Not just Chorley A&E, 80% of other routine services also to go

WHEN the consultation comes round certain committees will have been 'briefed' long beforehand about the dangers of attempting to run a hospital A&E on short staff levels.

Let's face it, there's been no change in the Hospital trust board's recruitment campaign so they'll use the staff shortage issue to push thru' the now not so hidden agenda of service transformation to an American style health insurance system.

After all, they've made it very clear, the A&E departments are driving all the deficit and if they can downgrade them one at a time (starting with Chorley A&E) they can proceed to concentrate on the longer term plan of closing Preston A&E and having a single 'trauma centre' somewhere in between both sites.

Ultimately, that's what THEY want, not what YOU or I want, but what 's best for the trusts longer-term finances. When hospital services are closed, there are no 'better outcomes'.

But that's only a small part of the plan, and last week the LEP reported the trust had plans passed at Chorley council to build a £17.5 m building including operating theatres to do ophthalmology and related procedures - which BTW is part of the elective only site planned for Chorley district hospital (CDH).

This again, is inline with the 2012 health & social care act (NHS privatisation act) which authorised hospital foundation trusts to gain up to 50% of their income from private sources - so expect many paying patients at the new building, the one taxpayers paid for.

The government so-called write off fund of £215m for LTHT may cover some existing costs but won't cover the deficit over the next year or 2 . It will however help to go dome way towards meeting the requirements in the STP/10 year plan to dismantle the NHS and transform it into 44 local American style Acccountable Care Organisations (ACO) throughout England run largely for profit.

EIGHTY percent of services, along with our A&E, are planned to be closed at CDH and moved into private buildings or hubs previously owned by local councils, but will become joint ventures along with sales of public hospital buildings & land left behind.

They did it with the land at the hospital and it became private property used for parking. The closures however won't be 'leased', they'll be GONE FROM OUR HOSPITAL FOREVER.

It will be almost impossible to integrate the services back where they belong, under public control in public buildings and hospitals.

The Health & Social Care Act simply must be revoked and an end put to the market in our NHS. All trade unions must come together and say NO to hospital trusts forming subsidiary companies (SubCos) and fragmentation of our services being moved into private community clinics.

An all out strike is needed by all unions as the Tories know full well they are winning the conversion of our NHS into a profit extraction machine, doing it bit by bit so it largely goes un-noticed.

When the time comes everyone must do their duty and fight tooth and nail to keep health services in the public sector. It's more than your life is worth. Everyone is at risk...

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Join the campaign to save Chorley A&E NOW!

For more on how to get involved visit the campaign group facebook page:

Protect Chorley & South Ribble Hospital Campaign

Chorley A&E, debt write offs, and the consultation farce

Chorley A&E, debt write offs, and the consultation farce...

11th July 2020

Ironic isn't it, no sooner have the Lancashire hospital trust received a £215 million 'debt write-off' [loans cancelled], the hospital board announce its plans to build a four-storey, state-of-the-art extension at Chorley Hospital.

The local democracy reporting team also reported this week that a public consultation into the future of the accident and emergency department at Chorley and South Ribble Hospital could begin within weeks of the unit reopening in September

No Local Plan to Retain A&E at Chorley

The local 'NHS transformation' plans titled 'Our Health Our Care' & public consultation are due to continue next month which implies all the trusts efforts (and plans) have been towards utilising their get out of debt card, constructing a four-storey building, converting Chorley hospital into a step down cottage hospital with pre-planned elective ops but no A&E, and accelerating progress on the Integrated Care Program.

It's a myth that Chorley & South Ribble hospital is getting its A&E back since it hasn't had a type 1 A&E since April 2016.

What Chorley hospital will be getting back from Preston, assuming the virus doesn't recur, is the staff that were moved to Preston to deal with the coronovirus uptake in March.

In August 2016 the a group established by the trust & CCG called the Systems Resilience Group (SRG ) agreed that "it has no other realistic option but to maintain the current service of an 8am until 8pm urgent care service at Chorley Hospital as the best way of ensuring the delivery of safe and sustainable care for patients".  This will be reviewed again in April 2017.

Chorley hasn't had an A&E since then, only the privately run urgent care centre with no overnight fracture x-ray diagnostics.

This week we've seen what little value is placed on 'public consultation'. NHS Managers in South West London and Surrey have announced their decision this week to downgrade two existing Major Acute Hospitals - Epsom hospital in Surrey and St Helier hospital in South West London - BOTH will lose ALL of their Acute Services.

So in summary, it's only clinically viable to open the Chorley A&E if the trust board wish it to be such. Currently, the trust have been criticised by the county councils health scrutiny committee for failing to provide evidence the trust have undertaken an extensive recruitment campaign to hire mid-grade doctors to enable re-opening of Chorley A&E.

And with the millions proposed for a new 4-storey building at Chorley, along with the local Our Health Our Care plans to centralise and have a single A&E at Preston (short term), the chances of retaining the Chorley A&E are down to everyone across the land coming together to take action. That includes trade unions, community partnerships, volunteer groups, community NHS campaigns, councillors, MPs, supporting GPs and so on.

As we've seen with the Huddersfield Infirmary fiasco and now the Epson & St Helier hospital service closures, consultations are a farce, and as long as the Lancashire hospital trust play the staff shortage card, it appears they will continue to push the local NHS privatisation plans through just as the government intended...

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Could Chorley and Grantham A&E closures be permanent?

A&Es are being closed as a temporary measure, but often in areas where NHS leaders have been trying to permanently close them in the face of strong public objections.

Serious questions have been raised over the future of the many services including A&E departments “temporarily” closed during the peak of the Covid crisis, many of which NHS bosses had sought to scale back in previous plans.

People of Chorley, South Ribble and surrounding areas are only too familiar with having to fight to save their A&E service at Chorley. The hospital has a history of having its A&E targetted for closure. Yet the resilience and fightback from  local campaigners has managed to stave off the ravages of capitalism and maintain the services, albeit part-time with a view to re-opening full time. But now even the part-time status of Chorley's A&E is at risk.....

Questions have been asked in the Commons over the “temporary” closure of already reduced A&E services in Chorley, Lancashire, and concerns have been raised locally over other “temporary” closures of A&Es in Cheltenham and Weston super Mare, and emergency surgery in Ealing Hospital.

Chorley

Health Secretary Matt Hancock has given a formal commitment in the Commons that Chorley’s “temporarily” closed part-time A&E will also reopen, although no time frame has been set. Here too plans to permanently downgrade the A&E, and use the Chorley site only for elective patients have been hotly debated for years.

Chorley’s MP is Commons Speaker Sir Lindsay Hoyle – and has been working with other local MPs to resist the pressure to downgrade the hospital. Sir Lindsay welcomed the health secretary’s comments about reopening the A&E commitment”, but stressed that “the pressure [will] remain until that happens”.

The Chorley hospital A&E closed in 2016 on grounds of staff shortages, triggering a storm of local protest that forced a partial reopening, but trust bosses and local commissioners have continued to favour options that would close the full-time A&E and critical care beds at Chorley.

Last August [2019] a document assessing 13 options for the future of hospital services in Chorley and Preston was published arguing it was not “clinically viable” to retain accident and emergency facilities at Chorley. However it also argued that “It is clear from high-level clinical activity modelling that the population health requirements could not be serviced by one of the two current hospitals” – and there was no money to build a new hospital, or expand either to cope. Indeed while the report claimed to be “clinically led” it noted that its preferred options were precluded by a lack of capital and the financial plight of the trust.

By January 2020 it was clear that reports by four different sets of clinicians had all come out against the possibility of either restoring a round-the-clock A&E unit or continuing with the existing limited hours service at Chorley.

Whilst that may sound defeatist, we must remember that all these so called clinicians are guided, not by proven clinical outcome, but by promises of an untrialled system that aims to alleviate financial constraint by providing less healthcare. 

Some excerpts above taken from the full article of The Lowdown [see link below] which looks at the disgraceful way Grantham hospital and its residents have been treated and how Chorley and other hospital A&Es need to be aware of the dangers of broken promises...

Click below to read the full version from The Lowdown

Will “temporary” closures and cuts ever be reversed?

We want social care not American accountable care

Sustainability & Transformation Plan (STP)

Remember that term? STP?
Turns out it wasn't just an acronym for Straight To Private or Slash Trash & Privatise. These 'plans' were all along a smoke screen for salami-slicing the NHS in England into 44 regions then implementing private health style American Care Organisations (ACOs).

The plans have thus little to do with delivering a local vision to improve health and [social] care across Lancashire & South Cumbria.

These ACO plans are ultimately a response to cull the rising costs of healthcare and out of control hospital trust deficits and council social care costs.

The system the current government wish to replace the NHS with (they call it 'transformation') uses American 'accountable care organisations' (ACO) that are based on providing less care to save costs. 

The ACO does this using a restrictive and mean-spirited 'fixed-term' per-person (capitated) budget that relies heavily on patients 'looking after themselves'.

The mainstay of the savings however come from rationing or denying patients treatment and medications, after all that's how American health maintenance insurers operate.

Rationing of surgery and medications in fact has already begun. An ACO simply salami slices public NHS services then hands them over to the private sector for profit extraction.

Warrington & Halton hospital trust for example have already prepared a NHS price list showing how hospital operations will cost patients up to £8,000 each

As reported June 2019

And to help the ACOs along, they've drafted in Simon Stevens, the ex vice president of United Health (commercial operations Europe), the largest private health insurer in America.

The NHS has no place for Mr or for that matter Mrs 'Moneybags' as it was not designed for profit and has shown to fail miserably when market forces are used to run it. It's time to take back control and kick out the rotten money grabbers and get the NHS back in the control of the people it serves.

Revoke the 2012 Health & Social Care Act and reinstate a universal publicly funded/run NHS free at the point of need. Do it before Handcock and Johnson sell it off to the American multinational health insurers, who have already infiltrated the NHS...

Related/Links

• Mr NHS 'Moneybags' in local post..

Chorley Hospital must not be fragmented into a cold-site

Fragmented services will see the demise of Chorley A&E

I've just read an article from the Health Service Journal (HSJ) promoting separating pre-planned surgery (elective) from unplanned activity A&E/Urgent care.

This is the plan the Lancashire Teaching hospitals NHS 'foundation' trust have in mind under the Our Health Our Care program - part of the governments 10 year plan to close and downgrade many hospital A&E departments thus priming elective procedures to take in private paying patients.

After all, that's what a foundation hospital was setup for, as a company that could make up to 50% of its profits from private means.

This will no doubt mean the A&E at Chorley and South Ribble hospital will close altogether leaving no emergency cover for over 200,000 people, excluding tourists and others that may need to be diverted there due to other A&Es having no beds.

I'm also being lenient on the future numbers as well, since the mid-2000s there has been an explosion of housing in the Chorley and central Lancashire area that would no doubt require accident and emergency services to prevent overflows at neighbouring A&Es.

See also: Chorley population increase warrants own A&E

Splitting elective surgery on a separate hospital site (called a cold site) from unplanned activity at a trusts other hospital (called a hot site) is a financial proposition that deals with a short-term bed-blocking and financial problem.

It is not a viable long-term solution for a growing population as seen in Central Lancashire and many of my fellow campaigners would argue that such short-sightedness will cost lives in the longer term.

As an example, take the idea of separating A&E into 2 parts: patients that present at A&E but after triage don't need emergency treatment (urgent care), and those who do (emergency care).

The A&E at Chorley has always had this urgent/emergency triage system.
However, it was almost impossible to convert such a system into a profit-making venture as all those who presented at the A&E department came under the public NHS umbrella.

What was needed was to fragment the A&E into the 2 parts thus priming the urgent care ready for privatisation.  This is what's happened at Chorley hospital, and any steps to fragment services further, such as making it a cold-site, could result in further privatisation of elective procedures. 

In fact, this is the objective of the 10 year plan and we've already had a peak of just how ugly it looks. Take a look here at the 'price-list' proposed by Warrington & Halton hospital trust who planned to charge patients up to £20,000 for treatments - previously available for free, but removed and charged for by the local Clinical Commissioning Group (CCG).

Fragmented Hot & Cold sites are a response to previous hospital and bed closures

A well managed general hospital fully staffed working well below 100% capacity wouldn't see an increase in A&E attendances as 'random intrusions' (as this HSJ article so bluntly puts it) to daily elective and outpatient services .

The sole reason for concentrating on elective pre-planned ops is they are lower risk with a higher guaranteed profit turnover, either via Pbr (Payment by results) or private patients (tending more to the latter these days).

The separation across sites also fails to recognise that staff who work in ED are also required to work in other hospital departments when A&E sees less activity.
If an elective patients' condition deteriorates they still have to be transferred to ICU anyway making it another hurdle and risk.

The model shown in the HSJ article is flawed and reaches a false economy since it suggests increasing bed capacity over the peak winter months to meet demand.

There is something inherently wrong, not with the models proposed, but with the sheer number of unpredictable A&E attendances. And that's the capacity Vs demand problem.

The HSJ article/model attempts to plan bed capacity around A&E activity which is futile due to the fact that over half the beds (and hospitals) have been cut over the last 30 years. To make it worse, successive governments have closed post-trauma/chronic support hospitals and geriatric hospitals which used to take a huge bed burden off general hospitals, including A&E.

That's where the solution lays. 

A modern hospital building program is needed to accommodate an increasing population and to replace those closed over the years. Closed by incompetent politicians who have tinkered around the edges of the NHS for their own political gains.


Related Links

HSJ article: The case for separating 'hot' and 'cold’ facilities

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

council service cuts add to coronavirus misery

Geoff Driver - council leader

Lancashire County Council Cuts to Health & Wellbeing Services add to Coronavirus misery

According to latest recorded coronavirus death toll figures*, the UK mortality rate due to the coronavirus (COVID-19) stands at 12.15%.

That's over four times higher than the 3% Boris Johnson and his health advisers forecast mid March.

Social Isolation

Dementia is the highest killer in the UK today. Previous studies have shown that social isolation, or having few interactions with others, is associated with an increased risk of dementia and cognitive decline.

The support to socially isolated families before the outbreak was cut by Lancashire county council last year.

The health & wellbeing servcies of people in Lancashire helps vulnerable people with issues such as Social isolation - loneliness, few or poor social skills and those who find themselves in difficult circumstances - family finance, employment, education and so on.

All these services, which included dementia patients, were STOPPED by the Tory controlled County Council just before the coronvairus outbreak last December.

Advice ignored

At the time, civil servant advisors warned Lancashire county council (LCC) they were creating a 'false economy' since the social return on investment (SROI) for services to be closed was seven-fold, and cuts in these areas would need to be accounted for in other service areas. Their advice was ignored and LCC went ahead anyway.

The proposal to end the Lancashire wellbeing service (LWS) was purely financial as LCC have provided no evidence that demand has exceeded supply and no business case has been proposed to replace the LWS with other services.

Vulnerable people using the wellbeing service have literally been thrown on the scrapheap, and now they have the added burden of having to contend with social isolation due to the coronavirus.

We are now all paying the price of social isolation due mainly to the complacency and arrogance of the unelected Prime Minister and his handling of the viral outbreak in the early warning stages.

And it could be sometime before the lockdown is lifted.

But hey ho, not to worry, due to the flagging economy, ministers are now considering balancing the results of health implications due to the lockdown and those due to the virus and whether to ease the lockdown earlier than forecast.

Well we all know what happens when this government make forecasts.

Either way, the ill-thought out and misjudged errors they made is going to finish off many UK citizens, whether social isolation is lifted or otherwise.. the damage is done, yet the death toll due to this awful virus continues to rise...

Related/Links

*8.4.2020 UK recroded infected 73,758 deaths 8,958

Social Return on Investment (SROI) analysis

This document commissioned by LCC LWS in December 2017 proved the need for the Lancashire Wellbeing Service in terms of the benefits vs financial input.
SROI analysis showed the that LWS creates positive impacts for its service users, for their family members, and for associated partner services of LWS.

Lancashire County Council budget: protesters defend value of public health and children's services which could be scrapped

Deaths from recession and due to coronavirus may need to be balanced


Dementia: Preventing social isolation

The NHS is being Americanised, and we're all about to pay the price

image courtesy of Vox health

Demand management, capped budgets, restricted care, rationed operations, drug price hikes... American style health care is now almost certain to change the face of the NHS.

Well, with the December 2019 general election now over and the results favouring the Conservatives, the chances of the NHS in England going the 'American way' are now very high.

I'm hoping at this stage you're all aware of what myself and other NHS campaigners have been saying for some time, and what you are about to lose.
So here's a recap....

The man running the English NHS 'Simon Stevens' is the ex health boss of Americas largest health insurer, United Health. Ex Labour councillor and adviser to New Labour's 'Tony Blair' his CV as a privatiser should be of interest to NHS campaigners...

• Stevens was UnitedHealth Group Vice-President and President and/or Chief Executive Officer of UnitedHealth group companies 2004 – 2014;
• Since 2014, Head of NHS England Stevens has been in charge of implementing the five-year plan for “integrated care”, in other words completion of the takeover of the NHS by UnitedHealth Group;
• His duties at UnitedHealth included lobbying for the NHS and other European national health services to be included in the Transatlantic Trade and Investment Partnership (TTIP); An even Higher risk after a no-deal BREXIT.
• His 'plan' is to utilise the NHS budget to run the profit-driven American 'Accountable Care Organisations (ACO).
• ACOs change how the NHS is funded, removes accountability, and introduces two disastrous processes 'demand management' and 'capitated payments'. In other words, a fixed amount of money per capita (per patient)- and when its gone there is no more, and managing which patient gets access to which service. As with the ACO in America, the less care an ACO provides, the more money it makes (i.e. the more it saves). This is then passed on to the shareholders - called 'providers'. 
• With an ACO the budget (contract) is long-term and can be held by private companies who then sub-contract work out to other 'providers'.
• There is a HIGH RISK that the NHS is split into those who can pay for certain treatments, and a state funded element for those than can't. *See below co-payments made via an ACO.

[PDF] The rest of Simon Stevens' historical CV can be downloaded here...

An Integrated Care System (ICS) is based on the American model of care called an Accountable Care Organisation (ACO). An ICS holds a single long-term budget which is allocated to its partners called Integrated Care Providers (ICP).

As with an ACO, an ICS is profit-based operating on the principle of treating fewer people to make savings [profits]. The profits are then passed back into the system to shareholders.

This restriction of care and services is accomplished in several ways, the main method is to allocate an up front annual per person (capitated) budget to each 'registered' patient in the area then 'manage the demand' of services using health maintenance techniques.

These include but are not limited to: guiding patients to other areas provided by volunteers, treating patients at home, allocating some patients a personal health budget, promoting prevention, and allowing hospital foundation trusts [as partner providers] to undertake 'paid for' procedures previously provided free on the NHS but restricted under the new ACO regime. *See Warrington hospital.

Two months ago the chief officer of Central Lancashire's two CCGs for Preston and Chorley with south Ribble implied.....we’ve got senior people doing long-term strategic planning [aiming to] save money and configure only the type of really important services for each level [each care pathway].


It appears that in future, patients may only be able to access the 'really important' services with other services going the same way as those currently being rationed and placed on a 'self-pay' basis. Either that or go private, take out an ACO plan as in the states, and make co-payments towards the cost. It is a REALITY folks.
Here's an example..

However, there is currently no legislation which permits either the ICS or its ICPs to exist as formal entities - that's why they are described as operating in “shadow form”.

NHS England are trying to dodge and 'work-around' avoiding changes in legislation..."for now the powers of the two [CCG] groups are only as strong as the statutory bodies from which they are comprised, indicating a merger of two or more CCGs would provide for a single joint committee holding more sway along with standardising rationing policies for the represented areas for certain treatments, increasing some treatments in some areas and decreasing others in other areas [as they call it rounding up or down] or to you and I 'a postcode lottery'.

The aim is not to come in on budget, but to limit overspending - to no more than £112m across the region.[1]

In Lancashire and South Cumbria, the collective deficit is derived exclusively from the region’s hospital trusts and stands at seven percent of their combined annual budget of £1.6bn i.e around £112m. The area’s CCGs, however, are aiming for financial balance.

Gary Raphael, executive director of finance for the region’s Integrated Care System (ICS) said that ringfencing for primary and community care £4.5bn out of the additional £20.5bn which has been pledged to the English NHS by 2023, will cause “a big problem” for acute Hospital trusts.

However, Raphael fails to mention just what the regions hospital 'big problems' are or how they might be tackled.

Affordability will be a “key issue” for the Lancashire-wide plan for the NHS over the next five years which is currently being drawn up.

To limit the overspend, savings must be made via cuts to services along with changes to the way services are provided, who provides them, and where they are provided. It's understood that the underlying deficit for Lancashire and South Cumbria is higher than £112m, when one-off savings are excluded.

The Heist - aka the bribe

If the control total is met, the region [L&SC] will receive an extra £76m in funding as a reward.

This target is shared by all the organisations involved so each are accountable to each other. In the USA, this has resulted in some organisations in the ACO cutting corners by cherry picking the more profitable patients and services along with corruption and many legal challenges between organisations that are supposed to be collaberating and working together.

https://www.lep.co.uk/health/can-partnership-plan-for-lancashire-s-nhs-improve-care-and-bridge-funding-gap-1-9908020