Straight out of “Yes Minister”- Not enough staff? Build smaller hospitals

Deposition to Calderdale and Huddersfield Joint Health Scrutiny Committee
9th March 2016 by Colin Hutchinson

I am speaking as a resident of Halifax and as a recently retired Consultant Eye Surgeon who worked for 20 years for Calderdale and Huddersfield NHS Foundation Trust. During that time, I was Clinical Director managing the Ear Nose and Throat, the Maxillo-Facial and the Eye Department, which together account for a quarter of the patients treated by the Trust. I was also Lead Clinician for the Skin Cancer Service . So recruitment and retention of staff was one of my main concerns.

I can fully understand the pressures facing the Trust as a result of the grossly inadequate numbers of doctors and nurses that are being trained in this country, and the inability to attract and retain staff in key specialties, but the idea that if we do not have enough staff, we need to build smaller hospitals, is a solution of which Sir Humphrey would truly be proud. Yet this is one of the key reasons for proposing the reconfiguration of hospital services in Calderdale and Kirklees.

The budget for training doctors and nurses for the nation is administered by Health Education England. They have received flat-line funding in the financial settlement for this parliament, which means that they do not have the ability to respond to the major staffing issues that exist. All they can do is tweek the numbers of training places a bit. As the Public Accounts Committee of the House of Commons discovered, in their hearing of 23rd February, Health Education England receives information from Trusts about the numbers of staff that they need, to inform their decision as to what training places they fund. But these estimates were then vetted by NHS England and the Trusts were told to revise them in line with the funding reductions that they would be experiencing. So training numbers were brought into line with projected budgets, not with clinical needs.

The budgetary allocation is a political decision, which lies entirely within the remit of the Government and could be rectified by the Government, if it wished.

It would be wrong to think that there are only problems staffing the A&E Services and Paediatrics. Many other specialties have similar problems, and these will not be resolved by hospital reconfiguration.

The Skin Cancer Service should be led by a Consultant Dermatologist, not by an Ophthalmologist like me, but this Trust cannot recruit Consultant Dermatologists, and even when it does, they can’t hang onto them. It is not necessarily the fault of the Trust – nationally there are about 200 vacant Dermatology Consultant posts. Health Education England has increased the training numbers nationally by four this year!

Last month the Eye Department interviewed for 3 Consulatnt posts, one of which has been vacant for 3 years. One candidate turned up.

The Maxillo-Facial Service is provided in Huddersfield Royal by six Consultants based at Bradford Teaching Hospitals, but recently two have retired and one has moved to York. This is another area to which it is almost impossible to recruit, and as a result, the Head and Neck Cancer Service, which deals with complex and potentially mutilating surgery, often in younger patients, is under serious jeopardy.

The problem and the solution both lie at a national level and need to be dealt with, rather than being used as the main driver for the destruction of local health services.

The stock response is that services are being moved out of hospitals into the Community, but there is a crisis in General Practice, with insufficient GPs to replace those that are retiring, let alone to meet the increasing population and their increasing health needs. The Pre-consultation Business Case is silent on how it will address these problems.

Care in the Community is not the cheap option that it is often portrayed as. It actually takes more staff to deliver care in patients’ homes, because you can only treat one patient at a time, whereas, on a hospital ward, you can be treating and supervising the treatment of a number of patients. The staff also need to be trained to a higher level as they do not have direct access to back-up from more experienced nursing and medical staff. We are not talking about changing the odd dressing here. My wife, as a District Nurse herself, had two patients to look after that were on permanent full-time ventilation in their homes, as they were unable to breathe because of neck injuries.

So, one would expect that there would be a major investment in Community Nursing and other staff groups, to help look after the more acutely ill, the patients with multiple medical conditions and patients wishing to die in their own homes, but free of pain. But no. Between 1998 and 2013 the number of qualified District Nurses fell by more than 40%, and 35% of those remaining are over 50 years of age, so likely to retire soon. For the whole of London, five District Nurses were trained in 2013.

The Pre-consultation Business Case makes no mention of the kind of escalation of staffing in Community Nursing services that might allow the reduction in numbers of hospital beds, nor how they are going to train up the required skilled staff, because the lavish salaries on offer are not going to entice trained staff to move to Huddersfax, so we need to grow our own, here. We are fortunate that we have a University in this town that could do that.

The lack of detail in the Business Case suggests that insufficient consideration has been put into developing services in the Community upon which this whole plan could succeed or fail, and if it fails, it will do so spectacularly. The detail is all-important and needs to thrashed out before permanent and irreversible changes are made to local hospitals.


  1. I personally worked closely with Colin in the local CHFT. He is an excellent professional and a true advocate for the NHS. I can assure you that he is speaking the truth here.


  2. This is such an excellent, expert critical analysis of the CCGs thinking. Mr Hutchinson has described so clearly that the plan is inadequate and shambolic.


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