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ONE: The title.

Make sure your consultation has anabsurd, happy-clappy title that belies itsreal purpose: many have already beentried -- Shaping a Heathier Future, APicture o Health, Better Care Closer toHome, Healthier Together. Use one othese or make up another.

TWO: The smokescreen.Make sure your consultation documentbegins with at least 10-15 pages o generaltwaddle on public health. All you needis a series o truisms on local prevalenceo disease, mortality statistics, smoking,

drugs, alcohol and other health issues,deprivation, ethnic mix and inequalities.And o course preventive health.

Anything will do. O course none othis bears any relation to the plans you areputting orward. This is not the real reason orchange, or a basis or your proposals.

In act you are likely to ignore theseissues altogether when you closehospitals and services in the mostdeprived areas with the best servicesor those most in need. This is what hashappened in NW London and SE London.

THREE: The threat.You need to work in a subtle hint onancial pressure, while strenuouslydenying o course that your plans arenance driven. Reerences to value ormoney are always helpul. Dont overdoit, or repeat too oten, and try not to linkyour cutbacks to cash savings.

FOUR: The safety catch.

Make a strong play or your credentials asupholding saety and improving patientcare. Not only does this divert rom what

you are actually doing, but the saety cardcan prove very handy as an excuse or thesecond wave o cuts that will inevitablyollow on once the rst wave is in place.

Having reduced a site to electiveservices only and removed ITU etc, youcan pick your time to argue (obviouslywith regret) that it cant be properlystaed, and more services need toclose perhaps temporarily, and thenpermanently or saety reasons. Thisway you can get away with closureswithout any consultation at all.

FIVE: Target A&E!

Make a beeline or closing an A&E,possibly replacing it with an Urgent CareCentre not because you can make bigsavings rom A&E (which is very cheap to

run), but because once you push throughthat closure you have cleared the pathto closing the rest o the hospital. Someservices will automatically close alongsideA&E, others can be saved or later. Thethreat to an A&E will also draw almost all

the attention o local public campaigningand press coverage, letting you get onwith other cuts with little disruption.

SIX: Closer to home

Imply or even promise you will replacehospital care with a range o services closerto patients homes or in the community.Never mind the act youre closing thenearest hospital, or that there is no evidencethese services can replace A&E or thattheres no money to pay or them.

SEVEN: Figures of fun

A reconguration needs more than justclosures: it needs a ready supply o dodgyplans appearing to cut costs, improve

productivity and ocus resources. One readysource is the McKinsey report rom 2009which rst mapped out ways to save 20billion rom the NHS through measuresincluding the rationing or exclusion oelective treatments including hip and kneereplacements, cataract operations orcutting doctors consultation times.

Lard every argument with plenty ododgy gures. Take your pick or exampleabout which infated proportion o A&Epatients you want to claim might betreated in primary care or in communityservices i they were ever to be madeavailable: so ar we have seen claims o60%, 70%, 75%, 77% and 80%.

Other old avourites include imaginarytravel times to more distant hospitals.

EIGHT: Turn a deaf ear

Ignore any questions on embarrassinggures and issues that might discredityour argument such as gures showingthe continued rise in emergencyadmissions and reerrals, the pressureon hospital beds, the spiralling workloadon over-stressed sta, the levels odeprivation and other specic needs o alocal population, etc. Just ignore them.

NINE: Keep it vagueWherever possible avoid oering anyconcrete plans or alternative services. Youare trying to save money, not spend it.Your only concrete plans, with timescalesor implementation should be your cutsand closures.

Remember its always easier not to make apromise than to break one.

TEN: Control the consultation

Remember the consultation processis your way o brushing aside popularresistance and inormed criticism. Somake sure your consultation document isdecorated with the ull gamut o spuriousoptions and skewed questionnairesgiving no chance to say NO to your cuts.

Set up a series o poorly advertised,one-sided meetings or you to rattleon to small audiences at inconvenienttimes and inaccessible locations,and inadequate numbers o patchilydistributed documents: make suretranslations are only o summaries andappear late in the consultation i at all.

The one thing to remember is never,ever to answer any awkward questionsthat may be raised or address genuineconcerns in your response to theconsultation. You can rely on ministers topush through your plans.

Thats it! If you follow these

simple steps you can gag theopposition and push your plans

through. You will be unpopular,of course but, hey, you will keep

your job, even as others losetheirs.

BRIEFINGS FOR CYNICAL COMMISSIONING GROUPS (1)All the guidance you needto turn any popular andsuccessful local generalhospital into a clinic orhousing development.

Tis handy guide compiled by John Lister, www.healthemergency.org.uk

Reconfguring hospital services

How to get away with it