In the midst of its worst financial storm the NHS is hit by a perfect media storm
The secrecy surrounding attempts to re-fashion NHS services - and keep them within the government's tight funding limits - has suddenly become a major issue of media interest - and of public interest as well.
We first reported on the Sustainability and Transformation Plans (STPs) last March. Since then deadlines for the plans completion have come and gone - the next one is in October and may well be missed by some of the 44 'footprints' running the STP process.
Led by BBC News, the media have leapt on the STPs and the cuts to services they are likely to bring, as a strong August story. And while politicians are away - or simply keeping a low profile - the story has got, as they say in newsrooms, legs. And the 'story' may well run and run.
The online lobbying group 38 Degrees is actively involved in this news frenzy. They are drumming up support by telling members what cuts they think STPs will bring to their area and asking them to get their MPs to' lift the lid' on the secretive STP process: "...will you sign the petition asking Claire Perry to lift the lid on the plans for the NHS in your area?"
For the STP 'footprint' that includes the Devizes constituency - this 'footprint' covers Wiltshire, Swindon and Bath and North-East Somerset and is known as BSW - 38 Degrees have been told some changes to frontline services are coming: "...but the exact services haven't been nailed down yet."
They have also published a figure of £490 million as the deficit in NHS and social care to be faced by 2021 across 'BSW'. That must be a large under-estimate as the shortfall for BSW's health organisations alone will rise to £337million a year by the end of 2021. And we know that local authorities' social services and public health programmes are hurting badly from the government austerity cuts and should be counted into that deficit.
38 Degrees claim they have "uncovered Jeremy Hunt's secret plans for our NHS" - the truth is that many STPs are nowhere near complete, which may be just as worrying while the financial crisis threatens to engulf the service.
However many people sign their petitions, 38 Degrees are unlikely to get much joy from the majority of MPs who have, we should not forget, backed their governments' low level funding of the NHS - which has caused this crisis. Over the last six years this funding has edged up point-one-of-a-percentage-point (that's 0.1 per cent) over inflation - just getting over the promised 'real terms increase' threshold.
In the process MPs have wilfully ignored the NHS' own levels of inflation - rising drug and treatment costs and the big rise in demand from a population increasing in numbers and also ageing.
Coming un-invited onto budget spread-sheets are extra costs the NHS has to bear following cuts to social service budgets (causing, for instance, rising numbers of delayed transfers from hospitals - those 'blocked' beds), the government cuts to public health budgets (now also squeezed by local authorities to whom public health was passed) and government inaction on obesity and air quality.
All the while not forgetting the estimated £3billion costs of the Lansley reorganisation. These costs are still coming through - recently two Commissioning Support Units set up under the Lansley Act were closed costing £6million in redundancies. STP may well bring many more redundancy and closure costs.
As the media storm moved onto the Sunday newspapers, one former Health Minister woke up to the size of the problem and began talking about extra tax raising powers for social care. Why? Because cuts to social care were undermining the NHS.
The problem with secrecy is that it leads to a welter of half-truths and rumoured truths. The latest guidance from NHS England says that STP 'footprints' should be careful about asking for capital spending to re-jig their infrastructure or connect with new IT schemes.
The capital funds available will be "extremely constrained". There is even talk of STPs being advised to explore land sales to raise money. This is really weird as the NHS Property Services (known widely as PropCo - a company owned by the Secretary of State and probably on a fairly fast track towards privatisation) have been hoovering up NHS estate and ordered to charge commercial rates for its use.
We are told that that this is about collaboration where there has been competiveness - for instance acute hospitals vying for 'business'. But how far collaboration gets beyond sharing 'back office' staff and costs remains to be seen.
The eminent King's Fund tells us: "STPs must also cover better integration with local authority services." A similar line comes from an NHS Manager writing anonymously and entirely sensibly in the Guardian.
'She' puts a very positive spin on the STP process: "The benefits of STP could be huge...we must bring health and social care services together..." How this is can happen when Wiltshire Council has only been a 'consultee' on the BSW STP board is unclear.
NHS England is determined we should not think of the STP boards as new organisations within the NHS. Who then makes the final decisions?
Presumably if the clinicians on the more locally responsive - and empowered by statute - CCGs do not like a closure or a money-saving reduction in service ordered by the STP, they will vote it down. Though if they do, they may face some sort of penalty - or perhaps they will all be blacklisted from future MBE handouts.