Remember the 2010 election? Remember David Cameron's pledge not to have another top down reorganisation in the NHS which was soon rendered meaningless by the Health & Social Care Act?
Well the Tories have learned from all the negative publicity that harmed them last time by seeking to undertake their latest reorganisation away from public scrutiny.
You probably haven't heard about Sustainability and Transformation Plan (STP) "footprints" yet but these are going to be the major vehicle to drive big changes to your local NHS over the next few years.
Just a few days before Christmas 2015, instructions were issued to NHS bodies to come forward with "footprints" for their local health economy area. There are 44 of these up and down the country ranging in size from 300,000 people in West, North and East Cumbria to nearly three million people in Greater Manchester.
With health devolution steaming ahead in Greater Manchester that footprint seems logical but in my own area of Cheshire we have been included with Merseyside which is currently considering health devolution, whereas Cheshire is not. The inconsistencies this creates are just a side show though. Each of these footprints has been tasked with coming up with a sustainability and transformation plan by the end of June 2016 which will effectively be the local detail of delivering the NHS Five year forward view.
The five year forward view is supposed to be the NHS's plan to deliver £22billion worth of savings by 2020 in order to match the growing demand for health services with what the current Government are prepared to fund.
The problem is that virtually nobody in the NHS believes that this £22billion of efficiency savings is remotely realistic without cuts to staff or cuts to services. With more than three quarters of NHS Trusts currently in deficit, there is a big challenge balancing existing budgets, let alone finding efficiency savings of the magnitude required.
The fear therefore is that the STP footprints will be used to make unpopular decisions behind closed doors about closing services in order to meet the unrealistic savings demand by Government. That could mean A&E closures and downgrades, at arms' length from the Government and on the basis other services within that "footprint" will remain open.
Each of the 44 footprints has a "senior leader" who are mainly chief executives from local trusts but apart from knowing who they are we know little about how they will be accountable to the public or how the difficult decisions they will make are going to be arrived at. There is no model of governance in place yet and there is no public involvement in the blueprints that are currently being drawn up.
I have asked a number of Parliamentary questions about the footprints and some of the few facts these have revealed include that the footprints and leadership teams do not have legal status or legal duties and will not have the ability to borrow. This means that if these bodies do come to the conclusion that certain local services will have to go as part of a blueprint, there may be no public consultation on such decisions and no formal mechanism to challenge them.
To date these radical reforms have not been the subject of any Parliamentary debate or vote, with information being released via bland press releases on the Department of Health website. Given the potential these bodies have to change the way publicly-funded NHS services are run in the future it is about time a spotlight was shined upon them.
Justin Madders is a shadow health minister and Labour MP for Ellesmere Port and NestonSuggest a correction