Friday, 28 October 2016

Councillors must look before they leap into secret NHS cuts plans

Jeremy Hunt can no longer pretend he's following 'the NHS's own plan'.  Expect fierce local battles ahead.

Image: Simon Stevens, NHS England

It’s all going horribly wrong for Simon Stevens.

Theresa May has not taken kindly to the NHS boss’s belated admission that he had originally asked for considerably more than £8billion “extra” for the NHS (even as that £8bn figure was itself criticised as “misleading” by Sarah Wollaston MP, who points out the true amount given to the NHS is considerably less than the government claims, and the Nuffield Trust, which argues the £8bn may in reality be just £880m).

On Tuesday, Stevens told MPs that “we didn't get the funding that the NHS had requested [for 2017-2020]... So as a result we have got a bigger hill to climb.”

Jeremy Hunt was forced to stop claiming that he has given the NHS “all the money it asked for” and admitted to MPs it was only enough to “get going” on a restructuring plan.

Indeed the new prime minister reportedly told Stevens where to go when he went back again to ask for more cash. May has made it clear there will be no extra cash in the Autumn Statement. 

So it’s local NHS bosses – and local campaigners – who are now staring in despair at that hill – or abyss.

Last Friday local NHS bosses had to submit their “Sustainability and Transformation Plans” to NHS England, to show how they are going to realise the impossible dream of realising £22bn of “savings” to balance the NHS books by 2020.

This will – supposedly – “integrate” health and social care to support more frail older people in “the community” and in their own homes, reduce demand on A&E and hospital services by creating healthier populations and speeding the discharge of those who are admitted.

But it’s a triumph of hope over experience. And it will mean hospital services being run down.

Senior NHS England director Julia Simon has jumped ship and denounced the STP process as “shameful”, “mad”, and “ridiculous” and the plans as full of lies. NHS Providers chief executive Chris Hopson points out that just one in six NHS finance directors believe they can deliver on STP plans, and that there is just not enough money in the pot.

Behind the lies, the STPs savings basically centre on new cuts. A new Health Service Journal survey of 99 CCGs has found almost one in three reporting that their STPs proposes to downgrade or close A&E or urgent care services, almost half planning to cut hospital beds and more than half planning to close or downgrade community hospitals. One in five also wanted to cut acute service staffing.

There are rumours that Stevens may even be pushed out or walk away as he sees his pitiful “Transformation Fund” eaten up by deficits, and the Health and Care Taskforce that was set up under Cameron to promote the idea of integration of the NHS with social care scrapped by Mrs May.

Up and down the country he knows STPs assume the ready availability of capital for new investment – despite clear and public warnings that there is virtually no capital available.

A storm is brewing. In Devon, Oxfordshire, Yorkshire and East Anglia local Tory MPs and even councillors are being forced to stand up with protestors and challenge hospital closures and service cuts in their constituencies.

Trade union leaders and professional bodies have warned that the pace of change planned for STPs means it’s impossible to negotiate on any of the issues affecting the workforce – at a time of chronic staff shortages.

As the whole issue comes to the boil, now is the time for campaigners to pile pressure on local councillors and council leaders to take a stand. They must speak up for local people, and demand these cuts-driven plans are published, not just secretively rubber-stamped.

Birmingham and Camden councils have now given the lead on this by publishing their full STP drafts.

Councillors must now also demand the evidence for far-fetched claims of “demand reduction” and “prevention”, which seems to boil down to “reducing access”.

They need to demand answers on how patients can be expected to travel up to 50-60 miles in some areas to access hospital services, or how their relatives can be expected to visit them: and how ambulance services will cope in Cumbria, for example if services at the District General Hospital in Whitehaven is closed and patients have to travel to Carlisle.

There are many similar examples where closures are being accelerated by STPs, with little or no consideration of the transport and logistical problems, or the lack of capacity at the remaining hospitals.

In North West London the plans cover 8 boroughs. Only 2, Ealing and Hammersmith, demanded to see the full draft of the plans. They found all of the financial pages were still missing, and that the document specifically proposes to speed through the “reconfiguration” of Ealing Hospital, which both boroughs have consistently opposed.

But by then the other six NW London boroughs had already signed the incomplete draft, without even seeing it.

They were eager to get their hands on minimal extra funding (“transformational investment”) for social care – just £21m a year between 8 boroughs in 2017/18 rising to £34m a year in 2020/21.

Such sums hardly compensate for the continuing cuts in central government funding for social care, the increase in the vulnerable elderly population, and the list of cost-saving measures social services are expected to deliver in return.

Yet this is the type of plan that council leaders all over England have been pressurised to sign up to. In each case the tiny pot of future additional cash for social care is used as the lure, and the loss of it the stick, to draw them in.

If councillors want to be re-elected, they must show their commitment to local services. Let’s press now in every area to make them stand up and challenge the cuts and the cash freeze that is squeezing the life out of our NHS.

As in North West London, it’s clear that many of the boroughs and counties that have signed up in support of STPs have done so without reading them or understanding their consequences. They must be forced to think again.

Instead of blindly signing off STPs, councils should be invoking their powers through Health Oversight & Scrutiny Committees to hold NHS managers to account, and block controversial changes pending a decision by the Secretary of State. They should trumpet their refusal to collaborate in plans for cuts, closures and “efficiency savings” that won’t work, but will put health care at risk.

JOHN LISTER 25 October 2016

About the author

John Lister of London Health Emergency is a writer and academic who has campaigned against NHS cutbacks and privatisation for almost 30 years. He has taught journalism and health policy at Coventry University, is a founder member of Keep Our NHS Public, and a board member of the International Association of Health Policy.

"Currently facing such high levels of demand"

"The accident and emergency department (A&E) at Charing Cross Hospital is currently facing such high levels of demand that we are asking members of the public to help us manage this by only visiting A&E when it is absolutely essential " (Imperial NHS Trust website 26.10.16) 
Imperial's desperate message fundamentally contradicts claims that developments in community health are reducing the need for acute hospitals. The vital role CX Hospital plays in providing acute care for local people is clear and Save Our Hospitals is determined to protect it.

H&F Council Public Meeting on STP- Save the Date
H&F Council are equally committed to saving the hospital and have commissioned a review of the cuts & closures package known as the Sustainability & Transformation Plan (STP)The findings of this review will be launched at a public meeting in Hammersmith Town Hall from 7pm Tuesday November 29th - Save the date!
H&F Council Public Meeting on STP Tues Nov 29th 7pm Assembly Hall Hammersmith Town Hall

Next STP Draft
Attached is the latest version of the STP - big on aspirations for healthier living and community care but silent on how these aspirations will be met in an era of dwindling social services funding and NHS under capacity. A resource pack from the group HealthCampaignsTogether gives a very useful assessment and critique (attached). 

SOH Saturday Stall
SOH leaflets across the borough informing people about the dangers of the STP - this week we're in Fulham, join us if you can.
SOH Stall Sat 29th Oct 2 - 4 St John's Church North End Rd (southern end - facing market on paved area behind Church)

Support The NHS Bill
Of course the threats to our NHS require national as well as local campaigning. In particular we need to get back to a publicly run NHS - universal, comprehensive and adequately resourced. The NHS Bill seeks to achieve this by reversing the policies of increasing fragmentation and privatisation. It's possible that the bill will be heard on Nov 4th and therefore Keep Our NHS Public are rallying in support outside Parliament. SOH will be there. If you can't make it you could still help by joining almost 80,000 others and signing this petition.

Support The NHS Bill Fri 4th Nov 11 - 1 College Green (paved area opposite public entrance to Houses of Parliament)

Concerns about Ealing's privatised Urgent Care Centre
A patient unhappy at the provision of equipment, level of medical cover and quality of care at the privatised Urgent Care Centre at Ealing hospital went public in the letter attached. This follows worries about the performance of Vocare, the private company which has taken over the Urgent Care Centre at St Mary's which we recently reported.  

If anyone fancies making a guy for our SOH stall on Sat Nov 5th feel free, we'd love it. Regards AD

STPs consultation process inadequate, conference told...

STPs (sustainability and transformation plans) will lack a sense of ownership if the consultation process is rushed or inadequate, doctors have warned.
Tyne and Wear GP George Rae told a conference on regional devolution of health services last week that he feared that many STP plans were proceeding too quickly. 
Dr Rae told the Westminster Health Forum conference in London: ‘I can only speak for the north-east of England, but more than likely what’s happening in the north east is not atypical of what will be happening in other areas.
‘When I speak to doctors they’re saying the STP is being brought in under the radar.’
He said it was wrong that doctors and patients were only consulted on plans once the draft had already been approved, and that failure to properly engage risked undermining the entire STP enterprise. 
‘If you’re going to have a consultation, have a genuine consultation. Have it from the onset because that’s what engenders a sense of ownership. When that happens everybody signs up to it.
‘I’m very sad that the consultation and the engagement [in his area] has not, in any shape or form up till now, been all that it should have been.’


STPs have come under recent criticism from some health leaders, with NHS Providers chief executive Chris Hopson warning that many of the plans currently being drawn up by trusts would prove undeliverable due to unchecked deficits and insufficient funding.
At the same conference, former health minister Lord Warner urged providers to seize on opportunities to work more closely together and devolve services.
He said: ‘I think the reality now is, as Simon Stevens said a few days ago, there’s a pretty big hill [for the NHS] to climb.
‘If you look at the numbers, it’s not too bad this year for the NHS financially, it gets worse next year [and] on present plans it’s pretty horrific in 2018/19.
‘You [health providers] haven’t got long to get going on this agenda and make sure the STPs are not just another grand NHS plan and initiative, but that something happens that does actually transform service.’
The BMA has stated that while STPs present opportunities to improve collaboration and long-term planning, it has concerns over issues such as financial viability and levels of accountability.
Created:  by Tim Tonkin

NHS cuts 'planned across England' - BBC

Plans are being drawn up that could see cuts to NHS services across England.
The BBC has seen draft sustainability and transformation plans (STPs) which propose ward closures, cuts in bed numbers and changes to A&E and GP care in 44 areas.
There have been no consultations on the plans so far.
NHS England, which needs to find £22bn in efficiency savings by 2020-21, said reorganising local services is essential to improve patient care.
But the Nuffield Trust think tank said while STPs could lead to "fundamental changes", many of the plans do not meet the financial targets set by the government and will face a "dauntingly large implementation task".
Laura Townshend, director of the campaign group 38 Degrees, said the plans had received very little public or political scrutiny.
She told BBC Radio 4's Today programme: "A key concern is why it hasn't been this transparent up until now.
"These plans are due to be signed off this October - a matter of weeks away".

'We need more courage'

The STPs are being drawn up by local health and social care leaders, although many remain unpublished.
They were asked to find potential savings and efficiencies at the end of last year to meet financial targets set out by the former Chancellor George Osborne and NHS England head Simon Stevens.
Stephen Dalton, chief executive of the NHS Confederation, said that the NHS would not "indiscriminately close services".

He said local discussions were "better than having a single plan" for the whole country.
Mr Dalton told the Today programme that in the past there has been reluctance from political leaders to address the way things are organised in the NHS.
He said much of the structure is "an accident of history", arguing that MPs have been dodging issues for too long.

'More inconvenienced'

38 Degrees uncovered many unreported draft STPs, including plans for the closure of an A&E in the Black Country and the merging of two of the area's three district general hospitals and the closure of one site.
In the area of Leicester, Leicestershire and Rutland, there are plans to close acute services from one of three hospitals.
There are also plans to put GP surgeries under "review" because of a shortage of funding.
A draft plan circulating among NHS managers in West Yorkshire reveals proposals to close the equivalent of five wards in the Leeds Teaching Hospitals Trust.
A spokeswoman for the area said: "We will be engaging and consulting as and when appropriate."

Analysis by Hugh Pym, health editor

It sounds like another piece of management speak but the Sustainability and Transformation Plans are highly significant for health services and patients in England.
NHS chiefs want local health and council leaders to work together to make the best use of resources at a time when efficiency savings are required.
If that means caring for more people out of hospital and concentrating services at fewer sites then, NHS England would argue, so be it.
But closures are never popular at local level and campaigners in each area will no doubt oppose cuts to services.
It will be a big moment for the NHS when the final plans are published in the autumn.
In a blog published on the Nuffield Trust website, its head, Nigel Edwards, said: "The speed of the process to shape these plans has meant that they have so far not been very visible".
Mr Edwards said in some cases large numbers of patients would have to be shifted into community settings to make room for growing demand, while in others up to 20% of beds may be closed.
The role of community hospitals is being questioned and the number of mental health inpatient sites could be reduced, he added.
Sally Gainsbury, senior policy analyst with the trust, said many of the plans at the moment appeared to be proposing shifting or shutting services.
"Our research finds that, in a lot of these kinds of reconfigurations, you don't save very much money - all that happens is the patient has to go to the next hospital down the road.
"They're more inconvenienced... but it rarely saves the money that's needed."
Richard Murray, director of policy at the King's Fund - a health think tank - told BBC News that the plans were complicated and very difficult to carry out all at once.
As a result, he said there was "a need to make investments first in order to make savings later".


An NHS England spokesman said: "This is a unique exercise in collaboration. It is hardly a secret that the NHS is looking to make major efficiencies and the best way of doing so is for local doctors, hospitals and councils to work together to decide the way forward in consultation with local communities.
"Proposals are at a draft stage but we expect all local leaders to be talking to the public and stakeholders regularly - it is vital that people are able to shape the future of their local services.
"No changes to the services people currently receive will be made without local engagement and, where required, consultation."
David Pearson, STP leader for Nottinghamshire, told BBC Radio 4's You and Yours programme: "Sometimes, we have particular conditions or particular treatments that are best in a centre of excellence...
"But this is fundamentally about making sure we are doing the best things across Nottinghamshire and that, as far as possible, services are locally delivered to an agreed understanding of what best practice is.
"The transformation of services is rarely just one big dramatic closure."
Andrew McCracken, of patient group, National Voices, said: "'Health and care services need to change, but those changes must be made with local communities, not behind closed doors."

Smokers and obese 'denied treatment by hard-up NHS' and more news...

Why not write to your Council Leader asking them to publish the Sustainability and Transformation Plan for your area?

Reminding you that the Leaders of H&F Council, Stephen Cowan and Ealing ​Council Julian Bell refused to 
sign t
​he STP​

North Durham GPs' private contract referral 'disgraceful', says MP

​​GPs are asking patients to consider using private health insurance in bid to cut NHS costs

Hard-up nurses being forced into debt as 35,000 rely on payday loans – almost double 2013's number

How much money the NHS gets is a political decision

Don't have your NHS baby out of hours: Three-quarters of maternity wards have no consultant at the hospital overnight

Example of how crisis in care is very relevant to STPs. Care home provider to close 166 beds

​ ​
Stop the NHS closure of the Royal Brompton hospital heart unit.

The most important NHS legal case you haven't heard of Dr Chris Day: (here in @PrivateEyeNews )

My sister needed a ridiculous & scary Halloween costume so I made her the Brexit Bus(​Anna Wilson)

Friday, 21 October 2016

October 2016 newsletter

October 2016
Dear Supporter,

September and early October have been busy months for the campaign.


Before the AGM of Imperial College Healthcare NHS Trust on 14th September, SOH supporters demonstrated outside the meeting, handing out our information leaflet on STPs. Chair of the Governing Body, Sir Richard Sykes, was ‘caught on camera’ by campaigners. He acknowledged that the NHS is underfunded, that there is no room for more efficiency savings and that ‘we’re killing staff’ through overwork. This was taken up by BBC London News. Here’s the BBC version of our video:

Supporters also attended the AGM itself, asking important questions about the STP – the financial basis, time scale, lack of public consultation and the future of both Charing Cross and Ealing Hospitals. We were told that CX would not be turned into a local hospital within the next 5 years, but this was still their expectation. They have been forced to accept that the services out of hospital are simply not there now. The same assurances don’t seem to be forthcoming for Ealing Hospital.

We attended the Imperial Board meeting later in the month, where Dr Tracey Batten, CEO of Imperial, publicly announced that she would be meeting with officers of SOH to look at how consultation might be improved. Clearly a sign that what we are saying is causing NHS bosses to be worried!

H&F CCG CONSULTATION MEETING ON THE STP (Sustainability and Transformation Plan)

By carefully planning for this meeting on 3rd October, SOH supporters and other members of the public were able to stop the CCG continuing with its ‘sales’ agenda for the meeting. We insisted that, rather than scheduled ‘sales’ workshops, there should be more questions and discussion contributions from the public. The introductory presentations from Health bosses were a gloss on what the STP means. They were followed by a counter argument from Steve Cowan, leader of H&F Council, which, with Ealing Council, has refused to sign the STP. Cllr Cowan stressed that the plans still include closure of Charing Cross Hospital in the future and Ealing much sooner. He also pointed out that the plans are working towards more cuts and more privatisation in the NHS.

SOH campaigners raised the important issues of lack of real consultation, of failures to provide evidence for their claims that moving care out of hospitals would work, of increasing pressures on GPs etc. And we gained a promise – yet to be fulfilled – that the CCG would send Merril, our Chair, the background papers providing both clinical and financial evidence for their plans … We will see… But, despite the ever increasing workload on GPs now and even more under the STP, Dr Tim Spicer, Chair of the CCG, stated explicitly that there is unlikely to be an increase in GP numbers. It would appear that, under the STP, GPs surgeries would be “reconfigured”, perhaps closed, with a smaller number of locations and that patients might lose their traditional and trusted relationship with their local GP surgery. We suspect the public (us!) won’t accept this!

STPs are clearly not going to work – and certainly not in the context of ongoing cuts to the budgets of local authorities and, in real terms, to health care.

If you live in H&F or in Ealing Boroughs, please write to your local councillors to say how much you support these councils’ rejection of STPs.

For those in other boroughs, please write to local councillors pointing out that the plans simply cannot work and that all borough councils will share the blame for the underfunding of our healthcare.

Across the country, in each of the 44 STP footprints, local people are finding that their local health services are under unprecedented attack. It is still the case that many areas have not published their STPs – the NW London STP was one of the first published because of a Freedom of Information request from campaigners in Brent. Other areas are also organising and protesting against the plans to cut health budgets and to reorganise health services – more and more acute hospitals are under threat.

SOH joined other London campaigns and campaigners from Grantham, Huddersfield and Banbury to protest at closure and reorganisation plans at a rally in Trafalgar Sq on Monday 10th October. London campaigners – from SOH, Ealing and Lewisham – were there to support the northern campaigners as they presented their petitions to the Dept of Health and to Downing Street.

The monthly Ipsos-MORI poll of public attitudes published across the media this week, shows concern about the NHS moving to the top priority again, a concern shared across the country because of the underfunding and undermining of the NHS and even further cuts to public health provision – a key feature of STPs.

Together we can fight these plans;  together we can win!


Thanks to all who joined us at the North End Road Autumn Market on 8th October – and thanks to H&F Council for again helping us to be there! We distributed leaflets, spoke to many people, got more signatures for our petition, received donations – and distributed badges and t-shirts for a donation!


A warm thanks to all those who have helped us deliver leaflets – in H&F and much more widely. Local supporters have already distributed many thousands of leaflets – with more about to be distributed.

We regularly produce leaflets with updated information for distribution. If you would like to join those who are delivering in their area, could you please email us at giving us contact details and we will get back to you.

SOH is a campaign group of local volunteers who are fighting to protect our health service. We are entirely dependent on contributions for our work. If you would like to contribute – and many thanks to those who have already done so! – you can send a contribution to Save Our Hospitals, 7 Kimbell Gardens, London SW6 6QG or pay directly into our account with Lloyds: Sort Code 309897 Account No. 39956060

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