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A hot autumn beckons for our hard-pressed NHS. After a summer with wretched scenes of stacked-up trolleys in the corridors at Royal Stoke University Hospital, and last week's abrupt suspension of children's A&E at Stafford, the sirens are already howling loudly again.
Yet, just as public confidence demands openness about the way ahead, the NHS powers-that-be have now regressed to defiant, default mode – secrecy and stealth, instead.
Staffordshire, like many areas of the country, is currently in the throes of another sweeping health re-organisation – in the jargon, a Sustainability and Transformation Plan. We'll be hearing much more about STPs in the months ahead, and of cuts and closures, as the Government finalises plans for £22 billion of NHS savings by 2020/21.
That dwarfs, of course, the extra £8 billion pledged during the general election, when it promised to do 'whatever it takes' to help the NHS.
Locally, the process started back in 2014, just as the Royal Stoke – as the old UHNS was renamed – was rescuing Stafford hospital after the tragic Mid Staffs scandal there. Our county had been designated as one of 11 'distressed health economies' across England and was lined up for corrective discipline.
In default mode again, the Government refused to publish its findings, in a costly report by accountants KPMG. But a copy leaked to me showed that, without further funding, Staffordshire's NHS was heading for a £200m plus deficit in the years ahead.
In fits and starts, that work has continued, culminating in an hour-long presentation of Staffordshire's STP to NHS Chief Executive Simon Stevens in Whitehall in mid-July.
Local MPs, of course, were not invited. But we did hold three meetings with health minister Ben Gummer from February, when it looked as if the NHS might finally be opening the doors. There was no more money (the hospital wanted more help with Stafford), but the minister's attention was encouraging. In the reshuffle, though, he was off – to the Cabinet Office – and there's been official radio silence since.
What's clear now, though, after a bit of digging, is that two years of 'fits and starts' have produced a bureaucrat-driven straitjacket for the future. As a county, Staffordshire does not fit together as a healthcare whole. While the north and middle looks to Stoke-on-Trent, the south engages with Birmingham, Wolverhampton and Worcester even, and the east to Derby.
Rather than plan integrated care along those 'pathways', what's on the cards now – behind the scenes – is a county-wide merger of everything, bar our local hospital trust (and Burton hospital, which will go to Derby).
That monolith – an 'Accountable Care Organisation', ironically, in the latest jargon – will sweep up Staffordshire's six local NHS Clinical Commissioning Groups, two mental health trusts and its social care partnerships.
And what's more, the whole process is being driven, not by rational planning to relieve burdens on A&E, make more of GPs' surgeries or improve home care for an ageing population, but by cost-cutting. Even if, short-term, it increases the pressures.
The effects are already being seen, and without any public say. Just before the summer, closure of Ward 4 at the Harplands removed a safe place of discharge for patients with mental health problems from the acute hospital.
Cuts to the County's Better Care Fund threaten the viability of drug, alcohol and other services, as well as the future of respite and rehabilitation facilities like Brighton House at Silverdale in Newcastle.
Just a fortnight ago, too, we learned that both wards at Cheadle hospital would close, further affecting acute discharges, while Social Services still struggles to help people at home.
In response, I have now asked the Secretary of State Jeremy Hunt to publish Staffordshire's STP when Westminster returns next week. In written parliamentary questions, I have also demanded to know how much this is all costing the patient and taxpayer.
According to sources in Whitehall, I understand that the combined salaries, for example, of the four executives leading the Staffordshire programme come to a mighty £750,000, each earning more than the Prime Minister. While Mr Hunt continues his battle with the junior doctors, and imposes austerity pay on frontline NHS staff, such rewards at the top should certainly be transparent, too.