They talk about “efficiency savings” rather than “cost cutting” and the difference is vitally important. “Efficiency savings” are when you can provide the same level of care for less money by being more efficient, whilst “cost cutting” is when you reduce your costs by reducing the quality of care.

The underlying principle of their proposals is that home-based care is as good medically but can be provided at a fraction of the cost.

On top of the reduction in hospital beds that would result from home care, they claim that beds are already under-utilised and that even more beds can be cut if we can cut bed blocking (so that social care support is available for patients who need it so that they can leave hospital).

All these make sense if the evidence is there to back them up, but these claims need to be independently analysed and verified. Additionally there is the inevitable fight about where the cuts in beds will be made, and questions about whether the replacement home care and social services will be in place and fully ready before the cuts in beds are made.

Like Claire, I set out to see whether the written evidence actually supports these proposals or whether the evidence has been fudged.

The Home Care proposal is based on pilots already undertaken in North Devon – and on formal reports that have been written following these pilots. When reading analyses like these, I want to see them take the data, ideally using objective measures of health improvement (such as mobility resulting from physio on some standardised scale) though subjective surveys of patients also have a value, and then summarise the good and bad points and only then draw conclusions about whether the pilot should be extended to the whole of the CCG area.

Unfortunately the reports are lacking in objective medical assessments of home care vs. hospital care, relying almost exclusively on subjective patient surveys of home care and without comparative subjective patient surveys of hospital care.

Even more worrying is that the reports seem to have been written in the wrong direction, starting with an objective in mind (i.e. a decision to roll home care out across Devon) and then selecting data to support this case (i.e. they give lots of individual survey comments about how good home care is but gloss over the negative comments).

The analysis is also deficient in highlighting potential down-sides to their proposals (for example increased difficulties for patients and visitors who do need hospital care to travel to the now much more distant hospitals) or the risks that might be inherent in these changes of approach (i.e. availability of immediate help from hospital nurses cf. planned visits from home carers, ability to handle emergency complications that need hospital facilities which are not available when people are being treated at home).

The reports do not give proposals for improving availability for social care for people who should be leaving hospital, because that is not funded by the NHS and so outside their control, but nevertheless they are going to cut those beds.

I guess they see this as a one-off issue, because once they have implemented home care, the people won’t be blocking hospital beds because they won’t actually be in hospital. Of course, that doesn’t deal with either this one-off issue of people who are in the beds when they are cut, or the resulting long-term issue of people now being treated at home who start to need social care in the same way that they would if they had been in hospital – but their thinking is presumably that at least these people are not blocking their beds.

The bottom line on home care is that it may well be as good or even better (for certain types of patients and conditions) but the evidence is insufficient to show this, and there are no guidelines set to ensure that the new approach is only chosen for patients who will benefit and not be at risk from home care.

BUT, suppose we assume that there is solid evidence that home care really works – the next issue is where to cut these beds.

The issue with the CCG approach is that they are looking simply at financial numbers, and not at the impact it may have on the ability of patients or visitors to get too and from hospitals which may now by 30-50 miles further away.

For example, the beds in Ottery St Mary [Axminster] and Budleigh Salterton hospitals are already gone, the beds in Honiton hospital are going in every option currently put forward by the CCG, and yet one of the options proposed also eliminates the beds in Sidmouth hospital. That would mean that ALL the community beds in central East Devon will be gone. How can this be right?”

Finally, we also need to be careful about use of terminology – whether to call it “over spending” or “under funding”.

We need to be realistic that if we decided to treat every medical condition, however minor, using the best possible drugs, however expensive, NHS costs would probably be unaffordable.

The reality is that NHS care has to be prioritised, with some treatments rationed or unavailable. So the issue is whether this prioritisation is undertaken nationally to set the national budget with regions spending what is needed to achieve this standard of care, or whether you continue as at present and fund each region individually (with inevitable inequalities in funding because demographics e.g. an older than average population or population growth due to massive house building or new towns are not properly factored in) and allow them to do the best with the funds they are given, which inevitably results in variations of care which get called postcode lotteries – and these regional variations in medical care (postcode lotteries) are likely to increase when you use local “Success Regimes” to cut costs (oops sorry – make efficiency savings) in individual regions rather than deal with matching treatments to budget at a national level.

The Health Secretary dismissed recent controversies – involving hip and knee replacements, eye surgery and fertility treatment – insisting it was perfectly possible to both “improve care and make efficiencies”.

The comment came as Mr Hunt came close to admitting that Theresa May had told him the NHS will receive no extra money in this Parliament.

The NHS had been given all the money it asked for – admitting it was only enough to “get going” on a restructuring plan.

Meanwhile, the Commons Health Select Committee was also told that funding-per-head in England will actually be cut in 2018-19.

The committee heard evidence from both Mr Hunt and Simon Stevens, the chief executive of NHS England, amid growing concern about a gathering storm in the health service.

The National Audit Office has warned that, without proper funding and tough efficiencies, “the result will be some combination of worse services, fewer staff, deficits, and restrictions on new treatments”

In recent months, there have been protests that patients are waiting up to 15 months for cataract surgery, that IVF treatment is being axed in many areas, and similar controversies about orthopaedic care.

Sarah Wollaston, the committee’s Conservative chairman, pointed out to Mr Hunt that there were “numerous examples of rationing”, adding: “This is happening on a widespread scale.”

But the Health Secretary said: “I don’t accept that, in order to make those efficiency savings, you have to make changes that will have an impact negatively on patient care

“There is of course an easy way to make savings – which is to reduce the availability of care for patients

“But there is a harder way, but the right way, which is to find ways that improve care and improve efficiency at the same time.”

Mr Hunt insisted the Department of Health did not allow rationing that made care worse for patients, telling the committee: “We step in.”

Last month, Mr Stevens warned that much of a promised extra £10 billion each year for the NHS has been “back-ended to 2020”, which made tough choices inevitable in the intervening years.

It was only in 2016-17 that the NHS was getting “broadly what we asked for” – which meant that, between 2017 and 2020, the Government was providing less cash than requested.

Yet ministers had repeatedly dismissed warnings of a crisis on the basis that the NHS had been “given the money it asked for” – and that the cash injection was “frontloaded”.

Today, Mr Hunt changed tack, acknowledging the NHS had only been given the cash “they said they needed to get going” – to “kick-start” the five-year transformation plan.

Emphasising the hard years ahead, Mr Stevens said there would be “negative per person funding” – a per capita cut – in the financial year 2018-19.

At the weekend, it was reported that Theresa May insisted there would be no extra cash for the NHS in next month’s Autumn Statement.

Asked if that was correct, Mr Hunt replied: “It was a private meeting.”

Thankfully, Stevens is unlikely to indulge in the same delusional fantasies about the state of his service. He already warned the public accounts committee in September of this “incredibly financially challenging period”, and “incredible” is the word he should cleave to. As every trust is forced to produce a financial plan that balances on paper, most – in private – admit these are fairy-tales; Chris Hopson of NHS Providers makes plain these pigs won’t fly. Hunt relies on threats and micro-managing. Just yesterday he put another three debt-ridden trusts into “special measures” to warn others their heads will be on Whitehall spikes. But there’s safety in numbers: he can’t sack them all.

Theresa May has said there is no more money: the NHS must save £22bn by 2020, despite three quarters of trusts being up to their ears in debt and missing waiting targets by miles. If she could cut police costs by 20%, why can’t the NHS, she asks. Because crime has dropped like a stone over recent decades while NHS need heads skywards, with growing numbers of the old, and collapsing social care. She risks a brutal brush with NHS reality before long.

But that’s not all. By Friday all 44 areas have to produce a sustainability and transformation plan (STP), unleashing vehement local protest against any mergers or closures.

After Lansley’s catastrophic 2012 act blew the NHS into myriad competing fragments, this re-reorganisation was meant to repair the damage and glue the fractured parts together again – a good idea. Stevens devised STPs to bind each area into a single unit, combining GPs, mental health and hospital services in one budget as a coherent whole. That might mean amalgamating maternity or A&E departments, rationalising stroke or cardiac care. Good idea, in theory.

But these plans collide with the £22bn “savings”, so how will local people trust the good intentions of these plans? NHS England has rightly taken fright: the Health Service Journal reveals there have been orders requiring each area to send every STP announcement to the headquarters communications team to make sure they “articulate tangible benefits for patients” in language that is “clear and compelling”. But it may take more than “compelling” language to assuage local fears.

Few of these plans have yet been agreed, allowing rumours and fears to fester – and when they do emerge, the government can expect no backing, not even from their own MPs and councillors. Expect every politician, irrespective of party, to dash to join the local “Save Our Hospital” demo. Any who pause to suggest some plans might be good for patients will be mown down in the stampede. Bandwagon campaigners will join every protest, regardless.

A cluster of hospital protesters went to Downing Street and the Commons last week, with petitions about closures from Barnstaple, Dewsbury, Chorley, Huddersfield, Grantham and St Helier. Each has their own circumstance, so it’s well-nigh impossible for local people to know which units should be “saved” and which rightly closed.

Among them were protesters about the Horton hospital in Banbury. At last week’s prime minister’s questions, the Tory MP for North Oxfordshire, Victoria Prentis, asked an impassioned question: “Does the prime minister share my sadness that the majority of Banbury’s babies cannot be delivered, as I was, at the Horton general hospital? Will she join with me to put pressure on the trust to reopen the unit?” The PM replied: “Every effort is being made …”

Horton swears they’ve moved heaven and earth to hire doctors but none would come: there’s a 24% vacancy rate
The Horton maternity unit closed abruptly this month after failing to hire middle-grade doctors, leaving a midwife-led unit. Part of the Oxford University Hospitals, its HR director swears they have moved heaven and earth to hire doctors but none would come: there’s a 24% vacancy rate in the district. The Horton obstetric unit lost its validation for training doctors as too few babies were being born there to qualify, so junior doctors won’t apply. They are still advertising, promising to reopen if they can recruit. Managers spell out the situation in painstaking detail, answering every possible query. But all this is to no avail.

A vociferous local Keep the Horton General campaign gathered 5,000 people to hold hands round the hospital, amid longstanding suspicions that it might be axed despite a plan to rebuild it. Every party supports the protest, with their Tory MP as militant as the rest. She says she doesn’t trust the management: “They make decisions about us without us.” She and the campaigners mistrust whatever they are told.

The Banbury Guardian relishes the story, as the local press always does. “It’s lovely how the community has come together,” Prentis says. Banbury businesses are offering any obstetric doctor recruited free shirts, free beer, cheap accommodation and discounted fees at a local private school. A packed meeting roasted NHS managers about the journey time for mothers in labour to travel to the John Radcliffe in Oxford. Nothing creates such feelgood community cohesion as a local NHS threat.

Talking to both sides, I am inclined to believe the managers’ good faith. But with deeper cuts scheduled for the years to 2020, can anyone know for certain where they might fall? At the Witney byelection, the Horton and other Oxfordshire NHS closures feature prominently. How Tory MPs get away with it beats me: they voted for these NHS cuts.

Watch this pattern repeated around the country as STP plans unfold. “Clear and compelling” language may not be enough when the NHS professionals, even the doctors, struggle to be believed. In the fog of war, with suspicions rife, local people have no way of detecting the good plans from dangerous cuts. As Stevens warned MPs: “Let’s be clear, there are going to be significant challenges, there will be choices, there will be controversies.”

Winner: Karime Hassan, chief executive and growth director at Exeter City Council

“Our judges said Plymouth City Council has demonstrated an exceptional and proactive approach to the built environment in the last 12 months. It has an innovative approach to planning infrastructure and housing needs and has a compelling vision for a waterfront city.”

It is also leading renovation works at the £12million rejuvenation of North Prospect for Plymouth Community Homes.

Other major contracts in Plymouth include the £5million extension to the Kawasaki Precision Engineering factory in Ernesettle.

Indeed having removed the beds from Ottery St Mary and Axminster hospitals, the CCG now proposes to take all beds from Honiton and Okehampton, leaving only 32 beds in Tiverton, 24 in either Seaton or Sidmouth, and 16 in either Exmouth or Exeter (Whipton), to serve 900,000 people in most of Devon.

The Town Council has expressed its grave concern at the threat to Seaton Hospital and the wider removal of community beds. With Councillor Martin Pigott taking the lead, I and other councillors have met with representatives of the Hospital League of Friends and the GP practices (who have questionnaires available for you to express your views to the CCG).

We will be organising a public meeting, probably on Friday 4th November, with Neil Parish MP – the CCG will be invited to send a representative.

The community hospitals are an essential half-way house, much valued by patients, between the acute beds in the Royal Devon & Exeter Hospital and care in the community. The whole point is to have them local. Taking their beds away will make only a small difference to the CCG’s ballooning deficit – the only thing that will really change it is for the Government to finally put in the extra funding which everyone knows the NHS needs. We need to link up with others in East Devon to make this a common battle.”

The action will see the government use surplus public land to build more homes more quickly by encouraging new developers with different models to enter the market, and to support small and medium-sized firms and constructors. This will help to close the housing supply deficit, ministers stated.

In addition, local planning authorities will be able to grant permission in principle on sites suitable for housing-led development, as well as turning abandoned shopping centres into new communities and increasing housing density around transport hubs.

Javid said that the government had made progress in boosting construction, with over 700,000 net additional homes delivered between April 2010 and March 2015, but it was now time to go further.

“We want to ensure everyone has a safe and secure place to live and that means we’ve got to build more homes,” he added.

“It is only by building more houses that we will alleviate the financial burden on those who are struggling to manage.”

Hammond stated there had been a housing shortage in this country for decades, and that the government was determined to tackle it.”

CMEC achieves this through a number of activities. Firstly, it organises delegations of Conservative MPs and Peers to the region. Delegations have visited Israel and the Palestinian Territories, Libya, Egypt, Syria, Bahrain, Saudi Arabia, Iran, Lebanon and Tunisia.

The planners came to our town
To see what they could do
We’ll smack this place around a bit
Who cares about the view?
We’ll knock it down and mess it around
We’ll sound its final knell
We’ll rip the heart right out of the place
And the locals can go to Hell

Hands off, hands off
They must be on Cloud Nine
The planners they can stick their plan
Right where the sun don’t shine

The planners came to our town
To grab the Market Square
There’s nothing much of value
That ever happens there
The market’s so untidy
We can’t see why the fuss
We’ll make it nice and neat and clean
For boring people like us

Hands off, hands off
They must be on Cloud Nine
The planners they can stick their plan
Right where the sun don’t shine

I don’t care what the planners think
Their plan is plain absurd
Its up to every one of us
To give the loonies the bird
We’ll march, petition and protest
With signatures by the load
And if that doesn’t do the trick
We’ll sit down in the road