Appendix Two to My Letter of 7th Feb

These are copies of my mails with Ann Filby regarding my conflict of interest over STPs:

Hi Ann.  (11/12/17)


I’m afraid I have to announce a conflict of interest on Tuesday. I have been wrestling with it since the last Council. STP behind closed doors is criticised and opposed by all my colleagues, including those in the Labour party and I cannot 1 remain a party to it. 



Hi Mike. I’m not sure what you are saying or what that means so can you advise please? The Trust is signed up to the STP with a number of organisations locally and Christine leading on acute to ensure we have influence – Andrew Palmer is also heavily involved as is his deputy. Our Board has considered this in detail at every stage and is absolutely focused on its statutory responsibilities to our patients.  We are one of 44 planning footprints in the UK – with something having to change otherwise the ‘do nothing’ option means a huge financial black hole and unsustainable services.


Thanks. See you tomorrow. (11/12/17)


Hi Ann.  (11/12/17)


Yes I’m well aware of the Trust’s commitment to SDP and the financial implications thereof. This is however, a major problem within the disabled community and the Labour Party and as a disability rights activist and a member of the Labour Party I cannot collude with it. It is also contrary to my values of patient and public involvement and Equal Lives’ commitment to co-production. And more pertinently, contrary to Nolan Principles and our own Trust values. Perhaps the quotes below will make it clearer (ACOs are a product of STPs).


“From the beginning, this process was rushed and carried out largely behind closed doors, by health and social care leaders trying to develop impossible plans for the future while struggling to keep the NHS from the brink of collapse.” (BMA)


Keep Our NHS Public is opposed to STPs. They are a way of breaking apart the NHS, not the regional improvement in integrated care they are proclaimed as.


In March 2017, Simon Stevens published his implementation plan for STPs to deliver changes equivalent to £22bn of cuts, Next Steps on the NHS Five Year Forward ViewHe introduced his assumed organisational form that the new sustainability and transformation partnerships would take – a coalescence of provider trusts and CCGs with any willing local authorities in area-based alliance organisations.

Stevens has named these ‘Accountable Care Systems’ (ACS). He predicted that these would evolve in a varied number of years but in all areas, into hardwired structures he unashamedly gives the USA-derived title of ‘Accountable Care Organisations’ (ACOs) the ‘ownership’ of which would be via a 10-15 year contract tendered out to an interested party or parties, explicitly including the private health and financial industry. Model contracts put forward the possibility of a Special Purpose Vehicle. SPVs are notorious in the case of financial wheeler-dealering of private finance initiative contracts (PFIs).” 


“The unacceptable secrecy in which these ACOs have been conceived and are being pushed forward is totally contrary to the NHS’s duty to be open, transparent and accountable in its decision-making. The manner in which the government is approaching ACOs, as with STPs before them, fails that test.


Labour want to foster a new phase of openness and engagement in the public’s relationship with the NHS. We’ll begin by forcing ministers to account for their Accountable Care plans in public – rather than behind closed doors.


Jonathan Ashworth, New Statesman, 10th Dec, 17.”



Thanks Mike. Maybe when you are feeling better we should have a chat about this as I am not sure where this leaves us.

Take care.

Ann  (12/12/17)

Hi Ann. (12/12/17)


That’s fine with me. When and where will be most convenient for you (give me at least three days).



Mike (19/12/17)

I am free on 4 or 5 January after 10am, if either day is good for you?




Thanks Mike for today’s useful discussion.  I confirmed the need for openness on the STP when there is something to engage/consult on – and that the private session with Governors is to enable full and frank views to be expressed by Governors and the Chair/Chief Executive/Executives on any strategic topic. STP-wide communications capacity has been enhanced and there are plans to release more information but this does need to be consistent across all STP partners – we also had the acute services review engagement sessions in early December on the three specific services where we specifically set out to engage with patients that know the service ahead of any changes being proposed.  So on this basis you said you would keep this under review and there would be no conflict of interest at this stage. If you could confirm my understanding please that would be great.


We also had a good discussion with the Estates team on disability issues and I will get back to you as soon as I have an update.


Thanks again for coming in.


Take care.

Ann (04/01/18)

Thank you Ann for arranging the very positive meeting with estates. It not at all what I’d expected and I, on behalf of disabled users, am delighted with the plans. How much of this can I share?


You say: “So on this basis you said you would keep this under review and there would be no conflict of interest at this stage.” and that is correct. I have to say though, I’ll be watching for any hint of privatisation…


Mike.  (04/01/18)

Glad you felt it was positive. You can share about the meeting but probably not worth giving too much detail until we know from David what is manageable and affordable. But the will is there to do the right thing by all our patients and visitors which is a positive message.


Ann (04/01/18)


And then further news of ACOs came through renewing the matter of further privatisation…

Mike Llywelyn Cox.


In all, the JPUH managers (and the governors?) appear to live in a different world to the rest of us!

Appendix one to my Letter of 7th Feb

This is just a small sample of organisations who have declared STP secrecy from patients and public to be wrong:

Kings Fund

NHS England (ppp policy)

Parliament (20/09/16)

The Consultation Institute

North Kirklees CCG (and many other CCGs throughout the UK)

Leicester, Leicestershire & Rutland health and social care

the patients association

999 call for NHS

London School of Economics

The Labour Party

Bedford Borough

The Guardian


The Huffington Post

Campaign to Save Mental Health Services in Norfolk and Suffolk


Black Triangle

Socialist Health Association

38 Degrees

NHS Constitution

NHS Support Federation

If necessary, I can produce chapter and verse for all of these.

Anna Davidson,

Chair of Governors,

James Paget University Hospital

NHS Foundation Trust,

Lowestoft Road,



NR31 6LA.

7th February, 2018.

Dear Anna.

Your ref: AD/CHAIR/LT/LO17082

You have chosen to criticise me personally for my resignation as a Public Councillor of the JPUH. My resignation was because of the Trust’s failure to involve patients and public in discussions do with STPs (now termed Sustainability and Transformation  Partnerships).

You said, in your letter of 30th January: “Whilst you are perfectly entitled to hold an individual opinion about the Sustainability and Transformation Plan (SIC) for Norfolk and Waveney, in my view your personal attack is both unwarranted and unreasonable” (my emphatic text colour).

Looking at my resignation letter again, I’m at a loss to see how you’ve arrived at the above conclusions.

To underline what I’m saying, I’ve set out in appendix one to this letter (attached), a tiny sample of the many organisations, which disagree with NHS trusts’ failure to involve patients and public in STP discussions. I concur with their positions and it is as a member of some of them and in concert with them I made my final decision to resign. Although their values parallel my own, it was NOT a personal decision but a concerted stand.

In fact, I discussed the position with senior UNISON colleagues before my resignation. They felt so strongly about it that they wanted to organise group support for me at the council meeting on 19th January, and it was after I had explained to them they would not be able to do so because of the ‘private’ STP meeting. I decided to resign before the 19th to offset possible major disruption for the hospital.

I realise I’m labouring this now but you should be clear that, in mid December I attempted to follow protocol raising a conflict of interest for 12th Dec and 19th Jan. I contacted Ann (Filby) to effect this but Ann said she needed to meet with me to discuss the matter.

As there were issues around disability access too, Ann arranged meetings with Estates first then, with her in tandem, to discuss my conflict of interest. Whether intentional or not, this was a good ‘communication’ move as the meeting with Estates (and Ann would have known this) was far reaching and very positive. I was buoyed up after the Estates discussion and at the meeting with Ann I easily agreed to leave my ‘conflict of interest’ aside for the time being.

I’ve set my mails with Ann about this in appendix two of this letter. It was only on reflection and subsequent revelations regarding ACOs, linked to STPs I realised I still had a duty to resign in the circumstances.

The irony in all this, like a Joseph Heller novel, is: had I known your practice of excluding patients and public from STP discussions I would not have put myself forward for election in the first place. I couldn’t know, of course, because you keep STP secret.


Mike Llywelyn Cox.

Letter from Chair of Governors

 On 30th Jan I received a letter from Anna Davison (Chair) Which said:
“I was disappointed to hear of your recent resignation and to read your letter explaining the reasons for this, especially given Ann’s considerable efforts to reassure you both verbally and in writing about the concerns you had expressed.
However, your claims in the letter about values and principles he caused offence to me as my role as Chair and the entire board. Whilst (sic) you are perfectly entitled to hold an individual opinion about the Sustainability and Transformation Plan for Norfolk and Waveney, in my view your personal attack is both unwarranted and unreasonable.”
This is a complete misreading of the reason for my resignation. First of all I had no negative opinion of the Norfolk and Waveney STP – care and treatment closer to a person’s home and prevention  rather than crisis management in health has been a primary concern of mine since starting in social work in 1968; and I told Anna this at  length when we first met.
More importantly my resignation was purely because of the JPUH’s deliberate exclusion of patients and public from meetings and discussions about STP. It is an incontrovertible FACT that this is at odds with the JPUH’s loudly stated ‘values and Principles.’
I replied to Anna in detail:

My Resignation Letter

Ann Filby,
Head of Communications and Corporate Affairs,
James Paget University Hospital, NHS Foundation Trust Gorleston.
15th January, 2018.

Dear Ann.

Resignation as JPUH Governor

After giving the matter a great deal of thought and further research with NHS Improvement and UNISON, I am now clear that I can no longer collude with excluding patients, trust members and the general public from discussions and debates about StrategicTransitional Partnerships and one of it’s serious consequences ‘Accountable Care Organisations.’1

To make this issue clearer, I will quote my own trade union, UNISON:

“There is further concern about the lack of transparency so far with the development of STPs. As non-statutory bodies, STP footprints must not be allowed to bypass proper consultation with staff, service users and the public. NHS England has itself belatedly produced guidance on engaging local people in the development of STPs, which highlights that proper consultation and engagement are an essential part of making the plans work.

For such far-reaching plans to work they must have buy-in from patients and the local community. UNISON is calling for meaningful public engagement around STPs at the earliest possible stage, including full and accessible publication of the plans.

STPs have the potential to cause much uncertainty and disruption for those that work in the NHS. UNISON is calling for proper staff and trade union engagement in the development of the plans, along with reassurances from the government around security of employment and pay, terms and conditions.”

I am also of the opinion there is a serious anomaly with respect to the JPUH stated values (which led me to decide to try for governorship in the first place) a main one of which is: “Doing everything openly and honestly.” And further to this, working “openly” and “transparently” with adherence to Nolan Principles of Public Life and having a “duty of candour.”

Holding STP discussions in private – not allowing public and patients admission to those discussions – is patently a solid breach of the above JPUH values, and a breach of the NHS Constitution. It is also a breach of my own long-held personal values and I have concluded I can no longer collude with this duplicity.

Please accept my immediate resignation.

Yours faithfully. Mike Llywelyn Cox.

1 Information from NHS Improvement.

Croeso Bob Un

I think that’s right! Trying to be clever see! I am Welsh (from Llandudno but now exiled in Norfolk) but I’m ashamed to say I don’t speak my own language properly. The title in English says Welcome Everyone and I always sign off letters and reports etc with Heddwch (Peace) – seems to me it’s more meaningful than yours truly, sincerely or faithfully.