Image: Condition critical?

Ministers have ignored a strident “winter warning” from NHS Providers – the body that represents NHS and foundation trusts. The government is determined to stick to their plan to freeze NHS budgets for the decade to 2020 even as costs and population rise.

England’s hospitals and other NHS providers warned that if an extra £350m were not found by August at the latest, we will face another winter crisis even worse than the situation last year.

It’s the middle of September, and there’s no extra cash, and none promised.

Nor is there any let-up in the brutal 8 years of frozen or below inflation pay for more than a million NHS staff. Hospitals and community health services are finding it increasingly difficult to maintain hard-pressed services, so hospital bosses are now being threatened with the sack if they don’t meet A&E targets despite the struggle to retain and recruit staff.

Theresa May’s government opted not to contest a vote on scrapping the 1% cap. But May has made clear that she will ignore the will of Parliament, meaning NHS pay levels will be further eroded as inflation nears 3%.

The combined impact of these policies can be seen in Oxfordshire. 110 beds have already been closed with connivance of local councillors, and now the local acute hospitals trust has revealed a further 92 are now closed for “safety” reasons (presumably staff shortages). The county already tops the league for delayed transfers of care. The impact of spending cuts is a system seizing up and increasingly unable to maintain key services.

The quest for massive, unprecedented cash savings is of course the backdrop to the 44 Sustainability and Transformation Plans (STPs) secretively developed last year. These plans hinge on “new models of care” which appears to centre on cutting and de-skilling staff, and downgrading, downsizing or privatising key areas of care to cut NHS spending - while maximising openings for private companies to scratch out profits from under-funded services. There’s no evidence any of this will be effective, of course.

The current round of massive reorganisation and pressure for ‘new models’ is a bonanza for management consultants who are coining in millions and effectively now steering many Clinical Commissioning Groups and trusts.

The latest step was the publication last month of hundreds of complex pages of guidance and draft contracts for ‘accountable care systems’ (ACSs) and ‘accountable care organisations’ (ACOs) — explicitly drawn from privately-run systems that first emerged in the US. Jeremy Hunt has on several occasions stated: “We need clinical commissioning groups to become accountable care organisations.”

Pace-setters on this among 8 vanguard Accountable Care Systems have been South Yorkshire & Bassetlaw (where five Clinical Commissioning Groups have created a ‘shadow’ ACS without bothering to ask the five local authorities to sign it off. It will become a legal entity before April 2018).

In Nottinghamshire the Sustainability and Transformation Partnership is spending £2.7m this year getting bungling consultant Capita and US health provider Centene to help shape up an ACS.

In each case the reality will be an Accountant-Controlled System, focused primarily on cutting services to fit within a rigid cash limit. Nottinghamshire could even wind up giving the US company a contract to do the CCGs’ job, controlling budgets and services.

Neighbouring Leicestershire Sustainability and Transformation Plan leaders claimed the local authority backed their Accountable Care System. But the County Council has denied this, and it’s likely that many elected councillors and MPs in the other “vanguard” ACSs will be equally reluctant to take political responsibility for plans which masquerade as “integration” of services but threaten to bring only declining quality and restrictions on access to care.

The STPs and ACSs all lack any legal status to force through cuts. Councils still retain powers to challenge and force a review of decisions that represent a threat to local health care services – and they must be pressed to use them.

However politicians – like the wider public – will remain in blithe ignorance over developments in the NHS – unless campaigners can pile on enough pressure and present sufficient compelling evidence to make clear what is happening.

There is more and more evidence to show which way things are going. It’s reported in Healthcare Europa that NHS England has surreptitiously decided to award all six of the NHS contracts for organising the new “Integrated Care” models to private companies. All but one are American-owned - the other, OptiMedis, is from Germany.

If this proves to be correct, Tory politicians will find it even harder to convince suspicious voters that they are not destroying our NHS with cuts only to open the doors to the ultimate horror: US-style health care. Even NHS-run ACSs represent a huge retreat from a national NHS to 44 local plans each with rigid cash limits and no remaining accountability to local communities.

Theresa May’s team has adopted an ostrich-style response to the rising cash crisis and its likely impact this winter. But it’s clear that many of her MPs, fearing they could lose their reduced majorities at the next election, are pressing hard behind the scenes for a reprieve for local services.

MPs have already forced significant retreats from hospital downgrades in north Devon and Essex. Cabinet minister Andrea Leadsom has backed calls for a reprieve for hospital services at Banbury’s Horton General, and may yet have something to say about Oxfordshire’s latest bed closures.

Many more Tory MPs need to be confronted by local pressure to force this weak minority government to back off on cuts and new models – just as they have been forced to drop privatisation of NHS Professionals.

We urgently need to build a big enough and strong enough movement to force politicians to take notice if we are to avoid a further irreversible decline this winter and ever-deepening crisis in the NHS.

That’s why Health Campaigns Together has called for the biggest-ever gathering of health campaigners on November 4 in Hammersmith Town Hall in a conference that will share information and experiences, link trade unions, pensioners and campaigners, and build networks that can unite and concentrate the strength of local campaigns.

We have nationally known speakers and local campaigners – and lots of time for workshops, networking and discussion. Join us: book your place now!