60% dodgy answers at Textile Centre hospital cuts consultation drop in

Textile Center hospital cuts consultation drop In 15th May 2016 – this collates reports by 3 members of Friends of HRI who attended the drop in. Two arrived together at the Textile Center, browsed the boards on the tables and were asked if they would like to talk to anyone, then Dr Ollerton arrived to chat to them. A third FoHRI member also spoke with Dr Ollerton.

There were fewer than 20 people attending this drop in session. Laura and Jennie, both from the CCG, did say they had been around the B&Q car park to encourage people to call in.

Quite a few of Dr Ollerton’s answers seem to have been made up on the spot – they differ from info in the Consultation Document and from info given to the Joint Health Scrutiny Committee. (Questions 2, 3, 4, 5, 6.)

This needs sorting out at next drop ins and with emails to Greater Huddersfield CCG/ Dr Ollerton.

1. If the proposals Planned Care proposals were to go ahead at Acre Mills, would they be run by the NHS or Private providers?

Answer: NHS. Planned care according to Dr Ollerton must remain NHS as without this revenue the Trust collapses

Comment on Dr Ollerton’s answer:

At the 19 April Joint Health Scrutiny Committee, the co-chair Cllr Malcolm James asked:

Will work carried out by Trust move out from trust into private sector?

Matt Walsh (Calderdale CCG Chief Officer)said,

The CCGs’ response is we need to take account of patient choices, we have a duty to do that. There is a range of contracts that support those choices. Last 3-5 years experience is a small but steady drift of elective work to private sector.

His definition of NHS = care delivered free at point of need, so if delivered in private sector still NHS care.

He said value of clinical work done on behalf of private sector for NHS is about 5%. (In fact it’s at least 6% and last year 40% of all contracts in the NHS were given to private contractors like Virgin.)

He would want to create a hospital offer from CHFT footprint that would be the choice people would want to make.

CHFT Chief Operating Officer:

Want to make sure that quality of services for hospital and community services will be choice of patients and commissioners, including planned care.

Dr Brook:

As referring GP, most patients have first choice to use NHS hospital and go elsewhere when NHS waiting times are too long. Point of changes is to make NHS hospital run smoother & faster.

Dr Ollerton:

Planned care hospital will reduce waiting times.

2.If the proposed changes were to go ahead would there be more shuttle busses running via both sites?

Answer YES

Comment on Dr Ollerton’s answer.

Dr Ollerton’s answer is not what the West Yorkshire Combined Authority Bus Services Manager told the 19 April Joint Health Scrutiny Committee (JHSC) meeting. We need to ask for evidence to back up Dr Ollerton’s statement that there will be more shuttle busses running via both sites

The 19th April JHSC meeting scrutinised transport and travel issues. There was no suggestion that there would be more shuttle buses running between both sites. Neil Wallace, the Bus Services Manager for West Yorks Combined Authority, said he has had no involvement in plans for transport between 2 hospitals and no consultation on the issue.

He said that the 2014 transport doc (the Jacobs report) said that the impact on journey times is likely to be more significant and varies more for bus users than car users. He asked what they can do to improve the “disproportionate impact” on public transport users, and said it depends what the issues are & they don’t know what they are.

He said that In Mid Yorks, the WYCA bus services have procured and managed bus services linking hospitals on Trust’s behalf.They can also enhance existing bus services. But the matter of funding underpins this. Over the last few years, bus service funding has reduced about 25%. In 2016/17 there is about £0.5m less to spend than last year.

He wants to talk about options but they need to talk about where the money would come from. He said he is happy to engage and talk and understand disproportionate impact on public services users.

3. Where have you obtained data showing 54% would go to urgent care, rather than A&E when the Royal College of Emergency Medicine state 22%?

A: Dr Ollerton disagreed and said it was more like 80%, and that information was unhelpful

Comment on Dr Ollerton’s answer.

We need to get back to Dr Ollerton and point out that 80% of current A&E patients going to urgent care centres is NOT what the Consultation Document says (p28) – it definitely says 54% and this is borne out by the (weak and unconvincing) answer CHFT have sent in response to Ck999’s request to see the raw data and data analysis that this claim is based on.

However, 80% is a figure being bandied about by other A&E reconfigurations, eg in Liverpool. Who knows where that figure comes from?

The importance of accurate projections and modelling of patient flows is shown by the overcrowding and decline in A&E performance at Ealing and Northwick Park hospitals London following the closure of Central Middlesex and Hammersmith A&Es on 10 September 2014, as part of the Shaping A healthier Future NHS reconfiguration in N.W London.

Evidence given to the Mansfield Commission investigating this reconfiguration stated,

“…what is likely to have gone wrong is that their projections and modelling for Northwick Park and other surviving full accident and emergency departments, after the closure of Central Middlessex Hospital and Hammersmith Hospital, have been inaccurate.”

4. The Emergency Center would be run by A&E Consultants, whereas the Urgent Care Centers would be run mainly by GP’s – how would this happen, would the GP’s work ½ day in their surgery and ½ day in the Urgent Care Center?

A: Dr Ollerton said possibly, I then pointed out that there is a shortage of GP’s so how would this be possible. I’m not completely sure I got a direct answer.

Comment on Dr Ollerton’s answer

This is a slightly different answer from the answer given by Drs Brook, Carsley & Birkenhead at the Threeways Centre drop in. David Birkenhead said that the UCCs will be doctor-led. They will be doctors with GP skills, given training in advanced life support. Dr Brook said there would be GP-trained doctors – but they won’t be “stealing” from existing workforce – they could be new GPs who are putting together a “portfolio career” who would work there 1-2 days/week. There would be emergency nurse practitioners 24/7.

Asked if the doctors would be there 24/7 or just in the daytime, Dr Brook said they will be there as much as it turns out to be worthwhile. Possibly by video. He said,

“Who will staff it, will be who it emerges will be appropriate to have there.”

Urgent Care Centres have already been set up to replace A&Es that have been closed, eg in the Shaping a Healthier Future reconfiguration of NHS services in NW London. A report by Michael Mansfield QC, commissioned by NW London Councils, found that there was “widespread confusion” among GPs, consultants and patients about what the urgent care centres could do and who should go there. It said they should be co-located with A&E departments wherever possible to avoid “fatal consequences”.

The report also said that the “deeply flawed” decision to downgrade several North West London hospitals must be halted.

5. Would there be more ambulances within our area, as ambulances are dispatched from there last drop of point, none of which would be Huddersfield?

A: Dr Ollerton pointed out it is Yorkshire Ambulance Service and they could even be in Bradford or even Leeds, and they are good at controlling where the ambulances are, and 1st responders are in the area.

We pushed for an answer on the would there be any more ambulances and it was suggested there would be an additional 2 Ambulances, no more 1st responders.

Comment on Dr Ollerton’s answer

Dr Ollerton’s answer that there could be an additional 2 ambulances is not borne out by what YAS told the 19th April Joint Health Scrutiny Committee.

In terms of the need to get ambulances into Kirklees from other areas – because they won’t be here, as ambulances tend to “drift” to areas close to A&Es – the YAS guy said that the NE Commissioning Support Unit travel analysis just gave the 10K extra hours/year ambulance journey time that would happen if HRI A&E closed, based on getting from a to b, not getting ambulances back from outside the area. They will need to model that.

They asked ORH (who did their mapping and scenarios) to do this based on actual Yorkshire Ambulance Surveys journeys, to give a figure for both CRH and HRI, to mitigate the extra 10K hours/year.

The YAS rep told the JHSC that to “mitigate” this would need 10.6 extra FTEs: 5 paramedics and 5 non clinicians plus back up, on a 5 week roster with 10 staff and back ups.

Cllr Marchington asked who will pay for those 10k extra hours/year ambulance journey time.

Carol McKenna, the GH CCG Chief Officer, said she would anticipate that the CCGs would continue the conversation with YAS about how to accommodate change in service – it had not been quantified in terms of cost – they will do more work on this.

There was no mention of extra ambulances.

6. Questions about the urgent care centres and Hear See and Treat ambulance service

Would the urgent care centres be provided by CHFT or private sector?

A:Dr Ollerton said that the urgent care centres will feasibly be outsourced.
Again the conversations were not inspiring and there was a lot of,

“We don’t know what the urgent care centres will look like, we don’t know how much they will cost, we don’t know what we may need in the community to support this plan, we haven’t got to that bit of the plan yet.”

According to Dr Ollerton they do not need to know these bits of logistics at this stage.

Hear See and Treat relies very much on paramedics being able to prescribe, as far as we know. But according to information from an emergency nurse practitioner they have been just declined this right.

Dr Ollerton was unaware of this and said, well the plan is dependent upon this. Dr Ollerton was very vague about the hear see treat plan, he referred to it as a WYMAS idea.

Comments on Dr Ollerton’s answers

We need to ask CCGs if they plan to put the contract for urgent care centres out to competitive tender.

Re Hear See Treat, we need to ask about emergency care practitioners (ECPs). These are paramedics mainly with extended skills.

  • Is the plan that ECPs with extended skills will attend as first responder and perform the whole episode of care assessment / diagnosis and treatment?
    So either they are going to need to prescribe or carry a drug cabinate in the car. Are they allowed to prescribe?
  • A big question has got to be around the pathways in place ie can they gain follow up if required from GP after initial diagnosis / treatment? Is there a pathway into hospital if deemed necessary?

This info about Hear See Treat is from a YAS Board meeting.  As part of the the West Yorkshire Urgent and Emergency Care Network (WYUECN) Vanguard Programme, YAS is leading on ‘Hear, See and Treat’. The plan would include:

  • ‘Hear and advise’ – the development of a Clinical Advisory Service providing specialist advice in NHS111, 999 and to healthcare professionals which included care coordination to signpost and book patients into primary care and community pathways, mental health and alternative pathways.
  • ‘See and Treat’ – continued development of a range of services to see and treat patients nearer home including Urgent Care (UC) Practitioners, Frequent Callers, Falls response, UC Transport and Mental Health crisis response. UC Centres would need to be aligned to the hospital reconfigurations and emergency departments and services.

7. Care Closer to Home & what will happen if they do not get the money from the Dept of Health.

A: Dr Ollerton seems to think the plan rests on money but possibly there will be an offer in the middle.

Spoke about the complete mismatch between what they were talking about as excellence / ideal plans and what was deliverable . Got the impression that even Dr Ollerton agreed that there was a gaping hole in the plan in terms of Care Closer to Home.

Dr Ollerton said that Locala will probably be taking on much more of the care closer to home. He did say something about having considered other providers.

Aren’t there small things that the CCGs have to do like invite bids for new contracts before they can say who’s going to get them?

Natalie Ratcliffe said at Slawit Save Our Surgery celebration that Locala are “crawling all over contracts from Halifax to Wakefield”. Will ask about this at Weds consultation drop in in Halifax

8. The Sustainability and Transformation Plan (STP) for the West Yorkshire and Harrogate STP “footprint” has to eliminate the area’s NHS deficit 2016/7. How will this affect the proposed hospitals reconfiguration and Care Closer to Home scheme?

Answer: Dr Ollerton had no idea about any STP plan talking about eradication of debt 2016/2017 or what I was talking about with West Yorkshire & Harrogate STP footprint. He found the idea laughable and I have his email address to forward him this.

Comments on Dr Ollerton’s answer

Dr Ollerton chaired Greater Huddersfield Clinical Commissioning Group Governing Body meetings where the STP was discussed, including the requirement under “national must dos” to “return to aggregate financial balance”. How can he say he doesn’t know about this?

Re STP removal of debt in 2016/17, this is from Wakefield CCG’s report on the STP Planning guidance (and Wakefield CCG is  the lead in the West Yorks and Harrogate STP “footprint” and is hosting the STP Programme Office). In the section “National ‘must dos’ for 2016/17, “Other ‘must dos’  include:

  1. Produce a sustainability and transformation plan for the health economy.
  2. Return to “aggregate financial balance” with secondary care providers delivering savings through the Lord Carter productivity programme and caps on agency spending. CCGs will be expected to save money through reducing variation and implementing the Right Care programme in every area.

Dr Ollerton chaired the GH CCG Governing Body meeting on 10 Feb 2016, which had the Sustainability and Transformation Plan as agenda item 7. The agenda for the Meeting shows that Julie Lawreniuk and Natalie Ackroyd were due to give an oral presentation on the STP.

The Minutes of the previous GH CCG meeting on 13 Jan 2016 show that Julie Lawreniuk (JL) had given a presentation on NHS Planning Guidance 2016/17–2020/21 guidance, where she explained that

“ this is supported by £560 billion of NHS funding, including a new Sustainability and Transformation Fund which would support financial balance, the delivery of the Five Year Forward View, and enable new investment in key priorities.
As part of the planning process, all NHS organisations had been asked to produce two separate, but interconnected plans:

  • A local health and care system ‘Sustainability and Transformation Plan’ (STP) to cover the period October 2016 to March 2021. Although no specific guidance was given on STP footprints, the guidance indicates they could cover a larger geography than an individual CCG.

  • A plan by organisation for 2016/17. This should reflect the emerging STP.”

The Minutes also show that at the 13 Jan 2016 GH CCG Governing Body meeting, JL delivered a slide presentation highlighting the following areas:

  • Place based planning
  • Access to future transformation funding
  • Content of STPs
  • National ‘must dos’
  • Allocations
  • Sustainability and Transformation Fund
  • Commissioning stream allocations
  • CCG admin allowances
  • Returning the NHS provider sector to balance
  • Efficiency assumptions and business rules
  • Closing the finance and efficiency gap
  • Measuring progress

Governing Body members asked a number of questions in respect of:

  • Provider sustainability
  • CCG access to the Sustainability and Transformation Fund.
  • Understanding system leadership arrangements.

JL advised that an update would be brought to Finance & Performance Committee in January, and Governing Body would be asked to sign off plans and budgets in March, with the Sustainability and Transformation Plan to be finalised by June 2016.
The Governing Body RECEIVED the presentation.

So what was Dr Ollerton doing when he said at the drop in that he had no idea about any STP plan talking about eradication of debt 2016/2017, or West Yorkshire & Harrogate STP footprint? The idea may be laughable, as he apparently believes. But that’s a totally different matter to saying that he doesn’t know about it.

9. What about the consultant, Arin Saha, who asked the final question at the Stadium public meeting, regarding the general surgery beds?

A: The CCG are meeting with him next week.

10. What about the  Debate @ Westminster, where Barry Sheerman MP asked Ben Gummer about the PFI deal for Calderdale Royal Hospital, where Ben Gummer said they would be picking thru all PFI deals?

QUOTE from Dr Ollerton,

” IF THE PFI DEAL WERE UNPICKED, THIS MODEL WOULD BE BLOWN OUT OF THE WATER”

Comments on Dr Ollerton’s answer

FoHRI are meeting on Wednesday and we will discuss how and who to contact to see if we can do anything with this.

At the drop in in Reinwood, the paediatric consultant said CHFT had had three legal teams looking at the PFI contract and they say it’s iron clad. We are still waiting for copies of the three reports on the PFI that they said they had commissioned …. promised at Slawit and again in Halifax and still no sign of them.

The Ernst & Young 5 Year Strategic Plan for CHFT (p 167) mentions:

“the potential to treat PFI as an onerous lease. Such a change would require sign off by DH [the Dep’t of Health], Monitor and the Trust’s external auditors. The cash obligations to the PFI provider associated with financing the PFI would be unaffected and the cash liability would still need to be met.”

A lease is onerous if the expected benefits (net cash inflows) from using the leased asset are less than the unavoidable costs…

It seems odd that an onerous lease would still have to be honoured? People vs PFI are a useful group to contact for info about how to tackle CRH PFI. CK 999 has asked them about this onerous lease business.

A technical note about onerous leases from GrantThornton Australia is about International Accounting Standards, so presumably applies in UK? The technical note includes the proposal that where a lease is onerous, an onerous lease provision could be to negotiate a settlement with the landlord (lessor). This is different from the EY statement in their CHFT 5YFV, that treating the PFI lease as an onerous lease would mean that “The cash obligations to the PFI provider associated with financing the PFI would be unaffected and the cash liability would still need to be met.”

Another thing is – if declaring the PFI an onerous lease WOULD mean the Trust would have to go on paying the PFI finance costs, does this mean it would NOT have to go on paying the service charges, which make up about half of the overall unitary charge, which covers repayment of capital, interest as well as the hugely inflated service charge?

This all needs following up with questions to CHFT and to People vs PFI.

People vs Barts PFI have a proposal to nationalise Special Purpose Vehicles:

We could consider a petition to open the books on CRH PFI – as Common Weal and People vs PFI have done in Scotland following the Edinburgh schools PFI scandal

There is info about managing an onerous contract here

Do we know any friendly accountants?

Dunno what any of this really means, need to ask CHFT Finance Officer to explain.

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