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Are we really going to lose more than half our A&Es in England?

The short answer is yes. But don't just take our word for it; Prof. Sir Bruce Keogh, Medical Director for NHS England, and Simon Stevens , CEO NHS England, say so too.

In 2013 we had 144 A&Es in England this will be reduced to only 40-70.

This figure comes from Prof Sir Bruce Keogh's Urgent and Emergency Care Review from 2013. It details how hospitals will be reconfigured into different levels of urgent care, with only 40-70 Major Emergency Centres (the equivalent of A&E) with 24/7 Urgent Care being provided in the remaining hospitals, except for where they are closed completely or demolished and rebuilt as smaller clinics (Charing Cross, for example).

The programme was shelved in November 2014, with the general election 6 months away, but was brought back and incorporated into the 5 Year Forward a year later. It is on NHS Choices and this is an extract from the introduction with the figures:

"Once we have enhanced urgent care services outside hospital, we will introduce two levels of hospital emergency department – under the current working titles of Emergency Centres and Major Emergency Centres. In time, these will replace the inconsistent levels of service provided by A&E Departments.

The presence of senior clinicians seven days a week will be important for ensuring the best decisions are taken, reassuring patients and families and making best use of NHS resources. Emergency Centres will be capable of assessing and initiating treatment for all patients and safely transferring them when necessary. Major Emergency Centres will be much larger units, capable of not just assessing and initiating treatment for all patients but providing a range of highly specialist services. These centres will have consistent levels of senior staffing and access to the specialist equipment and expertise needed to deliver the very best outcomes for patients. We envisage there being around 40 - 70 Major Emergency Centres across the country. We expect the overall number of Emergency Centres (including Major Emergency Centres) carrying the red and white sign to be broadly equal to the current number of A&E departments."

Across the country we can see this in progress, as District Generals become 'paired' where one will receive extra funding for development into a major emergency treatment centre and the other will be downgraded. (Halifax and Huddersfield or Milton Keynes and Bedford, for example).

The Sustainability and Transformation Plans look very much like the end game of transforming the NHS into a US style system. That is to say making it one provider among many in an insurance system where the state is one of the insurers - the NHS as the equivalent of Medicare. We are even creating the same models, Accountable Care Organisations (ACOs), based on Kaiser Permanente. That's in the 5 Year Forward View and has been documented - and even discussed in Parliament - since the 2000's.

The first ACO is in Northumberland where a company has been created to hold the CCG, primary care and specialist treatment budgets, which will be run by a consortium. In Manchester, meanwhile, the foundation trusts are to merge and become a hospital chain. Campaigners have predicted all these developments as they are the logical steps to completing the Americanisation of the NHS and preparing profitable sections (like hospital chains) for sell off.

All the 5YFV programmes follow the same principle, de-skill the staff, extract the maximum cash flow from fixed assets (like charging commercial rents), reduce the number of premises used and sell whatever else you can, use IT as a substitute for meeting face-to-face, discourage patient attendance, reduce the services available, regroup along commercial lines.

NHS services and hospitals are forced to go along with the plan because 'transforming' is the only way to access the diminishing funds, and the money is in desperately short supply. There are areas of the country where staff shortages are so bad there seems little option but to merge or shrink services to put together working services with limited staff. But the sell off in the wake of these changes means there will be no room to expand again in better times. And this shrinkage is intended to be permanent.

What can you do?

Write to your local MP

Write to your local Sustainability and Transformation Leaders.

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