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

Is Chorley A&E closure being used to fill financial black hole

Are hospital service closures being used to fill black hole in Trusts finances?

The Chief Executive of Chorley and Preston Hospitals 'Karen Partington' stated in June 2018 that financial and operational performance are inextricably linked and this has had an affect on patient care and missing targets.

The fact that the Lancashire hospital trust are £37m in deficit [June 2018]  adds to suspicions by local NHS campaigners that their A&E in Chorley is intentionally being primed for closure to save the trust money.

The financial difficulties beset by the Lancashire hospital trust are a culmination of issues that have accrued over the years. In 2017 the hospital trusts financial director stated that A&E (Preston and Chorley) was 'driving all the deficit', indicating this service area would be a likely target for efficiency savings (cuts).

This was further evidenced in the regions 'Sustainability & Transformation Plan' (STP) which identified savings could be made by relieving pressures on acute hospital services by closing many hospital services and relocating them into communities. According to the regions STP, health bosses across Lancashire and South Cumbria need to save £583m between 2015 and 2021.

STP: In 2015, the head of NHS England Simon Stevens, an ex vice-president of U.S. private health insurer 'United Health', divided England into 44 footprint regions with each 'footprint' asked to prepare their own Sustainability & Transformation Plan. The plans were a response to deliberate government underfunding with the overall intention of pushing through American health models called 'Accountable Care Organisations' (ACO).

In 2017, a report from a program design team of advisers working on an STP plan for Central Lancashire recommended 80% of outpatients currently seen in acute settings at Chorley and Preston hospitals will not be seen there in future.

The Trust chief executive said “This month [June 2018] local health and care organisations met to map and review urgent and emergency care processes and pathways, to identify what’s working, and address what isn’t, so that together we can drive improvements to ensure that in the future our communities can access the care they need, when they need it, in the appropriate setting.

It's still not understood why the trusts chief executive believes a hospital is deemed an inappropriate setting for providing these services, as these services have served hospitals well for the last 70 years.

The STP however indicates the more lucrative and low risk hospital services will be shifted out of public NHS hospitals into private clinics within communities - all at the risk of being taken over by private ventures campaigners assert.

After all, the credentials of the man running the show Simon Stevens speak volumes (see link below).

Simon Stevens spent the best part of a decade as a senior executive at UnitedHealth – the largest private health insurer in the United States..
More: Who is the boss of NHS England 'Simon Stevens'?

NHS Chiefs trying to plug £37m black hole in finances

chorley population increase warrants own A&E

GP and commissioner claims Chorley's ballooning population massively missing from NHS shake up plans in Lancashire.

■ Population of the Chorley borough rose from 97,000 in 1991 to 116,000 this year [2019] and is estimated to increase by another 18 percent [in the 25 years] up to 2039.

■ Estimated growth in households in Chorley over the next two decades is the largest in Lancashire.

In a news article in July this year Dr Cairns, a GP and member of local clinical commissioning group (CCG)  highlighted the above facts appearing to be strengthening a case for retaining Emergency Services in the borough of Chorley & South Ribble - but stopped short saying he was 'reminding people of that fact' [population increase].

Lack of resources

A draft “model of care”, produced under the local NHS change program called 'Our Health Our Care] (OHOC)  last August [2018], recommended closing Chorley & South Ribble Hospital A&E, suggesting that the public would be presented with a proposal for:

■ a single A&E unit for the whole of Central Lancashire,
■ keeping the existing two urgent care centres at Preston and Chorley hospitals,
■ and the creation of a “ringfenced” facility for pre-planned operations.

But when the OHOC joint committee agreed a final model in March this year, references to the numbers of individual facilities had been removed. Plans for a public consultation in January were also put back by twelve months until 2020.

The CCG running the OHOC program couldn't identify any specific sites/locations to put services removed from hospitals so had to delay plans and put them back 12 months.

In September 2017, the solutions design team for the OHOC program recommended 80% of outpatient services be removed from hospitals and relocated to private clinics called 'Multispecialty Community Provider Clinics [MCP clinics] run by a consortium of primary care networks.

Plans to further privatise the NHS are being rushed through with little if any public consultation.

The plan for Lancashire and South Cumbria, called the Sustainability & Transformation Plan (STP) came about due to trusts building up large deficits and deliberate government underfunding of the NHS budget.

The original STP for Lancs released late 2015 calls for the American profit-based system of healthcare titled 'Accountable Care Organisations' (ACO) to be established to control demand and manage access to healthcare by implementing schemes such as 'self-care', digital access, prevention and up-front restricted 'capitated' budgets.

But the association with the unpopular single-payer American health insurance system resulted in NHS England changing the ACO name to 'Integrated Care System' or ICS for short.

NHS England have however now conceeded that the ultimate goal of every STP/ICS is to become an American style ACO.

In a further attempt to fool the public, there have been several other name changes, yet the same outcome is to have a single prime aco provider/contracter sub contracting services in a private-public network of providers [as with the American health insurer kaiser permanente]*.

* Kaiser Permanente has had disputes with its employees' unions, repeatedly faced civil and criminal charges for falsification of records and patient dumping, faced action by regulators over the quality of care it provided, especially to patients with mental health issues, and has faced criticism from activists and action from regulators over the size of its cash reserves.

---

Campaign update [24th Aug 2019 see shortlist of options link below]

■ A shortlist of options on which NHS services are to be reconfigured is set to be discussed at a public meeting of the joint OHOC committee on 28th August

■ Thirteen possibilities had been assessed and whittled down to six, but CCG now say a 'broader set of options' are back on the table.

■ shortlist of options due to be considered by independent medics from elsewhere in the North West in mid-September before being examined by NHS England in December [2019].

■ there is currently no legislation which permits either the ICS or ICP to exist as formal entities - and they are sometimes described as operating in “shadow form”.

■ NHS England have told the Integrated Care System (ICS) for Lancashire and South Cumbria they are required to publish their  own five-year plan for the NHS by November [2019].

■ 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. The area’s CCGs, however, are aiming for financial balance with little consideration to how the ideological ACO plans may work.

■ Hospital trusts deficits will be shared and reduced by handing over NHS services to private primary care networks in the ACO which could be run by the private sector (as in the states). Currently Private Primary care providers such as GPs work under a GMS or APMS or similar contract which will change when they become partners in the ACO

■ CCG Accountable Officer claims Limiting overspend is priority to make savings

■ Local CCG have offered £4.5m support package to Lancashire Teaching Hospitals - the trust which runs the Royal Preston and Chorley and South Ribble Hospital - to help it meet its own individual control total, dependant on 'certain circumstances' which are currently unknown to the public.


RELATED LINKS

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

https://www.lep.co.uk/health/central-lancashire-a-e-planning-needs-more-thought-gps-told-1-9908025