Was dividing Chorley A&E a marketing ploy gone wrong

Marketing plans to fragment A&E departments continue.

In 2017, Warrington & Halton hospital trust board setup a detailed marketing plan for people who opted to pay privately [PDF]  for surgical operations that were previously banned by commissioners (Clinical Commissioning Groups).

The marketing plan was relaunched in 2018 where it was revealed the trust had actually established the pay private scheme five years earlier in 2013, immediately after the 2012 Health & Social care act came into effect.

[1] Other 'changes' to how the NHS functions also came into effect such as 'fragmenting' A&E departments into two parts (emergent & urgent) then selling off the 'urgent care' contract to the private sector later.

Can anyone think of where [1] above has already happened?  I'm sure you can, just think local..

In their marketing material, the trust said they were "prepared to rebut ‘privatisation’ messaging via interest groups and media". 

It didn't work, and a clear message was sent from the public that all treatment under the NHS must remain universal and this is merely for those what had the ability to pay - and potentially jump any queues.

NHS patients were being charged as much as £8,500 for operations at the Warrington hospital trust, sparking outrage and claims "privatisation is already here".

Patients raised concerns over the cost of surgeries under the My Choice programme at NHS Warrington and Halton Hospitals Trust.

Since the introduction of the H&SC act in 2013, commissioning groups, also setup under the act, began to ration and ban NHS medicines and treatment, a list of which can be viewed here.

Barbaric and 'immoral'

One NHS campaigner said "So no knee/hip replacements for those that genuinely need them? No D&C (dilation and curettage) for those unfortunate to miscarry? Barbaric."

Another patient wrote on social media "Several of the operations I've had are listed including a knee arthroscopy I had a few years ago when I couldn't work for months."

She wrote that she was "horrified" to see treatment for heavy menstrual bleeding on the list, describing the whole move as "immoral"

The trust claim the self-pay scheme provided convenient access for patients, which many patients rightly translated as paying to jump the queue.

Since the outcry the trust have suspended the scheme. 

However, clinical commissioning groups (CCGs) continue to ration and ban medicines and treatment so be very vigilant and join an NHS campaign group near you.

Links/Related

NHS hospital stops plan to charge patients almost £20k for operations after outcry

History shows closing Chorley A&E results in worse outcomes, not better

History shows closing Chorley A&E results in worse outcomes, not better

When opposing closures by CCG and LTHTr don't look too closely at their reasons for closing Chorley District Hospital (CDH) A&E but look at historical data as reasons for RETAINING CDH A&E, and even 'expanding' these services.

The evidence for opening CDH A&E full time is compounding; as closing it permanently would result in worst outcomes for patients due to many factors including:

Overlcrowding at surrounding A&E hospitals - this includes Wigan WWL as their Chief exec has already stated the WWL could not manage additional patients in 2016/17 when CDH A&E was closed.

Perhaps the most compelling evidence to keep A&E services in Chorley is what's called' ambulance handover breaches'.

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

Paramedics are left waiting to handover their patients to a hospital A&E department. If that department is overcrowded and does not have enough beds then the handover times shoot up. The result is seriously ill patients waiting in corridors or backs of ambulance and thus fewer ambulances on the road.

When Chorley A&E closed in 2016 Ambulances began queuing up at Preston hospital so couldn't  get back on the road to reach emergencies. Subsequently it emerged in Jan 2018 a local man died of a suspected heart attack after waiting over 90 minutes for an ambulance to arrive.

If they close Chorley A&E, this could become commonplace, particularly as the Ambulance service comes under more pressure.

Now how much evidence do you want?

Well, let's have a quick look at another disaster that happened over at Blackburn hospital when it started taking patients when their Trust closed Burnley hospital A&E.

Let's do a comparison of ambulance handover breaches.

The figures for 2015/2016 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.

Now take a look at the table where it shows the Royal Blackburn [hospital] where they shut Burnley A&E taking patients to Blackburn.

The increase in handover and serious handover breaches at the Blackburn hospital is HUGE going from 191 handover breaches in Apr 2015 to 366 breaches a year later in May 2016.

Is this what we want for Chorley & South Ribble hospital?

and Remember, before Burnley A&E was closed the hospital trust claimed the Royal Blackburn hospital could accommodate patients from the Burnley area - including Burnley, Rossendale, Pendle and many other towns.

So how can that be deemed 'better outcomes' for patients as we're led to believe?

When it comes to the crunch, and public consultation arises, those wishing to close Chorley A&E need to prove alternative provision is already in place in the community and that any bed closures can accommodate patients elsewhere. They also need to prove there will be no overcrowding at surrounding hospitals pushing their resources and placing patients at risk.

I say it can't be done, and along with my fellow NHS campaigners intend to continue to fight tooth and nail to KEEP and EXPAND our life-saving services at Chorley & South Ribble hospital.

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

Related

Where's the legal basis for STPs?

NHS England hold Lancashire Hospital Trust to Ransom

A local Hospital Trust have been told to get their deficits under control or face bankruptcy.

Lancashire Teaching Hospitals (LTH) NHS foundation trust still have a deficit¹ of £10.8million. They blame temporary changes to emergency services at Chorley & South Ribble Hospital for driving all of the deficit including both the income and expenditure.

The deficit as a result of the Chorley A&E closure was reported as £1.7million which has resulted in the trust being refused £3.3 million from the sustainability and transformation fund (STF) from NHS England.

The LTH Trust have applied to the Department of Health for a loan of £15.3million of which £13.1million would support the revenue deficit² and £2.2million would support capital expenditure.

Before becoming a foundation trust the Dept of Health were obliged to help out a trust without resorting to the trust asking for a loan. So the real tragedy of being a foundation trust has now hit home and LTH are having to 'borrow' more money to cover the loss of the A&E tariff due to the temporary closure (a tariff is a fixed amount of money the trust gets per patient with the amount depending on the procedure, more high-risk/complex procedures demand more money).

The Trust have indicated to the health regulator NHS Improvement (formerly Monitor) that a further revenue loan may be required to offset the costs associated with the temporary closure of the Chorley emergency department and any resultant effect to the sustainability and transformation fund (STF).

The above is worrying. the cost of closing Chorley A&E is £1.7m plus the £3.3m loss of the STF results in potentially borrowing another £5m. If LTH can't make up the shortfall in the meantime, they don't get the STF funding. Yet if they don't get the STF money they might just 'have' to continue to borrow more placing their part-time re-opening of Chorley A&E at risk.

The Finance Director added that there would be further impact on the Trust’s financial position following introduction of the urgent care centre (UCC) service in November 2016.

Now we have a REAL problem. 'further impact on finances' means the deficit is likely to go up and not down. WHY on EARTH have the trust not undertaken a financial risk assessment when their bid for the UCCs failed?

There's no excuse since they were already managing the UCC's so the problem must be down to the something else?

The trust are asking the new UCC service provider GTD Healthcare* if they may have access to recorded activity [from UCC activities] to include within trust performance data.

This seems strange since the trust seem to be claiming credit for operations undertaken by a separate organisation (GTD Health who will be running the UCC from Jan 2017).

The LTH trust board again confirmed that demand and ambulance transfers had increased since the closure of C&SRH A&E. Indicating the problem still exists.

Due to changes in the Health & Social Care Act 2012, Clinical Commissioning Groups (CCGs) are now under no obligation to provide healthcare services to people who are not registered with a GP practice. This means that patients presenting at hospital could be turned away and redirected to a doctor instead. The Lancashire Hospital Trusts medical director Mark Pugh seems to emphasise this in the board report topic on 'A&E improvement programme'..

"The Medical Director noted that data was also available to show changes in behaviours, for example patients not registered with GPs who would need to be diverted to GPs for appropriate advice".

It had been confirmed that the urgent care centre service may not mobilise from November 2016 and it may take until January 2017 to introduce the service.

There are already communications problems between the GoToDoc healthcare Ltd and the trust.

Weeks have now passed and GTD have yet to reply to the trusts request for information. Disputes between GTD and LTH trust already seem to have arisen over a contract for accommodation and...

It was explained that the Trust had been asked whether the urgent care centre service could be covered by GPs working with the Trust at the moment to bridge the gap. A copy of an email had been received from the CCGs which asked GoToDoc to contact the Trust although this had not yet happened. The Company Secretary was currently working on the accommodation contract as the Trust would be acting as landlord for the urgent care centre facility and it was noted that no Trust staff would TUPE to GoToDoc and would remain as Trust employees. Mr M Welsh commented that GoToDoc might attempt to recruit existing Trust staff which would increase the staffing deficit within the Trust’s urgent/emergency services. It was agreed that this should be included on the risk register.

More Doctors Leaving?

"this week the Trust had lost two doctors to a Trust in Derby owing to a more attractive night-time rota and attempts were currently being made by the Trust [LTH] to secure three more doctors".

Only last week [20th Oct], 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, LTH trust 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.

• The trusts October 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.

STP related contracts have been brought forward and must be signed by 23rd of December 2016 indicating accelerated plans for privatisation before public consultation periods end. 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.

LTH Trust are rated RED in 6 out of 8 of the required NHS England standards potentially involving NHSI intervening. The trust could go bankrupt or be taken over by another provider.

---

source: LTH board papers 5 October 2016
http://www.lancsteachinghospitals.nhs.uk/board-papers

*Go To Doc Limited aka GTD Healthcare Limited are registered with the Care Quality Commission as a 'limited' company. See Here under 'Who runs this service'...

GTD Healthcare Limited refer patients to clinics and surgeries operated by GTD Primary Care Limited. GTD Primary Care Ltd are registered on company house as a 'for-profit' company.


¹deficit is where a sum of money falls short of what is needed; debt

²revenue deficit is where the net amount received by a company in revenue (income) is less than the net amount projected (expenses).

TUPE is the Transfer of Undertakings (Protection of Employment) Regulations, 2006, and its purpose is to preserve staff contractual terms and conditions of service, following their transfer from one organisation to another. 

Huddersfield hospital closure, GPs blamed for betraying NHS patients

Local GPs sitting on controversial 'clinical commissioning groups' have betrayed their patients by voting unanimously to close the Huddersfield Royal Infirmary. So what can we learn from this fiasco?


The proposed closure of Huddersfield Royal Infirmary (HRI) has brought home just how important it is we now concentrate on NHS England's 'STP' plans to introduce a U.S. style private healthcare insurance system in England.

GP-led Clinical Commissioning Groups (CCGs)

On Thursday this week the joint Huddersfield and Calderdale CCGs unanimously approved plans to close HRI A&E followed by demolishing HRI altogether and building another hospital (with NO A&E) on an adjacent site.

All this was done under the local STP plan titled 'Right Time Right Care Right Place'.

The consultation was a sham, with the CCGs basically ignoring 19 recommemendations put to them by the council Health scrutiny committee. The disgrace continued when a survey revealed 67% of those consulted didn't agree with the plans. Yet the GPs on both CCGs historically voted to remove vital local life-saving emergency services for their patients.

It's not comforting either when the Preston MP claimed these type of reconfigurations were 'pie in the sky'. I recall this sort of talk before from parliamentarians and with bluff called the exact happened with said MPs claiming to be astonished with the decisions. I don't trust em.

There seems to be more and more opposition to CCGs wielding so much power over such crucial NHS services, and rightly so. There was always bound to be many conflicts of interest with GPs on these CCGs awarding themselves contracts with other interests going 'undeclared'.

Relationships between Doctor and patient have certainly soured since the advent of CCGs.

"For some [GPs], to be blunt, the blatant systemic conflict of interest in providing services that they would themselves commission was embraced as an opportunity for personal enrichment. Greed was the spur. They were in a minority but they had disproportionate influence because they were pro-market and pro-GP commissioning and so had the government’s ear".

"It would be interesting to know how much gold had been promised to stuff in the insatiable mouths of certain doctors. The rewards would come quickly. A survey in Pulse – the GPs’ magazine – reported that by December 2012 over one-fifth of board members on clinical commissioning groups had financial interests in private health care providers; the BMJ put the number at more than one-third in March 2013.6 Things are looking good for Dr Fat Cat".

Above two paragraphs kindly reproduced from the book NHS SOS by Tallis, published 2013.

Back over at HRI, the plan to remove A&E from hospital surroundings is part of the 5 year forward view. The Private healthcare sector's primary objective is to separate out the more lucrative high turnover, low-risk unplanned services from hospitals. These will then be consolidated into smaller clinics called 'Multi-Speciality Provider' clinics (MSPs) as per the American Health Maintenance Organisation (HMO) model.

These clinics have been trialed over here in England a while back and were named Darzi clinics or Polyclinics etc. They were in effect 12% more expensive per patient, ideal money spinners for the private sector but a great loss for NHS tariffs.
*A previous Netcare contract for these clinics showed 39% of patients, for whatever reason, didn't receive treatment, yet NetCare collected £35m for work never undertaken.

The demolition of HRI also satisifes the STP criteria for releasing estate and introducing personal health budgets for chronic conditions via the MSPs.

Most CCGs are guided by committee officers who, ironically, are also allowed to vote on the NHS England policies they are recommending!

Many of these 'officers' are even ex employees of private health policy advisory consultancy firms such as KPMG, McKinsey or think-tanks such as the King's fund. No wonder HRI campaigners are angry, we have all well and truly been stitched up by those we thought we could trust, our GPs.

It seems the involvement of GPs on CCGs has been mostly limited to a group of willing ‘reformers’, many with an eye to potential personal gain and increased local influence available under the new scheme. Over at Chorley & South Ribble CCG, the basic pay for the Chairperson is £120,000 p.a.

A disgraceful amount considering the same position on the previous Primary Care Trusts was £15,000 p.a.

CCGs report to, and are manipulated by a body calling itself 'NHS England'.
It's CEO 'Simon Stevens' is ex vice president of U.S. based 'UnitedHealth', the largest private healthcare insurer in the world.

It doesn't take a genius to figure out that CCGs are therefore implementing the U.S. privatisation model throughout the NHS in England.

So what can be done to stop the onslaught against our NHS under these STP plans?

The 44 regions in England, inaptly titled 'footprints' by Steven's mob are all ear-marked for privatisation. And the consultation for most footprints hasn't even begun yet.

But stop it we must. And as Hands Off HRI campaigners have now said, the gloves are off, the fight is not over.

Chorley & South Ribble campaigners are fully behind the Hands off HRI campaigners as we're all aware whats happening affects not just Calderdale or Huddersfield but the whole of England.

A storm is gathering, we need to be prepared to support each other and ensure our NHS remains intact...

MPs 'disgraceful' voting record on NHS & disabled

Meet Seema Kennedy - MP for South Ribble. Seema has a secret she doesn't want you to know about.  Seema even voted in the house of commons to keep it 'top secret' so even her constituents don't know about it.

HYPOCRITICAL really, considering Seema voted recently for the spies charter which means YOU would have to provide information by law, yet Seema thinks she may be exempt.

So What's the Secret?
Seema voted recently not to publish her parties secret 'detailed' plans to dismantle and privatise the National Health Service. The plans are called Sustainability & Transformation Plans [STPs] and are an attempt to bring about financial stability (sustainability) across the NHS by including more of the private sector.

On the 14th September 2016 in the House of Commons, a motion was proposed by shadow health minister Ms Diane Abbot that the government reveal its plans to introduce a whole new healthcare system for England.

"That this House notes with concern that NHS Sustainability and Transformation Plans [STP] are expected to lead to significant cuts or changes to frontline services; believes that the process agreed by the Government in December 2015 lacks transparency and the timeline announced by NHS England is insufficient to finalise such a major restructure of the NHS; further believes that the timetable does not allow for adequate public or Parliamentary engagement in the formulation of the plans;and Calls on the Government to publish the plans and to provide an adequate consultation period for the public and practitioners to respond.

• Seema Kennedy voted not to reveal the controversial plans that could see the end of the NHS and the beginning of a private insurance-based healthcare system.

In 2013 we had 140 full A&E hospitals in England. When the STPs are complete there will only be between 40 and 70 left. According to NHS England boss Simon Stevens, to make the NHS affordable and sustainable we, the public, must get used to longer ambulance journeys for emergency care, longer waiting times for treatment and the possibility of paying extra to be seen by a doctor.  This was planned in 2013, but shelved until after the 2015 election as being 'politically sensitive'.

Any 'duplicated' hospital services will be merged, so if Chorley hospital provides the same service as Preston hospital, the service will be closed at one of the hospitals. GP surgeries will be closed and many will be merged into larger clinics called Multi-Specialty Provider Clinics (MSPs) with some specialist services transferred from the hospital into these clinics run by a consortium of GPs outsourcing the work to the private sector. It gets worse, but I'll explain more indue course..

Of course Seema voted to keep these toxic plans secret. To some people like Seema Kennedy, the thought of a publicly run, publicly owned health service is repugnant. And the only way they can change that is by stealth and keeping the privatisation plans under wraps so that when they are revealed, it will be too late to do anything about it. 

Seema's involvement in the closure of her constituents South Ribble Hospital A&E has been minimal to say the least. So much so, she feels her A&E doesn't even warrant a mention in her newly published 2016 MP Annual Report.

 
So while we're at it, let's take a look at some other things Seema may not wish you to see....

Seema Kennedy is a Conservative MP, and on the vast majority of issues votes the same way as other Conservative MPs. Seema Kennedy has never rebelled against their party in the current parliament. 

Welfare Benefits 

Almost always voted against paying higher benefits over longer periods for those unable to work due to illness or disability. Consistently voted for a reduction in spending on welfare benefits.

Seema's website says "some people are scornful of social action", yet Seema openly votes to cut benefits to the most needy in society such as the sick, poor and disabled. The South Ribble MP recently voted against higher taxes on banks.

In March this year, Seema Kennedy voted to force through the ESA disability benefit cut. The cut forced reductions of £30-a-week to disability benefits to some of the most disabled in society.

Local Government (Council) Funding & Transport

South Ribble council will be disappointed to hear that Seema Kennedy in February this year (2016) voted to CUT the government grant to local councils by almost 25% compared to last year (2015).
Seema has also...

• Consistently voted for reducing central government funding of local government
• Generally voted against more powers for local councils 
• Voted against greater public control of bus services 
• Consistently voted against a publicly owned railway system 
• Consistently voted against measures to reduce tax avoidance 

Has your local bus route recently been closed? maybe you should ask Seema why?

The council came up with an idea on how to part-fund new social housing for the less-well-off, but Seema's against this as well...

On 9 May 2016:
Seema Kennedy voted against giving local councils a right to retain payments in respect of vacant high value council houses to provide new social homes where they can demonstrate a need for them.

Seema's secret NHS privatisation plans involve mass culling of the NHS workforce. Not to worry, Seema's colleagues have another plan to suppress trade union workers human rights if they object.. read on...

On 10 Nov 2015:  Trade Union activity - restrictive regulations
Seema Kennedy voted against requiring the consent of the devolved administrations and local government before applying new regulations on trade union activity within their areas of responsibility. (clause 9) Seema Kennedy voted to require the appointment of a picket supervisor and for them to be identified to, and contactable by, the police.  On the same day Seema Kennedy voted to require a 50% turnout in order to make a strike ballot valid and for other aspects of increased regulation of trade union activity. 

How Seema Kennedy voted on Social Issues

• Consistently voted against laws to promote equality and human rights

•  Seema supports 'fracking' to extract shale gas yet voted against measures to prevent climate change.

 

Maverick's Comments

This MP is a disgrace not only to her constituents in South Ribble, but to British democracy.

Not content with preventing local councils using their own schemes to build affordable social housing for the poorer in society, she then votes with her cronies to attack the disabled by forcing through benefit cuts that remove much needed money to keep a roof over their heads.

Strapped for cash due to Seema's governmental cuts, local councils had no choice but to close some bus routes. So the councils came up with plans for a publicly run service to get them open again. But as usual, Seema Kennedy again voted to stop public control of bus services. Like a spoiled child clinging on to its favourite toy, there's no way Seema and her crony Tory buddies were going to let the peasants get their hands on the railways ever again. She also voted against this.

Not satisfied with apparently bullying trade unionists who actually do a days work, Ms Kennedy then has the audacity to vote against laws that would bring harmony and equality into peoples lives.
But Seema doesn't seem to want that. She apparently doesn't want YOU to gain control of something that would remove profits from government coffers.

I don't know about you, but I thought I'd seen the last of Margaret Thatcher. It seems we have either a reincarnation or Nora Batty has pinned a blue carnation on her pinny and gone on the warpath with the brush handle.

Either way, the sooner England sees the back of MPs like these the better our land will be. No secrecy, open democracy, and most important of all, people who can think for themselves and have a heart and feelings for others.

  I'll leave you with this thought...............

A free health service is a triumphant example of the superiority of the principles of collective action and public initiative against the commercial principle of profit and greed.

            Aneurin Bevan, In Place of Fear

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SOURCES
Seema Kennedy MP Voting record above from: they work for you.com

source origin: www.theyworkforyou.com

Are Clinical Commissioning Groups Awarding themselves contracts?

Chorley and South Ribble Clinical Commissioning Group have seemingly failed to declare conflicts of interest and awarded themselves contracts.

The following details are from the Chorley & South Ribble (C&SR) Clinical Commissioning Group report....

GP Out Of Hours - OOH
(1) The GP OOH services are currently delivered in Preston by Preston Primary Care Centre Ltd (PPCC) from their base located on the Royal Preston Hospital (RPH) adjacent to the Emergency Department (ED).

(2) OOH services are also provided in Chorley via Chorley Medics Ltd (CML) from their standalone OOH base at Euxton.

Point (2) above clearly shows that the CCG buy services from Chorley Medics Ltd. The Chorley medic GPs are also registered with the C&SR CCG under the 'any  qualified provider' accreditation process. GP's sit on the CCG. The CCG buys services from Chorley medics so it would be a huge conflict of interest, if not corrupt, if the CCG awarded a contract to Chorley medics Ltd (effectively awarding itself a contract). Yet the contract was still awarded....

Contract awards
The contract below has been jointly procured with NHS Greater Preston CCG.

Adult (over 16) direct access physiotherapy
■        Chorley Medics Ltd, 114 Wigan Road, Euxton, Chorley, Lancashire


Each time a GP refers an Adult to physiotherapy, Chorley Medics Ltd are paid for the session + any other expenses. The referrer doesn't even have to work for Chorley Medics Ltd, they don't even need to be a GP to direct funds to Chorley Medics.

GP-led commissioning has become a lucrative venture for many. Indeed, this financial year alone (2015/16), the part-time chair of C&SR CCG collected £155,000 from the taxpayer, for being the CCG chair, and that's not including the fact they collect another salary as a partner in their own GP practice. source: C&SR CCG Annual Report

The part-time chairpersons annual CCG salary alone would pay for a blood pressure monitor in every single GP surgery waiting room in Chorley and Preston.

Greater Preston CCG chair collected the highest remuneration for sitting on the part-time CCG committee. A whopping £305,000 including pension benefits remuneration.

 

CCGs, the beginning of privatisation

Chorley & South Ribble (C&SR) Clinical Commissioning Group have wasted no time in privatising local NHS services. As soon as the CCG was formed in 2014, they sold off musculoskeletal (MSK) services to Virgin Care on a £6.9m contract then proceeded to sell off Elective service contracts to the private company Ramsay Healthcare.

Since its advent, little is known about CCGs and how they consult other GPs in their area on service contracts. There's certainly no consultation with the public about how they feel on which services should remain in the NHS or otherwise. 

A CCG cannot even claim to have any popular mandate or support, since CCGs were set up without any public consultation or involvement. The process makes a transparent nonsense of the Tories assurance of ‘no decision to be taken about me, without me’.

For the most part, GPs recognised that if they were forced into the role of commissioners, they would have to take the blame for imposing cutbacks and the rationing of care to their own patients, which were integral elements of the reform package. Clearly this has created a fractious relationship between GPs and their patients.

Some also recognised that GPs would have little day-to-day control over running their local CCG. As clinicians with a caseload of patients, most GPs lack the time, energy and inclination to take on a major strategic management job involving a nine-figure budget, or for planning services in much wider areas than their own practice.

So how can any GP sat as a CCG chair justify collecting  £155,000  per year of tax-payers money?

It's quite clear that those GPs who jumped on the CCG gravy train are in it for financial gain and to forward the agenda of their paymasters, that of privatisation of NHS services.

A handful of well-meaning but misguided idealists have hung in and engaged with the development of the new CCGs, but the involvement of doctors has been mostly limited to a group of willing ‘reformers’, many with an eye to potential personal gain and increased local influence available under the new scheme.extract from NHS SOS

Finally, we must remember that the local CCGs have just sold-off a £35m contract for Urgent Care Centre and associated services that they themselves will likely be employed to use.

I was shocked to see the Health & Social Care bill make its way into an Act of parliament, thus paving the way for privatising NHS services to 'any qualified provider'.

Unless we do something NOW to stop such perceived corruption we will inevitably arrive at the bus stop of no return, and we will have lost our NHS forever...

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Related

C&SR CCG annual report salaries & remunerations

C&SR Contract Awards
source: https://www.chorleysouthribbleccg.nhs.uk/contract-awards

The Chorley A&E/UCC contract and the non-profit Myth

We should be asking WHY the Lancashire Teaching hospital NHS foundation trust sold-off the urgent care centres contract to a non-profit company, after all, we could argue the NHS is non-profit.

Here's a home truth: private companies have been circling the NHS for decades waiting to get their hands on NHS contracts and estate. Bidding for an NHS contract as a 'for-profit' company would reduce their chance of winning the contract.

So they front a company as not-for-profit/non-profit and either hide the for-profit parent company as a trust or subsidiary or simply start-up as not-for-profit then switch to profit making when the time is right (by contract exchange/renewal). *This is what's likely to happen in Central Lancashire once the bulk of NHS estate and contracts have been signed over to other companies next year under the STP plans (our health, our care for example).

There are other methods of switching but many don't need to switch from not-for-profit/non-profit at all since they can make a profit from their business ventures in other ways.

For example, tax-exempt non-profit companies often make money as a result of their activities and use it to cover expenses. In fact, this income is essential to an organisation's survival. As long as a non-profit's activities are associated with the non-profit's purpose, any profit made from them isn't taxable.

There are many other ways to make a profit from a non-profit social enterprise/business, And what's to stop services being sub-contracted out? If it aint accounted for in the contract, it can be done.  But for now we should concentrate on how the NHS A&E is going to work alongside such a company as GTD healthcare.

As suspected, the 5 year contract deal, sold-off by the local CCGs has backfired. The original contract was to provide the services to populations from facilities co located with the Emergency Departments (ED) of Lancashire Teaching Hospitals NHS Foundation Trust at Royal Preston and Chorley District Hospitals. But since the Chorley hospital no longer had an A&E, the contract needed some amendments.

To appease GTD healthcare, a scheme may have been designed that satisfies the above contract; albeit on a 12 hour part-time basis (ironic considering the trust chief executive Karen Partington argued at earlier board meetings the A&E must be 14 hours opening as per NHS England's guidance).

The 14hour/12 hour A&E opening issue is the likely reason the independent report was bounded back and forth before its final release. Someone's been telling porky pies, someone's been stalling the re-opening of Chorley A&E for quite some time and we can all guess who and why, But we'll come to that later....for now just remember these words 'our health our care'.

And be prepared to battle to save the very heart of our NHS in the coming months...

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Contract Description
https://www.contractsfinder.service.gov.uk/Notice/7e501d15-b25d-4d3c-9223-dd10aad95c73

Tory NHS Privatisation and its Labour Advisors

Which political party do you trust to save our NHS?  or is it too late to be saved?

Lord Patrick Carter, a Labour peer, is advising Tory Health Secretary Jeremy Hunt on how hospital budgets can be better spent.

Carter (Baron Carter of Coles) co-founded private nursing home company Westminster Health Care in 1985 with Martin Bradford. And now, he's just suggested that bed-blocking in NHS hospitals could be solved by sending patients awaiting discharge to,,,, you guessed it,,,,, private nursing homes.

In an attempt to recoup losses in the NHS brought about by his previous leader, the warmongering, NHS privatising 'Tony Blair'; Lord Carter has joined forces with NHS England boss Simon Stevens, a former Labour Councillor for Brixton, in advising Hunt on how to privatise the NHS.

Ironically, Stevens who also advised Tony Blair on health policy, also advised New Labour on how to get the private sector more involved in the NHS.
He supported Andrew Lansley’s NHS reforms which led to the Health & Social Care Act 2012 passing through parliament resulting in opening up the NHS to private companies, formulation of CCGs, and the STP plans we are seeing now across England.

Oh, and while we're at it, Simon Stevens wants the Conservative Michael Gove’s free school policy applied to the NHS.

The NHS must be really be in the sh1t if they are taking advice from a former president of American healthcare company UnitedHealth, the largest private health insurance company in the US.

Stevens' previous experience seems to be coming useful in preparing the NHS for privatisation, and for the introduction of a US-style healthcare system.

Times of austerity gives the Tories just the opportunity they need to implement allsorts of policies they otherwise wouldn't.

Remember austerity in the 80's amid the recession?
The Tories then began to propose privatisation as a potential panacea. Conservative MP Geoffrey Howe extolled the "discipline" of the marketplace in the NHS via commissioning.

The emerging doctrine was that privatisation would make the large utilities more efficient and productive, and thus make British capitalism competitive relative to its continental rivals. In this period, the government sold off Jaguar, British Telecom, the remainder of Cable & Wireless and British Aerospace, Britoil and British Gas. The focus had shifted to privatising core utilities.

But now, after being elected in 2015, they're back, they're bad, and this time they're after privatising our NHS. And it seems they have the support of Labour peers and former Labour councillors to nudge everything along!

They all more or less seem to support the same disastrous policies for dismantling our NHS.

Well, considering the UK electorate generally votes Tory or Labour 'cos their dad did' it seems we need to make a decision on which laughable party would better protect the NHS at the next election.

I don't trust any of the mainstream parties, but there are rumblings in the Labour movement that a bloke with the initials JC would uphold his promises when elected to government, to reverse the damages done to the NHS since the Blair years.

Yet time is of the essence, and the next election is a long way off.
Not heartwarming considering the tories are currently steaming ahead with plans to make full use of the previous coalitions H&SC Act and fully open up the market to privateers and implement Simon Steven's 'five year forward view'.

Between now and the next election in 2020 the only hope we have of saving our NHS is for the people to come up with their own ideas, their own 'plans' to prevent the private sector onslaught.

If you do have any ideas on how to save the NHS from privatisation, it might be wise to keep them to yourself. At least for now...

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Lord Carter's plans for saving the NHS £5bn a year
http://www.bbc.co.uk/news/uk-34589128

What's Stevens doing running our NHS?
https://leftfootforward.org/2014/04/4-things-you-should-know-about-new-nhs-england-chief-simon-stevens/

NHS internal market - a history of privatisation

A moment of honesty is required - New Labour began the dismantling of our NHS

Chorley & Preston hospitals could be demolished under new CCG plans

New information released under nationwide NHS transformation plans shows 'polyclinics' could take over most hospital services leaving many hospitals to be demolished and sold off to housing developers.

As we know, the sustainability & transformation plans (STP) are being rolled out all over England. This means some areas are at different stages of roll-out and some are behind.

clearly we should be watching what's happening with those areas that are ahead of us in the roll-out since we can learn from their experiences and how they are handling the privatisation plans.

As our Network expands we liase with other campaigners in the fight to STOP any further cuts & privatisation of our NHS.

So far, the STP plans, rolled out under various guises such as 'right time right place, or our own 'Our Health our care', have lacked any detail, with the CCGs and trusts giving the public fanciful ideologies about what 'might' be the way forward.

Multispecialty community provider (MCP) clinics

Finer details of the stp however are now coming in, and as expected, NHS England's STP plans follow the privatisation model where the more lucrative routine hospital treatments are 'integrated' into special clinics called Multispecialty community provider (MCP) clinics.

The MCP model, as laid out in the 5 year forward view, is where GP group practices 'expand', bringing in nurses and community health services, hospital specialists and others to provide integrated out-of-hospital care.

Essentially, private consortium's won't touch Acute (emergency) services since these are high risk with little or no return. So as VirginCare have done, they aim for the more lucrative procedures which are low risk and a guaranteed income.

These routine services are currently undertaken in hospital settings.
So part of the STP plan is to bring these hospital services 'closer to home' by moving them into new MCP clinics. This means demolishing some GP surgeries and expanding them into MCP clinics where consortium's will bid on which services to provide. *This is the reason C&SR CCG ran the primary care estate survey 2 months ago.

Both Chorley & South Ribble CCG and Preston CCG are currently promoting the MCP model (there are several versions of MCPs) and are intent on implementing it. Due to the large NHS deficit it's anticipated most of the MCP services will be contracted to the private sector. Ultimately, due to the loss of income, the NHS will cease to function as a publicly funded service and the CCG's will become insurance based intermediaries providing only basic means-tested services (similar to universal credit welfare).

Since hospitals will no longer provide these services, they will be demolished and replaced with much fewer super-hospitals.

But the MCP clinics (sometimes called 'polyclinics') are only part of the STP plan.

The two main thrusts of the STP plan are to keep people OUT of hospital and 'help' educate them on prevention.

Whenever you see the word 'prevention' replace it with 'rationing'.

Successive governments tinkering with the NHS have all tried the prevention route and it's always failed. You can lead a horse to water, but you can't make it drink.

But there is light at the end of the tunnel, and that light is YOU!

Educate yourself, ask your GP what he/she thinks about the STP plans and about GPs spending all their time planning and scheming with trusts to privatise your NHS.

what does your MP know?
your local health and well-being board or scrutiny committee?

Our NHS is on the precipice of collapse. Health bodies previously responsible for running our NHS such as local health authorities and GPs, once fervently opposed to privatisation, are now embracing it with open arms, under the umbrella of market 'commissioning'.

We simply cannot rely on others to help save our NHS. The passage of the privatisation policy riddled Health & social care bill into the Health and social care  Act in 2012 is PROOF that we can no longer trust the BMA, GP Confederation, politicians and others when it comes to protecting our NHS.

Our NHS has been betrayed by the very people we entrusted it to.

Battle lines have now been drawn. If WE stand together we can prevent the onslaught of marketeers and reverse the process.

Related
http://www.patients4nhs.org.uk/redesigning-services/

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Our Health Our Care, and Healthier Lancashire. A plot against our NHS?

England has been split into 44 regions called 'footprints'

here is a big change programme being designed across Lancashire and South Cumbria.”

Read more at: http://www.blackpoolgazette.co.uk/news/lancashire-s-hospitals-changes-on-cards-1-7949713

Read more at: http://www.blackpoolgazette.co.uk/news/lancashire-s-hospitals-changes-on-cards-1-7949713

There is a big NHS change programme being designed across Lancashire and South Cumbria, and we better be prepared. 

I'm going back a few weeks to the shock news that the local hospital trust board and CCGs are considering options to build a new super hospital and reconfigure or even dispose of Chorley & Preston hospitals.

Lancashire Teaching Hospitals (LTH) NHS foundation trust wouldn't mention this unless they were serious about their intentions, and this is why we must be prepared to fight tooth and nail to keep hospital services here in Chorley and South Ribble (C&SR).

There is much suspicion, and rightly so, that the Preston hospital site would be sold off for housing development with potentially the same fate for C&SR hospital. This ties in with the Lancashire County Council city build program which dictates future housing development in the region to take into account growing populations.

The LTH Trusts and CCGs 'Our Health Our Care' program is a short term plan that runs alongside the longer term 'Healthier Lancashire' program to transform how care is delivered in our region.

Both these programs are part of NHS England's five year forward view (FYFV) which divides England into 44 regions called 'footprints'. We are footprint 4, Lancashire & South Cumbria.

Each footprint has been ordered to produce a 'Sustainability & Transformation Plan' (STP) by 30th June this year to completely change the way the NHS works. Footprint Boards have to prove they can clear their debts within a year. And how do they do that? They cut more services, close more beds, sell off land and hospitals that are public assets.

These plans are not 'pie in the sky' and very soon we will be confronted with decisions that far outweigh the campaign we're currently fighting.

To give you an insight into just how serious the LTH trust are about implementing the STP plans in our region, they've just undertaken a risk-assessment that looks at what to do in a situation where the public seek a judicial review over the highly contentious decisions they and the CCGs will be making on the STP...

"The Strategy and Development Director acknowledged that the processes described within the [STP] presentation were formulaic although this was a tried and tested model utilised by a number of organisations involved previously in significant service change and would ensure avoidance of any potential judicial review".

The above is from last months trust board report, although I have doubts over the claim that significant service changes are tried and tested, but we can't take any chances. The first phase of the our health our care has now been implemented.  Of course you didn't know about it because you're not supposed to.

It's now time for all those concerned to step in and start asking questions about what the details are in the STP plans for our region. What does MP Seema Kennedy or MP Lindsay Hoyle know about these plans?

Doctor knows best, or does he?

Local Clinical Commissioning Groups (CCGs), which are supposedly 'GP-led', seem to be accepting the plans put before them by the hospital trust board with little or no opposition.

This is due mainly to the fact that they too are unaware of the long-term consequences of the plans, which many believe are for the current government to implement a privatised healthcare system similar to that in the U.S.

They will aim initially for a 3-tier healthcare system (basic NHS service, NHS services topped up with either private services or fee-paid optional NHS care, and fully private services). *As described in The Plot Against the NHS.

Basic NHS services will gradually be replaced with healthcare insurance similar to that in the USA.  As supported by the former private healthcare advisor and boss of NHS England ‘Simon Stevens’ (see link at bottom).

To implement the STPs, the trusts involved will need the backing of GP's as the trust and its directors of strategy progress through each stage of the STP.  Our aim now is to stop them, in their tracks!

We will need to work alongside our GPs and convince them that the STP strategy is taking our NHS in the wrong direction, that of privatisation. We'll need the backing of MP's and councillors from all over the region. We will need to get more involved and write and find out if MPs, county councillors and others if they are aware of what's happening. We will need to be very convincing...

and there's nothing more convincing that the thought of losing our National Health Service to  a government who is hell bent on making money off the backs of the sick and poor...

related link:
999 Call for the NHS & the 44 Footprints of Death

Trust Boss claims Grantham A&E is an Urgent Care Centre, stalling Chorley A&E re-opening

GP's have asked the trust board why Chorley A&E can't be re-opened on a part-time basis like Grantham A&E. The trust boss says Grantham is not running an A&E but an urgent care centre, but maverick has proven otherwise...

Differences of opinion have broken out between the GP commissioners group and the hospital trust over what type of Emergency services are currently being provided at Grantham hospital. 

Grantham A&E department was closed overnight in August this year [2016]. 

As with Chorley A&E, health trust bosses at the Lincolnshire Trust said there weren't enough doctors to staff Grantham A&E around the clock. United Lincolnshire Hospitals NHS Trust, who run Grantham hospital, said it was temporarily changing the opening hours of the Grantham A&E to 9am to 6:30pm.

So GPs at the meeting in September were asking the Lancashire Teaching Hospitals (LTH) Trust why can't Chorley A&E open the same number of hours as Grantham A&E?

The question was put to the LTH Trust at a previous meeting between GP commissioners and the trust.

Karen Partington, CEO of Lancashire Teaching Hospitals NHS trust was asked by a GP why Chorley A&E could not follow Grantham hospital and open Chorley A&E 14 hours part-time.
 
Ms Partington told told the meeting she'd been in contact with the CEO of the Grantham Trust who confirmed that Grantham Hospital was not operating an emergency department but was providing services in line with those delivered by the Chorley urgent care centre instead.

The Grantham hospital emergency department is however still operating 14 hours a day, and this has been widely publicised.  Confusion must have broken out with one GP claiming Ms Partington should provide evidence of this via NHS England.

To resolve the issue I thought I'd don my Sherlock Holmes cap and contact the Grantham Trust to see if the hospital was operating an emergency department. Here's the reply I received....

Dear Gary,

Grantham A&E  is opened from 9am -6;30 pm seven days a week. It takes medical emergencies but not surgical emergencies. Grantham and District Hospital A&E department supports patients with minor and major injuries from 9am-6.30pm.

For more detailed information please visit https://www.ulh.nhs.uk/services/accident-emergency/  and you can also find some answers to  frequently asked questions on https://www.ulh.nhs.uk/news/lincolnshires-aes-at-crisis-point-frequently-asked-questions/?platform=hootsuite .

Kind regards

United Lincolnshire Hospitals NHS Trust
Patient Experience Team
Grantham & District Hospital
101 Manthorpe Road
Grantham
NG31 8DG

So, why would Karen Partington tell the GP-led CCG that the CEO at Grantham had told her emergency services were not available, when they were?

Of course it is possible the CEO of the Grantham trust may have misled Ms Partington about the services available at Grantham A&E. BUT considering all the media publicity about Grantham A&E remaining open - which Ms Partington would have known about - this is unlikely

In this case it isn't a matter of being 'economical with the truth' now is it?
 
But what do the hospital trust hope to gain by keeping the A&E at Chorley & South Ribble hospital closed?

Their are several reasons ranging from the trust needing a 12-month trial period to determine how the Urgent Care Centres  and other surrounding hospitals would cope with the closure; financial reasons due to the loss of A&E tariff and the large increase in UCC running costs; to the fact that NHS England  will withhold Sustainability & Transformation Plan 'funding' if the trust don't reduce their deficit enough to allow the Sustainability & Transformation Plans to be implemented smoothly. And of course, the elusive middle-grade doctors.

It's little surprise that the LTH trust board along with other healthcare associated bodies such as the  CCG, ambulance service etc. don't wish the public to attend their secret meetings.

It certainly brings into question who's running the show in the 'buyer - provider' internal NHS market. 

I've always said I have faith in my doctor, and in this case, I maintain that belief.

Protect Chorley Hospital from Cuts & Privatisation

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Chorley A&E a less profitable venture?

14th Sept 2016

"we receive lower income for non-elective activity as compared to elective activity, and this year our non-elective activity levels have driven down our elective activity".

(Mr P Havey Acting Chief Executive Lancashire Teaching Hospitals NHS trust at a council of governor meeting April 2016)

Existence of foundation trusts rely on financial viability, if a service becomes financially less-profitable then that service may go out the window or take a lower priority.

In the above, non-elective (emergency) activity (services) have forced the trust to delay or abandon some of the more lucrative 'elective' services. Each time a planned elective operation is cancelled the trust risk facing sanctions plus a loss of income due to the non-elective taking up resources. Emergency services are also higher commercial and clinical risk.

Cancelled surgery due to a shortage of beds left the trust out of pocket as it had to pay for extra clinics and "outsource" operations to other trusts. The trust's chief executive said she will take "necessary action".  Source: Lancashire teaching hospitals NHS trust, June 2015

One way to 'take necessary action' and turn-around a loss of income and drive up the lucrative elective activity would be to remove the emergency service, or reconfigure it in some way so that less time and resources (i.e. money) are spent on that activity. One reconfiguration is to close the A&E thus downgrading it to an urgent care centre. There are several other methods LTH have supported such as paramedics ringing for a doctor home appointment so as to avoid taking patients to A&E...

Of course, closing the A&E means the emergency service would need to be provided elsewhere, but that's not such a problem for a hospital trust with '2' emergency departments. is it?

I'm not saying this is what's happened at Chorley & South Ribble hospital, but when campaigning to reinstate such a treasured service we must consider all possibilities.

After all, even though the Lancashire Teaching Hospital NHS Trust are in serious deficit they say that money is not the reason for the closure of Chorley A&E. But I'll let you decide...

Lancashire's hospital services are being privatised, and you never even knew it.

fictional image, but this could be the future of the NHS

Hospital services in Lancashire are gradually being privatised, and it's all being done before any public consultation takes place.

THE News a few weeks back of the possibility of Chorley and Preston hospitals losing their acute services with all other services being provided at a super-hospital came as a shock to many.

But for those who follow the changes in health services will recall that the idea of 'polyclinics' and 'super-hospitals' has been in the pipeline for a long time.

Back in 2012 the 'Independent' ran an article about what might happen if a hospital trust in serious deficit failed to pay its debts. It was mentioned that the DoH was unable to explain what will happen if a trust fails to pay its debts or how services to patients would be maintained.

"The scale of the challenge facing the NHS is revealed in figures showing that 34 trusts ran up combined debts of £356m in 2011-12 and another 42 relied on handouts from local health authorities or the Department of Health (DoH) to keep them going – almost 19 per cent of the 411 NHS organisations in total, MPs say".

For example, the Public Accounts Committee (PAC) in 2012 suggested administrators might be appointed to oversee the crisis-hit South London NHS Healthcare Trust and recommended that it be broken up and run by neighbouring NHS trusts, or offered to private companies.

Another example given is about a trust, which runs three hospitals in south London – the Princess Royal in Bromley, the Queen Elizabeth in Woolwich and Queen Mary's in Sidcup – overspent by £65m last year (2011), or more than £1m a week, and became the first in the country to be taken over by government-appointed administrators.

The same fate awaits other trusts unless they take radical action to cut budgets by closing departments and merging services with neighbouring organisations. What we saw in the news article the other week about Chorley And Preston & a super-hospital was a glimpse of Lancashire Teaching Hospitals trust 'sustainability & transformation plan' or STP for short. And there's a reason they've kept the STP quiet for so long.

Now recall from my previous post that in June last year, the health watchdog 'NHS Improvement' said it had "serious concerns" over Lancashire Teaching hospital trust's finances after it predicted a £44m rise in its deficit. The Lancashire NHS Trust's budget was forecast to rise from £2.8m in 2015 to £46.8m this year [2016].

Something drastic needed to be done. The Lancashire trust simply cannot continue to borrow money to prop-up its services without facing serous financial penalties. Or worse, having to be placed in special measures thus losing its 'foundation trust' status, and ulitmately going bancrupt.

This is where the transformation 'plan' comes in.

To remain financially viable, the Lancashire trust must run a 'two-step' process that involves relinquishing some services to the private sector, such as the recent contract awarded to the private provider gtd healthcare to run its urgent care centres, followed by a merger with neighbouring trusts.

The merger as we now know; is already taking place between Lancashire & South Cumbria under the STP reconfiguration plans. NHS England boss Simon Stevens wrote to all hospital trusts in England last year ordering them to get their finances under control and prepare to implement the 'five-year forward view', a document all trusts have been working towards over the last few years.

The 5-year forward view, which includes STP plans for all trusts, involves dividing NHS trusts in England into 44 regions called 'footprints'.

Each footprint, such as Lancashire & South Cumbria, have been ordered to produce a plan by 30th June this year to completely change the way the NHS works. This is why we didn't hear about the proposed merger and super-hospital in Lancashire until only a few weeks ago.

Footprint Boards have to prove they can clear their debts within a year. And how do they do that? They must cut more services, close more beds, sell off land and hospitals that are public assets.

The details of each STP plan for each region will vary, but essentially most if not all local hospitals will no longer provide emergency/acute services and instead be run by private consortiums under the NHS kitemark.

Think of this as having a combined hospital & urgent care centre using an 'integrated' approach with elective surgery and some emergency medicine (not A&E) provided by a very large consortium of GP's and nurse practitioners.  Essentially, the kaiser permanente American insurance model of a 'polyclinic'. All major A&E/trauma will be provided at the super-hospital, which, will eventually be run as a public/private venture (think of this as a PFI but for healthcare services).

The internal market created in the NHS has indeed got the ball rolling for a full privatisation of our NHS, and we have been betrayed by all those who failed to prevent it. Made much worse of course by the Health & social care bill sauntering through parliament into an Act in 2012 that allows such a takeover of publically run services.

The closure of Chorley A&E was no accident, since the Lancashire teaching hospital trust were told in 2014 by the CQC to recruit A&E doctors & nurses to sustain services for the future. The trust chose instead to run a skeleton staff coupled with agency cover alongside consultants paid over-inflated salaries to fill the rotas.

We, as stakeholders and users of these services are now paying the price for trust managers failing to take action when they should have. But there is hope.

The trust boards are now well aware they are under more scrutiny that that of the CQC. WE  are watching, and more importantly we intend stopping their secret STP Plans before they take hold of our services and hand them over to their private buddies.

MP's and others may have been sleep walking when they allowed the health & social care act to saunter through parliament. But that's where it STOPS, and now we know the overall plan to denationalise our NHS we can take evasive action and stop it in it tracks.

Our Networks are now in place, there will be no footprints, there will be no NHS take-over. And when the time comes, we will be prepared to fight for something that nobody will ever again attempt to take away from us again.

There has been no openness and transparency, We have no choice, we must STOP these plans.

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