Joint Health Scrutiny finds that no one knows if Care Closer to Home system can cope with proposed hospital cuts

Representatives of the Yorkshire Clinical Senate attended the Calderdale and Kirklees Joint Health Scrutiny Committee meeting on 22 March 2016, in order to answer questions about:

  • Lack of information about whether there is the capacity to deliver the proposed Care Cloers to Home services.
  • The impact of this on the proposed closure of Huddersfield A&E – which the Clinical Senate defended on the contentious grounds that “the centralisation of some services to deliver care to patients affected by serious conditions is entirely appropriate”

As Save our A&Es campaigners have pointed out at previous JHSC meetings, the Clinical Senate’s review of the hospital services model says (Pre consultation business case, p159):

“The lack of detail … left the Senate with questions regarding the ability of this model to deliver the standards proposed.”

As for the community services/Care Closer to Home model, the Clinical Senate Review of Community Services Specifications for Calderdale, Greater Huddersfield and North Kirklees CCGs says:

“…the visionary style of the documents…has compromised our ability to assess if the risks have been addressed.”

The Joint Health Scrutiny Committee Chair, Cllr Smaje, asked about the lack of information concerning whether there was the capacity to deliver Care Closer to Home services. These services include primary care, hospital care, community care and networked care.

Clinical Senate and NHS England haven’t looked at the capacity of the whole system to deliver the proposed changes

Both these organisations have responsibility for “assuring” the proposed cuts and changes and NHS England also has responsibility for “assuring” the consultation process. So why haven’t they done their jobs properly?

Cllr Smaje pointed out if  services lack capacity to deliver the Care Closer to Home scheme, this would affect the proposed hospital cuts.

She said:

“Capacity is a major area as to whether the system can cope with these changes, and that includes Care Closer to Home. So did the Clinical Senate and NHS England look at the system as a whole in that respect?”

A Clinical Senate rep said that the Clinical Senate didn’t look at the resources that are available, because the Clinical Commissioning Groups didn’t invite them to do so.

He said that the Clinical Senate always has concerns about the integration of services – primary care, hospital care and community care. And they identified in their review that this was something that needed work – but whether this was being done or would be done hadn’t been communicated to them.

Cllr Smaje then asked:

“Did NHS England take that into account at all?”

The NHS England rep Brian Hughes said

“In the documentation provided, there wasn’t a detailed analysis of the activity but that does form a part of the consultation.”

To which CK999 can only say,

“Which part of the consultation is that then?”

Apparently the same thought occurred to Carol McKenna, the Greater Huddersfield CCG Chief Officer; she added,

“There may be a need for post-consultation assurance and this may include a return to the Clinical Senate.”

Dr Alan Brook, Chair of Calderdale CCG Governing Body agreed that they would go back to the Clinical Senate post-consultation.

How can the public make an informed response to the consultation without information about whether the system will be able to cope with the proposals?

Cllr Smaje persisted with the Clinical Commissioning Groups:

“The Clinical Senate has a lot of qualifications in it. When are you going to ask the Clinical Senate about whether the system as a whole that you are consulting on will be able to cope with what you are proposing?”

Carol McKenna said:

“If we make a decision to proceed with these proposals at the end of the consultation, we will then need to go through the process of producing a full business case which would set out milestones before we got to any implementation. So there would be an opportunity within that proces for us to engage the Clinical Senate in helping us to determine if we were actually ready to implement, having made a decision on the overall service model.”

A Clinical Senate rep added:

“Integration of services needs further work. When we are invited to come back we will be looking to see if that’s happening.”

After further rhubarb from the NHS England rep about who would do what after the consultation to provide the missing information, Cllr Smaje reminded the reps from the Clinical Senate, NHS England and the Clinical Commissioning Groups:

“It is the role of Scrutiny to ask detailed questions and expect detailed replies as well.”

But instead of following up this reminder with a request for detailed replies, she let the subject drop and moved on to another topic.

So this is one serious omission from the Consultation Document, among many others. We the public are being asked to comment on proposed cuts and changes when the people planning them can’t even tell us if or how they’re going to work. This is wrong.

As a result the public can’t begin to make an informed judgement about the proposals, which is why new legal advice to Calderdale & Kirklees 999 Call for the NHS is that we should ask the Clinical Commissioning Groups to produce information immediately, for the public,  that makes good the errors and omissions in the Consultation Document.

And until that information is available to the public, to hold off responding to the consultation survey.

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