other “partners” to comply with majority decisions.

This potentially throws a spanner in the works of all 44 STPs consolidating themselves as bodies to drive controversial cuts, reconfiguration and service changes.

As some campaigners and analysts have argued from the beginning, they have no right to tell any organisation to do anything. And as bodies which function in secret with no transparency or publication of minutes, the STPs lack any legitimacy or public acceptance.

Conservative manifesto promises of plans to change the law to allow STPs to take control have had to be scrapped after Theresa May failed to secure a majority. Now the weakness that remains has been powerfully exposed in Hackney, and the door is wide open for campaigners to demand other CCGs and councils take up a similar stance.

The CCG has stood out against the plan to merge all 7 NE London CCGs under just one “Accountable Officer” thus minimising – and effectively dodging – any accountability to local people any of the seven NE London boroughs.

Hackney council’s Oversight & Scrutiny Committee has endorsed this with a powerful letter insisting on the need to retain the statutory levels of accountability that has remained after the disastrous 2012 Health & Social Care Act scrapped previous bodies and established CCGs.

The Health Service Journal publicising the CCG’s stand, the legal advice sent to the CCG and the letter endorsing the CCG’s position and restating clearly the case against local bodies being compelled into collective decisions and losing accountability are all available here.

See also the guidance from experienced NHS law firm Hempsons – on the centre pages of #7 of Health Campaigns Together Newspaper, and, on CCGs, at

Hackney KONP’s Carol Ackroyd has sent this letter to the local Hackney Gazette:

‘Dear Hackney Gazette,

‘NHS England (NHSE) are determined to roll out country-wide plans for 44 Sustainability and Transformation Partnerships, which will cut £22bn from the NHS budget by 2021 and create Accountable Care Systems (ACSs) which make the NHS more susceptible to takeover by healthcare corporations.

The new East London Health & Care Partnership (ELHCP) covers 7 East London Boroughs, including Hackney, and its Sustainability and Transformation Plan will involve massive reductions in NHS services in the face of a projected 18% rise in population by 2025

NHSE have made it clear that they expect Clinical Commissioning Groups (CCGs) to co-operate with these frightening aims. However City & Hackney CCG are reluctant to hand over responsibility for local decisions about NHS organisation and funding to the ELHCP, based on advice from their lawyers as to the legality of ELHCP’s proposed arrangements. We applaud the fact that Hackney Council is opposing this loss of control over local NHS resources.

However NHSE have reacted to this by expressing ‘concern about decision-making processes’ in the CCG, and have hired consultancy firm Deloitte (no doubt at considerable expense) to ‘investigate further’.

City & Hackney CCG is one of the most successful CCGs in the country. We are extremely concerned that it is being pressured in this way and that Hackney Council’s right to control local NHS resources is being undermined.

We hope that the Hackney Gazette, its readers and local people will give every support to the Council and CCG by emailing their local councillors and/or Mayor Philip Glanville, to confirm they want the CCG and Hackney Council to retain their lawful control over local NHS resources.

Yours sincerely
Carol Ackroyd
On behalf of Hackney Keep Our NHS Public


Wednesday, 16 August 2017

Private health is profit-hungry, but won't take risks

The private sector has never shown any ambition to take over the whole of the NHS, in the way private capital once coveted British Telecom, British Gas, and other utilities.

The reason for this is simple: .. the private sector is profit-hungry but largely risk-averse. Most of the NHS is high risk, and not profitable in its current form.

It can only be made attractive to the private sector by paying over the odds for services which the NHS currently provides at lower cost [1] – and thus inflating costs – or by excluding risk, for example by refusing to cover more complex and costly cases.

Private companies want only the sectors of the NHS which they (sometimes wrongly) believe offer the prospects of delivering simple, uncomplicated services for guaranteed profits. But their narrow focus of interest means that their perhaps surprisingly small total share of the cake has become far more significant than it might appear.

Davis, Jacky; Lister, John; Wrigley, David. NHS for Sale: Myths, Lies & Deception (Kindle Locations 3992-3999). Merlin Press. Kindle Edition.

[1] Take for example the patient wishing to jump the NHS queue for a hip replacement operation. Using his insurance plan, the insurance company would approve the procedure at a higher cost than the NHS tariff and since it's a high-turnover 'standard low-risk' procedure the company minimise any risks and at the same time make a profit. The problem of course is the NHS do not receive the work or profit and losing patients and income to the private sector destablises core NHS services such as A&E. Ultimately, the NHS will only provide the high-risk costly procedures unwanted by the private sector or when they hand patients back to the NHS when something goes wrong.

Monday, 14 August 2017


Lancashire Teaching Hospitals NHS foundation Trust (LTH Trust) are now more or less run by private consultants in the readying for new U.S. models of care.

Helped along by KPMG, the Lancashire Hospitals trust recently commissioned another 'Partner' in the form of the private consultants 'McKinsey' to help reduce the trusts deficits by £34m

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)

Chairman of LTH Trust 'Sue Musson' [originally from the USA where healthcare is private] is 'proud' to have been joined at her latest meeting by KPMG Partner, Amanda Latham, who provided a helpful presentation on KPMG’s audit opinion on their financial statements and quality account.

Private companies such as KPMG, McKinsey, Deloitte and Price Waterhouse Cooper (PwC) have a controlling influence on bodies regulating the NHS such as NHS Improvement (NHSI) and are also major beneficiaries. If in doubt, take a look at the executive board of NHSI the NHS’s economic regulator. You will see KPMG, McKinsey, Deloitte and PwC have pretty much got the board sown up.

Who's running the show?

The trusts finances are now audited by KPMG and their efficiency savings (cuts) strategy run by McKinsey. All we need to add to the mix now is a few more privateers and the job of privatising the NHS is complete....

Now consider this.
  • CCGs are running the hospitals and pushing NHS England's 'Five year forward view' plans called STP's, which as we know are really American ACO models of private healthcare.
  • NHS England fund the CCGs to roll-out the STPs/ACOs
  • GPs and their practices are in the pocket of the CCGs and do as they're told to follow the GP forward view, the STP part for GP federations (ACO partners)
  • Hospital trusts are underfunded but won't get the transformation funding from NHSE until they meet the financial reset, which means more cuts. That's where McKinsey & KPMG come in.
  • Pharmacies are in on it as well, as are the third sector (ACO partners).
  • Local/county authorities merging social service budget into partnership (ACO)

Change Management

This term is explicitly used when very controversial and unfair changes are proposed and reaction from opposition needs to be strategically managed on both sides.

Not to fear, in step the Chair of the Lancashire hospital Trust 'Sue Musson'.
Sue has considerable experience of dealing with 'change management', strategic planning, research and building sustainable partnerships with agencies such as local authorities and universities. She was the Chair of Southport and Ormskirk NHS Foundation Trust before joining Lancashire Teaching Hospitals NHS foundation Trust.

Yes, good 'ol U.S. healthcare has hit Warrington in the form of an 'Accountable Care Partnership' (a precursor to an Accountable Care Organisation or 'ACO'), which aims to bring together resources for health and for social care into one place, forging new partnerships and delivering more efficient, value-for-money services.

Value for money services, that's where the 'change management' comes in.

In this video, dismantling our NHS is shown to be done in 5 steps. All it takes for its completion is for folk to sit by and do nothing.

Related Links..

Private partnerships - Warrington begins NHS takeover

What are ACOs?

Friday, 4 August 2017

Care Homes or Cash Cows?

All this 'Care closer to home' stuff has been the mantra of many successive governments. The prospects for Sustainability and Transformation Partnership Plans (STPs) in shifting substantial amounts of care away from hospitals and long term care relies heavily on the availability of intermediate care services that are tailored to local needs and circumstances.

Well, that's the theory anyway. Certainly, the Labour Peer Lord Carter with his 'review' looks at how private care homes and fees can help home the geriatrics blocking up the beds in the local hospital. Lordy dawdy Carter of Coles bagged his first private care home in 1988 and now has a string of them so he's advocating the elderly + the taxpayer pay him & other care home providers to take in the aged from the hospitals.

But is that really the problem here in Preston and Chorley?

Delayed transfers of Care (DTOC) lead to cancelled procedures and can close a hospitals doors to other patients. If beds are taken up by the elderly who needn't be there then your ambulance could get turned away & redirected elsewhere, as happened 8 days ago at Preston Hospital. The backlog of patients at Preston was so bad one patient (anon) reported..

"My wife and I accompanied an elderly neighbour to Preston A&E and the corridor outside the unit had a long queue of patients on stretchers, by each stretcher there were two paramedics waiting to handover the patients. This meant that several ambulances were out of action. As the queue got longer a senior paramedic told everyone to put "reverse queueing" into action. When I asked what this meant he said that the stretchers would be moved round the corner so the problem didn't look as bad!"

Many elderly patients cannot be discharged from hospital until they've been assessed as being fit to either live alone or in a care home etc. then there's potential rehab and the mobility test and social services need to be involved for financial assessment and to find some sort of suitable care package such as re-ablement.

But even if this problem was to be solved, it wouldn't result in more doctors working in Emergency medicine with the Chorley A&E re-opening. But it would go some way to reduce the trusts financial burden which currently runs at a pre-deficit of £34m and a projected deficit even greater.

Richard Humphries of the social care institute for Excellence (SCIE) says "the evidence is positive. Intermediate care seems to work for most who receive it".

What he means of course is for those who can afford it.


[23rd July 2017]
13 February 2017

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: