Since January 2016, NHS England has driven through a massive new reorganisation of the NHS. They have carved the country into 44 "footprints" in which commissioners, NHS Trusts and local authorities are required to collaborate on 5-year plans to generate massive savings.
On one level this could be seen as a step forward from the chaos and fragmentation of the competitive market imposed by the 2012 Health & Social Care Act: however the ever-tightening vice of the unprecedented spending squeeze on the NHS makes it unlikely that the collaboration will result in any enhancement of services.
Each Footprint has to submit a "Sustainability and Transformation Plan" (STP) to NHS England by the autumn and be ready to implement the changes quickly to balance the books: only plans which satisfy NHS England will ensure access to £1.8 billion of "transformation funding".
NHS England boss Simon Stevens has made clear he sees the reorganisation as a way to create "combined authorities" which pool their powers - making it possible to override any local "veto" that might prevent controversial cuts or closure of popular local hospitals and services. The little local influence and accountably there is in the NHS will be eliminated. The new system leaves no room for serious consultation before 5-year plans are drawn up behind closed doors and imposed on local communities.
The new system also lacks any legal basis. Stevens' plan simply sidelines the Clinical Commissioning Groups - but leaves them still obliged by the Health & Social Care Act to continue to carve up services into bite sized, fragmented chunks. Services are still being opened up to "any qualified provider" or put out to competitive tender. The whole fragmented, wasteful costly market system remains intact.
So what are the plans that local health bosses are hatching up in secret? How do these new structures work?
Who is in charge, and how can campaigners and local communities make them accountable and prevent them cutting and centralising services and worsening access problems for patients needing care?
With jobs and services at stake, how can unions collaborate with local campaigners and political parties to maximise the impact of their efforts?
Health Campaigns Together was launched by a coalition of over 20 different local campaigns, the main health unions and TUC, and political parties committed to fight cuts and privatisation and restore our NHS.
More details of activity can be found on our website www.healthcampaignstogether.com, which makes clear that we welcome affiliation from local TUCs as well as health and other union branches which wish to fight in defence of our NHS.
NHS is now 7 years in to a 10-year spending freeze, with budgets each year since 2010 falling further below the rising costs of delivering health care to a rising population. Performance is falling and deficits are growing. Yet we face plans, unchanged under the new Tory government, to reduce real terms spending further until 2020 – effectively wiping out all of the increases in NHS spending as a share of GDP in the years 2000-2009.
Health Campaigns Together has led the way in exposing the danger of the reorganisation of the NHS this year into 44 “footprint” areas, in each of which the key task is cutting spending by tens or hundreds of millions to address a threatened “gap” between resources and needs for health care by 2020. It’s now becoming clear the process of drawing up “Sustainability and Transformation Plans” in each area (STPs) –taking far-reaching local decisions –is going on in secret, with no consultation with local people. The plans are soon to be revealed after being rubber-stamped by NHS England, and imposed as a fait accompli with the barest minimum of consultation or local engagement. We can’t let this happen without a fight.