Councillors’ weak questions about hospital cuts plans at 22nd March Joint Health Scrutiny Committee meeting

Calderdale 38 Degrees NHS Campaign Group Secretary, Rosemary Hedges, attended the Calderdale & Kirklees Joint Health Scrutiny Committee meeting on 22nd March 2016.

She made a deputation statement calling for the Clinical Commissioning Groups to carry out a risk assessment on increased patient death rates resulting from the closure of Huddersfield A&E.

These are predicted by reliable studies, that show increased patient death rates associated with having to travel increased distances to A&E, and increased inpatient death rates in hospitals that retain their A&E, when a nearby hospital closes an A&E.

Here is Rosemary’s report on the Joint Health Scrutiny Committee meeting.

There were 3 deputations to the meeting, from Helen Kingston (the Hands off HRI media contact), a Kirklees councillor and myself. They left quite early so I was the only member if the public there for most of the meeting. What does that say I wonder?

The Calderdale & Kirklees Joint Health Scrutiny Committee Chair, Coun Smaje, asked some perceptive questions but the quality of the other questions was mostly weak, with little follow up.

A Representative from the Clinical Senate was there. He said the Senate supported the strategic direction of the proposals but there hadn’t been enough detail about the whole system for them to comment on. He said integration of hospital and community and primary services, and networking across the wider footprint of W Yorks would be crucial. The Senate has not been invited back to look at the detail; but under pressure from Coun Smaje, the Greater Huddersfield Clinical Commissioning Group Governing Body Chair, Dr Steve Ollerton, agreed the Clinical Commissioning Group would do so after the consultation.

The NHS England (NHSE) representative admitted they had not considered the impact of the Mid Yorks changes on these plans but intended to. He said they will be looking at the sustainability of Calderdale and Huddersfield NHS Foundation Trust in the context of the wider “footprint: (W.Yorks), through a recent development of NHS England’s 5 Year Forward View. This is the development of sustainability and transformation plans across geographies.

He said:

“Some services will need to be delivered differently.”

Councillors failed to question him about this important revelation.

Coun Wilkinson asked about extra national funding for training and recruitment issues. The NHSE rep mentioned the £8billion being put into the NHS and said some of that would go into training. He spoke of developing new workforce models, presumably referring to the new lower skilled and cheaper grades of clinical staff such as physician  and nursing associates that we hear about in the media.

There were 2 GPs present who are involved with the Emergency Care Network which runs across W Yorks.   This is a body that looks at large health areas coming together to plan emergency services and develop “pathways”.  They are all in favour of the Clinical Commissioning Groups’ proposals.  Coun Smaje asked about the sustainability of Calderdale and Huddersfield NHS Foundation Trust beyond the 5 years in the plan.  The NHSE rep replied:

 “Beyond five years is clearly a challenge.”

This suggests to me that after borrowing all this money (£490 million) and carrying out this huge reorganisation, the future of our local services is still not guaranteed.  We do know that, even after carrying out all the cuts in the current proposal, Calderdale and Huddersfield NHS Foundation Trust will still be facing a funding shortfall of £9.5 million a year by 2020. This translates into an annual deficit that would accumulate within just over two years, to the same amount as the Trust’s current funding shortfall (£21m)  In 2020 we will be back to the current position, but with only half a hospital in each district left.  This does not make good economic sense to me.

Yorkshire Ambulance Service (YAS) and NHS111 were next on the agenda.  This is all part of what is called the ‘Hear, See, Treat’ programme. This is the system whereby the 111 phone line is first point of contact,  then a paramedic may be sent to assess the patient, then a visit to the Emergency centre at Calderdale Royal Hospital (CRH) may be arranged.  Alternatively the patient could be given advice to consult their local pharmacist.  This will apparently be all joined up, although it is not now.  One councillor spoke of ringing NHS111 in the night and being told they were overloaded with calls and to put the phone down.   Paramedics will be used to deal with emergencies in the home and then they will try to keep people at home rather than sending them to hospital.  It’s all going to be about ‘pathways’.  YAS was NOT discussed at any point and the YAS rep said nothing.  This is a huge gap in the plans which was not explored.

Dr Mazeb described the emergency facilities at the 2 hospitals.   There will be an Urgent Care Centre at both hospitals and an Emergency Centre at CRH.  He said this is:

all in line with national thinking’

and

‘Higher quality and safer services with a happier workforce’

When asked about staffing arrangements, he said the exact workforce models have not been worked up yet and they still don’t know if they will be able to reduce attendances at the two departments, with the new plans.  However, they are working on the basis of being able to cut beds from implementing Care Closer to Home – the scheme to move hospital services into the “community”.  Coun Smaje asked:

‘How can you model bed reduction if you haven’t modelled A&E changes?’

Her question exposed this as being all theory with no evidence to support the predictions and hypotheses.  She asked to see more work on this.

Coun Smaje also asked about Urgent Care Centres at Todmorden and Holmfirth but was told these were not being considered at the moment.

The agenda for this meeting was far too long and important issues were not scrutinised. The councillors still seem to have trouble in understanding exactly what is facing them, and back down far too easily in my opinion.

After the meeting I asked Coun Smaje about the Calderdale 38 degrees request for them to ask for a risk assessment of mortality rates from the CCGs,  and she said they would discuss it.

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