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A highly sensitive document has mysteriously appeared on my desk. It's a draft Business Plan from Cornwall's Primary Care Trust, outlining the ways and means of taking Cornwall's community hospitals outside of the National Health Service - a decision endorsed by the PCT Board yesterday.

This bit was deleted during a private part of yesterday's meeting, once the press and public had been excluded:

"...through our market assessment, we understand that it will not be possible for our new Community Interest Company to continue to offer the full portfolio of services that Cornwall Community Health Services did."

"In order to further the efficiency and cost-effectiveness of the Community Interest Company, a number of strategies already exist to reduce patient lengths of stay and acute admissions. As a result of this, it is envisaged that the number of beds required will therefore be reduced.....CHS needs to reduce its bed-stock by a total of 54 beds to increase productivity."(PCT emphasis)

54 beds is about 20% of Cornwall's entire community hospital stock. In other words, one patient in five would have to be "managed" out of the system. The document identifies stroke patients as those particularly suitable for treatment elsewhere (but it doesn't say where).

The PCT assures me that both of these highly controversial paragraphs have now been removed and of course I accept that assurance. I also accept that the document in front of me is an early draft and that the thinking that went into yesterday's decision took some months to evolve.

But I still have some questions. What has happened between December 2010 and today which has miraculously restored "the full portfolio of services?" Was the author of the draft correct in December, and somehow mistaken yesterday? I'd love to know more about the "market assessment" on which that December opinion was reached.

There are other questions about "process" - the way in which some highly political healthcare judgements have been considered in secret. Why was the idea of cutting 54 beds not debated in public? Is the National Health Service not a public institution, with every penny of its budget spent from the public purse?

The PCT tells me that much of the draft Business Plan is commercially confidential. I beg to disagree - it might be confidential to anyone who is looking to make money out of the NHS, but not to NHS patients or to NHS staff. So why not let NHS "suppliers" produce their own confidential documents? To those who suspect that these NHS reforms are all about privatisation, this document looks remarkably like a smoking gun.

The same section of this draft Business Plan goes on to talk about a "beds review" which should have been completed in March or April. I've asked the PCT for a copy. It also reveals a "" (Quality, Innovation, Productivity and Prevention) which talks of saving £6m on Cornwall's health services by 2014 - £0.5m cuts in 2011/12; £2.5m in 2012/13 and £3m in 2013/14.

St Ives MP Andrew George, who has expressed concern about the way the NHS is being "reformed" has some questions of his own and in a letter to the PCT asks for confirmation "(a) that these sections were contained in the Business Plan submitted to the Strategic Health Authority at the end of December last year? (b) that these sections were contained in the Business Plan shown to members of the Overview and Scrutiny Committee recently? (c) whether or not a Community Hospitals Bed Review has been undertaken yet whether would you acknowledge that by implication, such a process would be part of the preparatory work required for the setting up of the Community Interest Company?"

The document preparing the way for a "Community Interest Company" begs at least two more questions - which community? And whose interest? I've blogged the background to this before and I dare say there's more to come.

STOP PRESS: ³ÉÈË¿ìÊÖ Radio Cornwall aims to have more on this on our breakfast programme with James Churchfield tomorrow morning. I've invited the PCT to contribute.