True, false or bullshit? Answers to public’s questions at Halifax consultation meeting

Hospital cuts public consultation meeting, Halifax 14 April. Here are the first five questions & answers. There are more here.

Question 1
About why they propose building a new hospital on Acre Mill site, where Calderdale and Huddersfield NHS Foundation Trust (CHFT) already has to pay rent for Outpatients Centre, when they have the rent-free HRI

Answer

Owen Williams said CHFT provides renal facility for Leeds Teaching Hospital at HRI so gets rent from that.

He also said that recently a sewage pipe burst on the HRI site, closing 2 wards and an operating theatre. There is a £100m maintenance backlog. HRI is not fit for purpose. He offered a tour of the HRI building to see its fabric and maintenance problems.

True, false or bullshit alert?

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Owen Williams’ justification for building a new hospital is open to question. The main question being:

  • How come the hospitals Trust only discovered that HRI was in such a state of disrepair that it is no longer functional or cost effective to maintain, at around the time Ernst and Young came in to produce a strategic 5 year plan for the Trust to cut its deficit?

Until then, HRI had been CHFT’s preferred site for the acute and emergency hospital.

In 2014, the Care Quality Commission said that Huddersfield Royal Infirmary met the Safety and Suitability of premises standard.

CQC report)CHFT premises meet standards 2014

The proposal to sacrifice a non-PFI hospital in order to save a PFI consortium’s profits and investment in a nearby PFI hospital is repeated time and again around the country and seems to be a major driver behind A&E closures.

And the sale of NHS Estate is part of privatiser Simon Stevens’ 5 Year Forward View, which hadn’t been published at the time that CHFT declared HRI was their preferred site for the acute and emergency hospital.

Here Keep Our St Helier Hospital campaign explains their Hospital Trust’s “too old to keep” scam. At least their hospital did an Estates Review – even if it was deeply flawed. Where is the CHFT Estates Review that justifies their plan to knock down HRI?

Question 2

About how Care Closer to Home is going to work, when GP services are under-resourced and struggling, with an example from Ovenden of up to 3 weeks wait for a routine GP appointment.

Answer

Can’t remember who answered, this is what they said: One of the highest priorities is to increase access to GP services. The GP workforce is aging and it’s challenging to recruit more GPs. Calderdale is a net exporter of GPs – it trains more than it recruits. Need to make Calderdale a more attractive place to work for GPs. A better functioning health service in Calderdale will make it more attractive for GPs.

True, false or bullshit alert?

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This answer exemplifies the “aspirational” nature of the Care Closer to Home (CC2H) scheme that the Clinical Senate criticised in its review of the CC2H specifications. They said these “aspirations” are not backed up by evidence that the CCG has identified workable, well founded processes to turn their hopes into reality.

So a truthful answer would be:

“We hope we can sort out this problem. We don’t know how though.”

Question 3

About A&Es nationally reaching all time record levels of staff shortage and how the proposals are going to deal with that.

Answer

David Birkenhead, the CHFT Medical Director, said they have 10 A&E consultants across both sites, so only 4-5 A&E consultants in each A&E. They have the money for 14 A&E consultants but they can’t find 14 to employ. If they centralise the A&E this will enable more hours to be covered in the rota. He admitted it’s a national shortage so they can’t guarantee they’ll be able to solve the CHFT A&E doctors’ shortage.

The urgent care centre currently runs separately, but under the proposals it will be joined into Emergency Care.

True, false or bullshit alert?

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This seemed like a fairly truthful answer to me. I’m not sure how joining the Urgent Care Centre to the Emergency Centre would help Emergency Centre staffing problems – unless this is a reference to the fact that they expect around half of all patients who currently attend A&E to go to one of the two urgent care centres instead. Which is itself a whole can of worms, see Question 6, in post to follow.

But then there is the Royal College of Emergency Medicine statement on Emergency Department closures and reconfigurations. This says

“The College recognises that recruitment and retention of staff is often cited as a relevant factor. However this is commonly a consequence of historical poor planning and resourcing; in itself it is poor justification for service reconfiguration…

“Short-term staffing shortages cannot be a rationale for permanent reconfigurations. Longer term patient outcomes will be compromised

“Moving resource / capacity issues does not solve them. The necessary increased capital and revenue expenditures at the receiving site(s) are seldom properly modelled.”

Question 4

Where is the risk assessment of increased patient deaths associated with the closure of A&E?

Answer

Matt Walsh, Calderdale CCG Accountable Officer, said it was in the Quality Impact Assessment in the Pre Consultation Business Case.

True, false or bullshit alert?

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The risks evaluation table (Pre Consultation Business Case p182) in the Quality Impact Assessment identifies as a low (green) risk “increase in average ambulance journey time due to some patients to be transported further to the single emergency care centre”. It says this risk will be mitigated through “maintenance of an urgent care centre on the planned hospital site that will support the majority of urgent clinical needs” and “For bluelight patients, evaluation undertaken to date indicates an average increase in journey time from 16-22 minutes. The 6 minute increase is more than outweighed by the benefits of being treated in the most clinically appropriate setting.”

No evidence is given to support the judgement that this is a low risk. Is there any evidence? And if so, where is it?

Isn’t the risk inadequately defined anyway? I thought a risk assessment was about working out the risk related to a well defined situation and a recognised threat or hazard. If this is correct, then the risk in question is increased emergency patient mortality, the situation is going to A&E by ambulance and the recognised threat or hazard is the increased distances Kirklees patients would have to travel to A&E in Halifax. So the risk evaluation table doesn’t even name the risk. It conflates the risk and the hazard. Why?

The mitigation actions beg questions. Urgent care patients are by definition not suffering from a life threatening condition, so how is an urgent care centre in the planned care site going to reduce the risk of increased emergency patient death due to increased distance to A&E?

As for the blue light patients – who in fact are the only patients who are at risk in this situation – there is a question about the average increase in journey time of 6 minutes. It seems from the Consultation Document (p 20) that this average is for emergency patients from both Calderdale and Kirklees. If this is so, then the average increase in ambulance journey time for emergency patients from Kirklees would be 12 minutes, if each area has roughly the same number of emergency patients. This is because there would be no increase in average journey time for the Calderdale half of the emergency patients.

For Kirklees blue light patients, there is then the question of whether a 12 minute increase in journey time would still be outweighed by the benefits of being treated in the most clinically appropriate setting.

And there is the question of whether and how the benefits of being treated in a single emergency centre have been quantified.

And then there is the point raised by the Clinical Senate, that there is no evidence in the proposed hospital clinical model, that clinicians at the hospital have been sufficiently engaged with, to determine whether the resources exist to realise these benefits.

Plus the Royal College of Emergency Medicine’s statement on Emergency Department closure and reconfiguration:

  • Increased travel times are associated with worse outcomes for some patient
    groups with time critical illness.
  • The increased demands on ambulance services brought about by longer
    transport times are seldom properly modelled.

Question 5

Tony Wilkinson, the last chair of the Calderdale Healthwatch Programme Board, now on the Kirklees Healthwatch Programme Board, said he was amazed at how a pr exercise has aroused worry in Calderdale, but the more he hears about the proposals, the more reassured he becomes. He congratulated the CCGs. He said that moving planned care to Huddersfield will cause travel problems and asked what the CCGs have done about liaising with public transport.

Answer
Dr Brook said that major improvements were planned to A629. The Local Authority is open to working with public transport providers to improve public transport services.

True, false or bullshit alert?

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The main bullshit alert here is about the statement preceding the question. Stunned silence followed it. People may not know that Calderdale Healthwatch has been taken over by Kirklees Healthwatch and that Tony Wilkinson is on the Kirklees Healthwatch Programme Board now. Although a toothless organisation by design, Healthwatch is supposed to look out for the interests of NHS patients. Dismissing the worries of thousands of Calderdale and Kirklees NHS patients is hardly looking out for our interests. For this reason, I would say don’t have anything to do with  Healthwatch any more.

As someone who is required to look out for the interests of NHS patients, surely Tony Wilkinson should be aware of studies such as The Patient Impact of A&E Closures, published in the Ulster Medical Journal in 2013. This found that the patients found it harder to access  acute healthcare services following Midulster A&E closures. Few patients perceived benefits to the centralisation of services. The Patient Sick Score measurements indicated that patients were only willing to attend A&E when they perceive a more severe illness, following the closure of Midulster A&E. This could strain local primary healthcare services since patients are more reluctant to access acute hospital services.

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7 comments

  1. Thanks Jenny. Interesting that they’ve done no study into mortality effect from greater distance to A&E (additional 50-60 extra deaths pa) and are relying only on the supposed benefits of their proposal to counter that.

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  2. In response to question 5:

    Healthwatch is entirely independent of the CCG’s and Hospital Trust. Our role is to provide accurate, independent information on the consultation, and to collect the views of people in Calderdale and Kirklees. We have been feeding these views into the councils Joint Scrutiny Committee so that they can ask better questions of the Trust and CCG’s.

    Healthwatch’s Trustee Board is made up of a wide variety of people across Kirklees & Calderdale. The views expressed last week were made by a new Trustee in a private capacity. Those views are not representative of the Healthwatch Trustee Board.

    Since the consultation started we have visited 15 community groups and hospital receptions, gathering the views of 353 people. We have put 25 formal questions to the Trust on behalf of patients we have talked to, and provided feedback into 4 Scrutiny meetings. We are committed to independently gathering the views of people across Calderdale and Kirklees until the consultation ends.

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