As the end of June approaches, the Clinical Commissioning Groups (CCGs) in England will have to submit interim updates on their Sustainability and Transformation Plans to NHS England which will have to be finalised by the autumn of 2016. It was in March that NHS England issued the NHS Shared Planning Guidance and "asked every local health and care system in England" to come together in "collective discussion forums" to "create their own ambitious local plan for accelerating the implementation of the Five Year Forward View". It named these Sustainability and Transformation Plans (STPs) as "blueprints" that the government and NHS England is trying to create over five years. To deliver these plans it charged NHS providers, CCGs, local authorities, and other health and care services to come together to form 44 STP "footprints". However, what became immediately apparent is that this "guidance" on the STPs is not about "sustainability" and the funding of NHS services and their development as they exist now but is a deliberate five-year plan coming from government to accelerate the cut backs to acute, emergency, GP and community services.

In announcing this STPs "footprints" plan, Simon Stevens, chief executive of NHS England, admitted that he and NHS England had put local health leaders "on a burning platform"i to "create change quickly" and he revealed that NHS England "have held back the funding growth for the NHS over the next five years to the NHS" claiming that this is "strong incentives as to why people should take this process seriously". Of course, there will be no surprise that this confirms that the only direction and only message being delivered in "Five Year Forward View" is one of massive reduction in the availability of all types of health care for the people of England and Wales if these plans are allowed to go ahead, which will also impact on Scotland and Northern Ireland.

For example, in the Northumberland Tyne & Wear (NTW) STP footprint area a fully funded pilot has already closed Berwick-upon-Tweed, Ashington and North Tyneside A&Es to be replaced by Northumbria Specialist Emergency Care Hospital at Cramlington some 60 miles from Berwick-upon-Tweed. Since Berwick-upon-Tweed now has no A&E, patients have to be transported by ambulance long distances even in a life and death situation. Now plans are being drawn up to close further acute services and A&Es in the rest of the area.

These closures are being driven by what the five CCGs in NTW are calling a "funding gap". This has already been estimated at £648 million by 2019 for the NTW area if the health service "remains as it is now". Far from this being "shared planning", the government and their commissioners are holding a gun to the head of the providers of health care. In South Tyneside, for example, South Tyneside Health Care Trust (STFT) and City Hospitals Sunderland (CHS) have formed an "alliance" in which to "deal with" around a staggering £50 million shortfall in funding at both Trusts this year. This "alliance" instead of fighting to maintain services has declared that they intend to close all acute services in South Tyneside Hospital over the time of the plan which, with the loss of acute services, will also make the A&E at the hospital unviable. This at a time when both hospitals are full to capacity and suffering severe shortages of nurses and medical staff. At the same time, whilst the South Tyne & Wear health platform "burns", it beggars belief that the local commissioners of STFT announced this year a plan to close more hospital beds. They claimed that there is an "over-dependence on hospitals" and a need for "care in the community" based on pharmacies and "self care". This at a time when there is the lowest number of GP and community services in the area for many years!

It is important to understand what is the nature of NHS England. It is no longer the Department of Health with a Secretary of State for Health who has responsibility for the funding and provision of the NHS. Under the Health and Social Care Act, 2012, that responsibility and accountability of the Minister for the provision of health services was removed. Instead, NHS England was set up as head "Commissioner" of a purchasing mechanism comprised of nation-wide local commissioners (CCGs) in England. In this new arrangement which has been deliberately created over many years by Labour and Conservative governments the health providers, such as acute and community Trusts are treated as independent "not for profit" bodies and have to compete for contracts, with the commissioners and the private sector and sink, or swim jeopardising whole areas of health care provision.

It is a system that is extremely inefficient and wasteful of resources, fragmenting organisations instead of bringing them together. Most of all it is impossible to plan a future health care system for one year let alone five years with such a "market" system in health. It is this commissioning mechanism that the government is using to systematically implement massive cuts to the health budget which have now reached a crisis point for the NHS providers. This is leading to severe stress in every way on the health care system over recent months and the scandal of so many hospitals and health providers being declared to be in "deficit" by NHS England and the government. The plan of successive governments has been to deliberately cut funding of hospitals and services year by year with so-called "efficiency savings". Now, the present government hopes to accelerate this using the "Five Year Forward View" and STPs. This is not in the interests of a modern health care system but in the interests of paying the rich by starving this public sector of funding. This is the criminal scenario of NHS privatisation that the government and health monopolies they serve has in mind. They hope that by wrecking the NHS in this way they can divert these huge cuts in the NHS budget to lubricate the private health monopolies to take over the most profitable parts of a failing NHS. They will also hope to use the crisis they have caused in the NHS to justify disqualifying more and more patients from free access to health care and justify more and more charges to all patients.

The "Five Year Forward View" and STPs are the most blatant attempt yet to wreck the health service within the timescale of the present government. Already people are protesting these plans and are coming together to safeguard the future of acute, emergency services and GP and community services in Save Hospital campaigns in many parts of the country. These actions of the people have won a number of victories in recent years such as with the Save Lewisham Hospital Campaign.

Based on their experience the people involved are increasingly recognising that a stand has to be taken against this whole anti-social direction for the NHS and that the people must fight on the basis of a new direction that starts from the modern conception of the people that access to health care is a right of all in a modern society and that it must be guaranteed. As the lessons of the movement to safeguard the future of the NHS have so far demonstrated, what is important are self-reliance, strength in mobilising the people themselves to defend health service, unity in action irrespective of people's political opinion and most importantly the adoption of a political outlook that fights to deprive those in power of the power to deprive us of our health service and deprive us of the right to health care!

i http://www.thecommissioningreview.com/article/there-are-44-stp-footprints-stevens-revealed

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