The effect of the passing of the Health and Care Bill will be harsh. It is now an Act and as such will be implemented creating forty-two distinct organisations. Ours is the Cheshire and Merseyside Integrated Care System (ICS). Exactly who sits on these boards has yet to be published. We do know their chairs and many other posts.

Our anger at what is happening is righteous and well informed. As we campaign we want people to focus their anger into action, not let that anger become, as the Conservatives wish, debilitating and without purpose.

We need people to help with the campaign to reinstate the NHS and to monitor what is happening locally. Please do get in touch if you can help even in the smallest way.

Each  ICS organisation will be expected to keep to a set financial limit, and any financial risk-sharing will be within each ICS. This financial structure, in reality, is unworkable but it will be used to excuse and implement harsh cuts, which in turn will inflict death, pain, and suffering. It will mean worse pay for staff too. This is unless, of course, we can build a  deep and wide protest movement. This has been done before. We need to do it now.

The ICS boards will control all spending in the Cheshire and Merseyside health area. Hospital trusts start this era in debt, not from being spend thrift, but because budgets were not adequate for the treatments they had to deliver.

The ICS system is supposed to insist on no overdrafts, and that any over spend has to come from other hospitals in the local system. Well that’s not going to work, is it? In fact, this system is very dangerous for maternity as many of the Trusts in Cheshire and Merseyside do not provide maternity care and may not therefore even have an Ockendon Rep on their boards. Donna Ockendon insisted that each hospital had a board member responsible for Maternity on their board because of the poor oversight in Shrewsbury We have found no Ockendon Rep on the ICS board, in the paperwork available to the public We would love to be proved wrong.

Maternity is in crisis as the Royal College of Midwives, somewhat belatedly, said recently and that crisis must be addressed, rather than cuts in spending enforced. This is the lives of mothers and babies and the working lives of maternity staff that we are talking about. What is more important than the lives of mothers and babies at birth?

Meeting all the Ockendon requirements for safety requires major investment not cutbacks, not just in the Liverpool Women’s Hospital, but in Arrowe Park Hospital, in Leighton, in the Countess of Chester, in Ormskirk, in Whiston and any other maternity service in Cheshire and Merseyside and beyond.

Liverpool Women’s Hospital Board Papers said

“The Trust is in underlying deficit, and faces additional pressures to maintain levels of workforce recommended by the (first) Ockenden report. There is a significant increase in clinical negligence costs which have not yet been funded.

Financial impacts of the second Ockenden review, and any funding available to support this, are being assessed. There are other significant cost pressures which will be managed through an ambitious and challenging 3% cost improvement plan plus additional non recurrent mitigations. .”

When the Banks needed bailing out huge amounts of money were conjured up for them. Sajid Javid the health secretary was a banker in those crazy times. Hey! Sajid, health needs a big investment that will pay for itself many times over.

This money shortage is serious. Researchers have gathered the figures from board papers from local hospitals.

Mid Cheshire hospitals Trust wrote “The system has £183m less resource than in 2021/22, which is a 3% reduction in funding after inflation has been applied. There are several factors which are influencing the movement and some key risks to receiving the funding in full.

“1. Convergence: C&M funding levels are currently above its calculated target allocation by £338.5m, and has a target to reduce this over time, leading to the additional reduction of £51.67m…..”

North West region

The UK is experiencing high inflation, especially from fuel costs. This will affect the NHS too. So we need to add inflation to the cuts described above.

NHS pay has acted to keep NHS inflation below the national average for some years. Low paid NHS staff who stay in the job because they are committed to the NHS will feel the increase in inflation still more.

Although the Act is called the Health and Care Act it does little for the mostly privatised Care sector. This letter is not focusing on that important issue. (A separate article will cover that). This situation is looking at the breakup of the NHS.

The problems in social care are impacting badly on hospitals which at present cannot easily discharge patients to care homes. The shadow of the Covid deaths hangs long over the care home sector and the Covid virus is far from spent.

The New ICS system introduced by the Act has been present in shadow form for some time and regional control of budgets increased during the pandemic.

This model of healthcare finance and delivery is based on the US Accountable Care systems. Accountable here means “for accounting,” not “answerable to.” It is designed to make money for the private sector. Designed to give our tax money not to the sick or the hard-pressed underpaid staff but to the rich.

Plans for this have taken many years, back to Thatcher and more recently work at Davos, the working groups of the globally rich.

We have lost a  National Health Service. The national part of the health service is important for risk sharing, research sharing, national pay structures, and shared experience. These models will produce postcode lotteries and differential services. We can imagine that they will blame Merseyside for the effect of their cuts as they are now blaming Liverpool for the effect of 60% cuts in local government funding.

The huge health gaps in life expectancy will open wider. Remember more babies die in Liverpool under one year of age than anywhere else in the country. Working-class women have a life expectancy ten years less than those in rich areas. The Tory voting areas will get service though

If we can build a campaign we will deepen the commitment to the Bevan Model of the NHS in our areas.

In these new structures, the national part of our health service has gone. What we have now is more like a localised public-private partnership. We want to bring back a national health service.

Publicly delivered. We want to return to a national publicly delivered health service. Private companies are designed for profit, not for healthcare.

A health service, of sorts, is still functioning, hit and miss as to the treatment you get. Doctors, nurses, midwives, physios, scientists, porters. cleaners healthcare workers all continue to go to work, work hard and with skill, and many are delivering good services, but there are significant dangers. Some are wonderful services, but all are at risk. The Cheshire and Merseyside ICS has big problems with staff shortages, funding restrictions, poor organisation and the present major reorganisation but for now, for some a service is still there.

Major cuts in funding are underway. See the Lowdown  The Lowdown article referred to £219m deficit in the C&M budget – practically every single hospital in the area has a deficit. So, in other words, the ICS will continue by making more cuts and demanding more from an ever-shrinking workforce who are paying the price of this reorganisation. The staff risk having their pay negotiated locally. It is a major leap forward  for  privatisation and healthcare for profit

Staff are poorly paid, understaffed, and worn out. Covid is still a factor so there has been no time to recover. Waiting times are long and harsh. The pressure to pay to jump the queue is very real. The private health sector has been given huge amounts of Government money. This is likely to continue especially as these companies will be influential on the ICS boards.

So when the going gets tough, the tough get going. Join the campaign to fight for the health service locally and nationally. Don’t make the NHS a dim and distant memory.