This is the final batch of the Clinical Commissioning Groups’ answers to the questions Calderdale & Kirklees 999 Call for the NHS (CK999) asked them, in order to fix errors and omissions in the Consultation Document about proposed hospital cuts and changes to community services.
Their response is hugely disappointing. Our questions were an opportunity for the CCGs to show that they take seriously the views of members of the public who question their proposals. They passed up that opportunity.
We explained to the CCGs that the reason for our request is because:
We have an absolute commitment to assessing if the Right Care Right Time Right Place proposal is right, once we have all the information about it. We can’t do that until and unless you give us and the rest of the public full, accurate information that is currently missing from the Consultation Document.
This post covers questions 22-38.
Now we have reviewed and commented on all the CCGs’ answers, it is clear to us that the CCGs have provided hardly any new information.
Where they have provided new information, this is lists of “engagement” events with NHS staff – both hospital staff and GPs – and a justification their payment of “engagement champions”. None of this has shown that they invited or took notice of the views of the staff they “engaged” with – their answers are all about “presentations” they made.
But engagement is more about listening to ideas, views and concerns than ‘presenting a case’. Engagement is a skill that is not often recognised as such in NHS management circles. Managers are mostly driven by policy and budgets whereas staff will often take a vocational approach to providing safe and good quality health services.
It is absolutely clear, from this new information and from the generally dismissive tone of their answers to our questions, that this is in no way a formative Consultation. Many of their answers deny the validity of our questions, avoid answering our questions and repeatedly deny that they are proposing to close Huddersfield A&E.
Here are the last 16 questions and answers, with our comments on the CCGs’ answers
The Consultation Document fails to mention that the Clinical Senate stated 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 the claimed benefits of the cuts and changes. The Clinical Senate said that the hospital’s clinical model is based on national policies and guidelines, and that there is no evidence of informed local clinicians’ assessment about how and whether these are capable of being applied locally, given the available resources, in order to produce the required quality of care. We need you to acknowledge this publicly.
Please see answer to Q17 above.
No – Q 17 relates to the Clinical Senate Review of Community Service Specifications or Calderdale, Greater Huddersfield and North Kirklees CCGs. In their answer, the CCGs quoted that Review but did not address Q22.
This question, (Q 22) refers to the Clinical Senate Review of the Future Model of Hospital Services for Calderdale and Greater Huddersfield CCGs. These are two different documents about different Clinical Senate Reviews.
The Clinical Senate repeated throughout their Hospital Services Review their concern about the lack of evidence of ‘informed local clinical assessment’ of the deliverability of the proposed hospital model.
The CCGs have not addressed Q22 at all and have ignored the need to acknowledge the Clinical Senate’s repeated concern about this ‘informed local clinical assessment’.
As a result, the Clinical Senate review said that they could not vouch that the proposed hospital clinical model would generate the required quality of care. The consultation document makes no mention of this. On the contrary, it asserts (p13) that the proposed model of care would enhance quality of care. We need you to tell the public about this statement by the Clinical Senate and to provide data that shows how the proposed model of care would be of the required quality. If this is not available, you need to say so.
Please see answer to question 17 above
NO – AGAIN the question (Q 23) is talking about a different Clinical Senate Review to that referred to in Q 17.
Q 23 therefore has not been answered. The consultation document repeats many aims of the proposal as if they are definite outcomes. This is not helpful.
The Clinical Senate States:
“At this point, the Senate can only endorse the vision and give broad assurance of its potential to deliver a quality service. The proposed model needs to be described with greater clarity, particularly detail about the workforce, in order to answer questions regarding the ability of this model to deliver the standards proposed.”
Claims about engagement with the public and key stakeholders are flawed and statements about public and stakeholder support for the proposals are exaggerated. We need the CCGs to publicly acknowledge the limitations of their public and patient engagement and the criticisms of this by Calderdale Adults Health and Social Care Scrutiny Panel Chair, who told the CCGs when they presented their engagement review in August 2015, that they “should seek a wider basis of opinion about their plans” – instead of confining their “engagement” to “people inside the goldfish bowl.” When we decided to provide a wider basis of opinion at the CCGs’ Stakeholder Engagement Event, we had to protest vocally in order to gain admission. Once inside, we found that invited “stakeholders” – many of them the CCGs’ “community assets” – were saying that they didn’t agree with the proposals and didn’t understand them. We would like the CCGs to make public all the documentation relating to their public and stakeholder engagement events so we can see exactly what the CCGs base their claims on regarding public and stakeholder support for their proposals.
We have supplied evidence as part of the NHSE Assurance process that the four key tests have been met. One of these tests is: strong public and patient engagement. A copy of the letter from NHSE is attached as part of the answer to Question 2 above.
We do not agree that our claims about our engagement are flawed. We have published reports of all our stakeholder sessions on our website and a composite report of all our engagement has been produced by Healthwatch Kirklees and published on our website.( Link)
The Consultation Institute have signed off the scoping stage of their Compliance process – part of which assesses the quality of the pre-consultation engagement.
I can find no reference in the August minutes of the Calderdale Adults Health and Social Care Scrutiny Panel Council minutes to support the statement attributed to the Chair of the Scrutiny Panel. The CCGs’ Engagement report was not presented to that meeting, The minutes can be found here: (Link)
The Engagement report was presented to the August meeting of the Calderdale and Kirklees Joint Health Scrutiny Committee on 13 August. I can find no reference in these minutes to support the statement attributed to the Joint Chair of the Scrutiny Panel. The minutes can be found here: (Link)
A full report of findings in relation to the August event has been published on the Programme website.
No – there was no letter attached
Again denial and an over-reliance on the NHS England Assurance process report. Bear in mind that NHSE are driving these changes through across all of England.
See comment to Q 2, that the Investment Committee and not the Regional DCO should have undertaken the Assurance as CHFT is subject to enforcement action.
How can CCGs reconcile the clear difference between the engagement claims and the public disapproval and anger demonstrated at the Huddersfield Public Consultation Meeting on 18th April 2016?
The CCGs are correct that Cllr Malcolm James’ comment wasn’t made at the Calderdale AHSC Scrutiny Panel. It was made at the August 13 Joint Health Scrutiny Committee meeting, where Cllr Malcolm James said,
“In formulating future questions, the CCG should maybe take a wider basis of opinion as a basis for the formulation – not just from people inside the goldfish bowl.”
The fact that his comment is not minuted doesn’t mean he didn’t make it. It gave rise to some merriment and led us to produce the following graphic:
CK999’s report on the August stakeholder engagement event meeting is here
We would like to know why and at what point the mental health Trust (South West Yorkshire Partnership Foundation Trust), stopped being involved as a Right Care Right Time Right Place partner. SWYPFT was one of the 7 original partners in the Strategic Review and the Strategic Outline Case, but it does not seem to have taken part in the “Right Care Right Time Right Place” engagement processes and it is not taking part in the current consultation. We need you to clarify what the relationship is between the CCGs and SWYPFT, why mental health services are not included in the current consultation and in particular what the relationship is between Calderdale CCG and the SWYPFT Arts Psychotherapy Service in Calderdale. Does Calderdale CCG commission this service from SWYPFT? Does it have a view on whether SWYPFT should go ahead and cut this service entirely, as it was planning to do before legal action caused it to withdraw staff redundancy notices and engage with service users about the future of the service?
The Strategic Review was established to bring together the seven partners across Calderdale and Greater Huddersfield to develop proposals for transformational change across the health and social care economy of Calderdale and Greater Huddersfield.
The programme produced the overall Case for Change which identified that significant change is essential because we want to ensure that everyone gets the right care at the right time and in the right place whilst responding to the challenges of:
- An ageing population with increased needs;
- National shortages of key elements of the workforce that mean new service models are required
- Continuing to meet ever increasing external standards
- Significant financial pressures facing commissioners and providers.
In response to the case for change, three of the CCGs’ existing Providers (CHFT, SWYPFT and Locala) produced a jointly developed proposal for changing the way community and hospital services in Calderdale and Greater Huddersfield could be provided. They described their proposals in the form of a draft Strategic Outline Case (SOC), which was presented to members of both CCGs’ Governing Bodies in January, 2014.
It was presented to both the Kirklees and Calderdale Health and Wellbeing Boards (HWB) and Overview and Scrutiny Committees (OSC) in February and March, 2014.
The Providers subsequently developed the Strategic Outline Case into an Outline Business Case (OBC). This Outline Business Case was lodged with the NHS Procurement Portal Bravo in June 2014, but was not accessed by Commissioners until September 2014.
In May, 2014 the scope of the programme was revised and the partnership of seven was set aside as part of the transition arrangements. In order to signal the transition, the name changed from Strategic review to Right Care, Right Time, Right Place. The revised scope and phases were established as:
Phase One- Strengthen Community Services, Phase Two - Enhance Community Services Phase Three – Hospital Services
The CCGs have a commissioner/provider relationship with SWYPFT.
Mental Health Services are not included in the current consultation because we do not intend to change the services as part of this programme.
The SWYPFT Arts Psychotherapy Service in Calderdale is not part of this consultation.
There is no reason given why mental health is not included in the proposals, or the consultation paper.
Or why mental health was abandoned when the CCGs decided to set aside the providers’ Outline Business Case and make the “transition” to developing their own proposals.
YOU ARE changing the services for people with mental health problems. They are members of the public who have emergencies and accidents like everyone else.
- WHAT mental health liaison services will be available at the Urgent Care Centres?
- WILL the use of Section 136 suites increase if the Emergency Centre does not take people in mental health crisis?
- & WILL people end up in police cells again?
Have the CCGs discussed the future of the Arts Psychotherapy service with SWYFT as the commissioners, given the public concern about this service closure? Both CCGs have commissioner/provider relationships that are the same with both:
CHFT (for acute services) and SWYFT (for mental health and community health services).
SWYFT’s Summary Strategic Plan 2014-2019 is clear that it has a “transformation focus” which seems to carry on seamlessly from its proposals in the Strategic Review.
It says it aims to:
“support integrated team working closer to communities – in line with the transformation vision of the Trust and of our partners.”
In addition it says:
“…the vision for inpatient services is for high quality in- patient facilities at geographically strategic locations within the Trust area delivering single room en suite accommodation designed to support cost effective staffing models.”
Here is a list of the mental health services it intends to transform:
It seems odd that when the acute hospital provider, CHFT, wants to “transform” its clinical model, the CCGs run a public consultation on the proposals – but when the mental health trust provider, SWYPFT, wants to “transform” its clinical model, the CCGs don’t see any need to consult the public about the proposals. When you read SWYPFT’s summary strategic plan, the proposed changes seem massive. Why hasn’t there been any public consultation about them?
The Consultation Document mentions the recent public engagement on maternity services. Clinical Commissioning Groups carried out this public “engagement” late, and as an afterthought. The maternity engagement survey was filled in by all kinds of people without the remotest interest in maternity services, but who wished to support a community group in need of money. This was because the CCGs paid £5 per completed survey to cash-strapped community groups who promoted the survey. This was widely advertised on social media by well-meaning members of the public who wanted to support these community groups. This must surely invalidate the outcome of the engagement. We need you to explain why it is right that you fund cash-strapped voluntary organisations in this way, in exchange for them promoting your engagement activities, and how you assess as valid responses to the engagement that are made in order to benefit the cash-strapped voluntary organisations.
The pre-consultation engagement was carried out as planned and as reported to the Calderdale and Kirklees Joint Health Scrutiny Committee in August 2015. Link to minutes above.
It is not possible to comment on the reason why or the interest level in maternity services of those who completed the engagement survey.
The actual value of payments is not promoted outside the programme. Engagement Champions are representatives of local communities. They are trained to talk with people about local health services. They give local people the chance to influence the way services are delivered.
The CCGs are responsible for buying local health services in hospital and in the community. They need to talk to all communities when they are considering changes to local health services. We purchase this resource to reach an audience we would require extra capacity to reach – this would include staff time, additional resources such as interpreters, venue hire and administration including marketing and promotion.
The reimbursement acknowledges the time facilitation and administration costs of delivering in house activity.
Engagement Champions ask questions so that when changes to services are being considered the views of local people can be taken into account.
In a long-winded way they are admitting the payments made to “engagement champions”.
It is not best, or common, practice to pay organisations for quantities of surveys completed. Such organisations should be encouraging patient involvement within their role as service providers and within their ethos as community interest bodies.
It is not best, or common, practice to make payments to volunteer Engagement Champions, unless they take up strategic representative roles requiring specific skills.
See NHS England’s policy on this.
There are Employment Law implications for paying volunteers, minimum wage etc., and payment is counted as income for tax and benefit purposes. CCGs are obliged to inform people about these implications.
Such payments to individuals affect their independence which is the reason that the making of payments needs to be according to procedures that are in the public domain.
If the CCGs are doing this payment for engagement they are compromising the validity of the process and are taking action that has serious legal implications.
It is true that pre-consultation engagement was reported to the August 2015 Joint Health Scrutiny Committee meeting. But the CCGs do not admit that at that meeting, the engagement officer Penny Woodhead reported that they hadn’t got round to maternity and paediatrics engagement, as the CCG had been focusing on urgent and emergency care and Care Closer to Home. She said,
“We want to do young people’s engagements with children and young people when we have done the clinical model on paediatrics and maternity.”
Cllr Elizabeth Smaje asked why the CCG wasn’t ready with the clinical model for paediatrics and complex maternity.
The Calderdale CCG Chief Officer Matt Walsh said:
“Getting to agreement on the clinical model hasn’t been straightforward. We’ve only gained some consensus in the last two weeks or so, so we haven’t yet been ready to consider paediatrics and maternity.”
Some if not all of these groups are also serving the Clinical Commissioning Groups as “community assets” aka “community engagement champions”. Their role now is to act as a mouthpiece for the Clinical Commissioning Groups and to encourage people to respond positively to the consultation. This seems entirely unethical. At least one member of the public has complained to the Consultation Institute about inappropriate social media messages that include downright disinformation about the hospital cuts proposals provided by one of these “community assets” and rude dismissals of members of the public who have questioned the false information that the community asset has put on their fb page. We need you to explain: how and whether you monitor the accuracy of the information put out by your communuity assets and the ways in which they communicate with the public; and how you justify the ethics of paying cash strapped voluntary organisations to be your mouthpiece.
Please see the answer above in relation to the use of Community Asserts.
We do not agree that they act as a mouthpiece for the CCGs.
We are aware of the complaint that has been submitted to the Consultation Institute and we have agreed with the individual that this will be dealt with through the CCG’s complaints process.
It is not what the Community Engagement Champions are and actually do that is the issue here. It is how their role is perceived by the patients, carers and the public.
E.g. Most Healthwatch groups around the country are seen as ‘mouthpieces’ for NHS commissioners and providers by the general population.
One reason being that most are run by organisations with limited understanding, or proven track record, in engagement, involvement and participation. It doesn’t help that under the terms of the 2012 Health and Social Care Act, that created them, they are not allowed to criticise government policy.
Independence, accountability to the participants and an ability to challenge are essential to engagement facilitation.
The answers to questions so far, and the clear difference between the engagement claims and the substantial public opposition to the proposals demonstrate that the CCGs are not tuned in to the general feeling of the population they serve.
It is unclear from the Consultation Document that the CCGs have properly considered alternatives to the Right Care Right Time Right Place proposals. We need full access to all relevant papers concerning the consideration of all alternatives. The lack of disclosure of all the documents relating to all the alternatives the CCGs considered makes it impossible to see if there’s anything in the other options you’ve rejected that shows you’ve made the wrong decision, or if there’s an alternative that deserves to be considered that is worth raising.
The consideration of alternatives is set out in the Pre-Consultation Business Case. We do not agree that there has been a lack of disclosure.
Denial, simply relying on the options table in the Pre-Consultation Business Case.
It is unclear from the Pre-Consultation Business Case that the CCGs have properly considered alternatives to the Right Care Right Time Right Place proposals. We need full access to all relevant papers concerning the consideration of all alternatives. The lack of disclosure of all the documents relating to all the alternatives the CCGs considered makes it impossible to see if there’s anything in the other options they’ve rejected that shows they’ve made the wrong decision, or if there’s an alternative that deserves to be considered that is worth raising.
One of us asked for the planning data the CCGs used for the Right Care Right Time Right Place proposals, received an extremely vague and useless reply and has asked again for the planning data.
Again it is how people are perceived by the public. People see the CCGs’ leaders as really enthusiastic in their belief that the proposals are the right thing to do. However, this comes across as having closed minds and being led by national policies, (as stated repeatedly in the Clinical Senate (Hospital) Review.)
Have there been any blank sheet discussions with staff, patients or the public?
As far as we can see, the Consultation Document doesn’t say anything about the extra 10,071.86 hours/year of ambulance journeys that would result from the closure of Huddersfield and Dewsbury A&Es. We need to know what assessment has been made of whether YAS can cope with this. And if no assessment has been made, we need you to make one well before the consultation period ends. Otherwise, how can the public comment on whether or not they agree with your proposals, or comment on how these proposals will affect us? We also need to know how this figure was calculated, on the basis of what assumptions.
We are not proposing to close services – we are proposing to change the way we treat people. Under these proposals, both A&E departments would be replaced by Urgent Care Centres to deal with most ambulant patients, with a single more specialised Emergency Centre supporting both Urgent Care Centres. Instead of all people going to accident and emergency and waiting to be seen, only people who are seriously ill or have life-threatening emergencies would go to the Emergency Centre in Halifax. People who need urgent medical help would go to an Urgent Care Centre at either Calderdale or Huddersfield.
The assessment of additional ambulance hours is summarised in the Pre-Consultation Business Case and the full report detailing how these figures were determined is also available on the website.
YAS NHS Trust has been fully involved and engaged with the programme and therefore fully informed of the potential changes within the local health economy. The subsequent travel analysis was designed around YAS NHS Trust specification as well as the programme board’s requirements.
YAS has identified the additional resource that would be required to meet these hours and this was presented in public to the Calderdale and Kirklees Joint Health Scrutiny committee by YAS on 19th April, 2016
The public see the Emergency service at Huddersfield as closing, as it will no longer be there, and emergency services will only be accessible at Halifax.
We know where the information about additional ambulance hours is – our question was about why there is nothing about this in the Consultation Document, in terms of whether and how YAS will be able to cope. This is a major worry for the public. We know how over-stretched YAS is already.
We attended the 19 April JHSC meeting, where we learned that although the travel analysis may have been designed around YAS specifications, it does not include an analysis of the extra time ambulances may take to reach Kirklees patients, given that ambulance drift to areas near A&Es means that it will take time for ambulances to return to Kirklees – where there would be no A&Es.
See also our comments on questions 5 and 6.
Why did the CCGs not include a sentence or two to say that they will commission these extra hours from Yorkshire Ambulance to account for the extra journeys transferring patients etc.?
There is no proper equality impact assessment in the Consultation Document. You need to address this.
You referenced the availability of the published Equality Impact Assessment in Question 2 above. The Equality Impact Assessment is published as Appendix E of the Pre-Consultation Business Case
Neither is there any adequate information about how people who rely on public transport would cope with having to travel further for planned care and to visit family and friends in either the planned care or acute/emergency care hospital. At the 19th April JHSC meeting, Neil Wallace, Bus Services Manager for West Yorkshire Combined Authority said that he had had no involvement in plans for transport between the 2 hospitals and there had been no consultation from the CCGs on the issue. The 2014 transport document by Jacobs identified a disproportionate effect on public transport users, but Mr Wallace said that he doesn’t know what to do to improve this because that would depend on the issues and but the CCGs haven’t consulted him, so he doesn’t know what the issues are. He wants to talk about the options, but the CCGs need to talk about where the money would come from. We think the CCGs need to explain these facts to the public and say if they have money to commission bus services to improve travel for people who will have to travel further to hospital using public transport and if so, how much.
The Travel analysis has been published on the programme website. We have committed to setting up a travel group to give further consideration to travel matters – this is detailed on page 39 of the consultation document.
The minutes of the Calderdale and Kirklees Joint Health Scrutiny committee on 19th April, 2016 have not yet been published. The purpose of Consultation is to provide the opportunity for people and organisations to contribute their views. This includes the West Yorkshire Combined Authority.
Additionally, the West Yorkshire Combined Authority is launching a 12 week public consultation on 23rd May in relation to their Bus Strategy. We will feed into that work.
The key points raised in the question have not been addressed.
Are you including specific patient representatives in the travel group, e.g. people with sight or hearing loss, mobility problems etc.?
It would be helpful to clearly name, in the consultation document, the travel documents on the website.
The Consultation Document (p 20) talks about people’s worries about travelling further to A&E and says that the average ambulance journey time to the “Emergency Centre” at Calderdale Royal Hospital would be 6.48 minutes longer than the current average ambulance journey time to A&Es at both hospitals. This is misleading. For people in Calderdale, the average ambulance journey time would stay the same – not increase by 6.48 minutes. So since roughly equal numbers of patients travelling by ambulance to A&E in both areas, this would means that for Kirklees people, the average increase in ambulance journey times would be 13 minutes. The Consultation Document misinformation needs to be corrected.
We do not agree that the consultation document is misleading.
The document states that: We understand that some people are worried about the extra travelling time if they need to go to hospital as an emergency.
We have had some independent analysis done of ambulance journeys over a 12 month period.
This shows that the average journey time now for patients being taken by ambulance to their local A&E departments is 15.94 minutes.
For a single Emergency Centre at CRH the average journey time would be 22.13 minutes compared to 21.51 minutes if the Emergency Centre was at HRI.
Although the ambulance journey is a little longer, all of the specialist services needed would be available at the Emergency Centre at CRH, which would give patients a better chance of a good recovery.
Travelling to the Emergency Centre is the same as happens now for patients who need specialist care because they have had a heart attack and need to be taken to Leeds or very serious burns and need to be taken to Wakefield. (The travel analysis is available at www.rightcaretimeplace.co.uk).
Denial of the validity of our question and refusal to address our points.
Please read this question (Q 32.) and the comments we made at Q 5.
Both Q 32, and our comments made at Q 5, explain that the use of ‘average’ journey times in these circumstances has no relevance and is meaningless.
Further, by only reporting average journey time, the Consultation Document avoids telling people in the most remote parts of Kirklees what their actual ambulance travel time would be. The Consultation Document should report actual distances and ambulance journey times to the proposed Emergency Centre from the main towns and villages in Kirklees.
It is not possible to tell people what their actual journey time would be. The ambulance takes the most direct route to the most appropriate place depending on the care needed and the state of the roads at the time the journey is made. For example, as per current arrangements, people with serious multiple injuries, heart attacks or burns would go to a specialist emergency centre, such as Leeds or Wakefield.
In addition, the most important time is the time taken for the ambulance to reach the patient. The ambulance staff will then spend time stabilising the patient and then taking them to the place where the required specialism is in place to provide the required care.
The answer describes a few scenarios, it would be a simple task to give journey times for these, and at different times e.g. early hours and peak commuting times.
As already mentioned in question 29, the travel analysis does not include estimates of the extra time ambulances may take to reach Kirklees patients, given that ambulances drift to areas near A&Es means and it will take time for ambulances to return to Kirklees – where there would be no A&Es. This is worrying, since the CCGs say that the most important time is the time taken for the ambulance to reach the patient.
The Consultation Document (p6) makes the inaccurate claim that the proposed hospital clinical model would close the financial gap that the system is facing. We know from what Monitor told the Joint Health Scrutiny Committee, that although the proposed changes would reduce the “financial gap”, CHFT would still be £9.3m in deficit by 2020/21, when the proposed changes would have been implemented. And the Consultation Document says on p 12 that in the five years following the changes, if CRH were chosen as the Emergency Centre, the cumulative deficit at CHFT would increase by £47.5m. This gives the lie to the p6 claim that the proposed changes would close the financial gap – £47.5m is rather a large financial gap. Please explain to the public that while these proposals may narrow the financial gap the system is facing, it will not close it for at least a decade from now.
The claim on Page 6 of the Consultation Document is accurate. It states that: “That these developments would cost more than £291m but would generate efficiencies to close the financial gap the system is facing.’
The breakdown of these costs is provided on page 8 and 9 which clearly state: ‘The local savings challenge across the NHS in Calderdale and Greater Huddersfield is forecast to be £270m by 2020. This is broken down as follows:
CCGs’ financial gap £60m
Calderdale and Huddersfield NHS FT £193m
Other providers £17m
Such significant savings can only be made by designing and implementing major changes to services and patient pathways. Without change our local NHS would not be financially sustainable in the future and the Trust would have an underlying deficit of £27.5m (despite having made the required efficiency savings of £75m, most of which relate to services commissioned from the Trust by our two CCGs).
To bring about the level of change needed would require some considerable investment. We would be seeking funding support from HM Treasury of £291m to redevelop CRH and build a new hospital on the Acre Mills site at Huddersfield.
In addition we are seeking £179m from HM Treasury to support the hospital deficit position. Our proposed changes cannot go ahead if we don’t get the money from HM Treasury.
And on page 12 we state: ‘While money raised in the way at HRI would not cover the cost of the investment needed for both hospitals going forward it would mean we were better placed to seek the additional funding that would be needed. This would help us to invest in both hospitals so that CRH could be further developed to become the state of the art Emergency Centre and the Acre Mills site at Huddersfield developed to become a state of the art planned care hospital.
‘The total funding required, including the funding to develop CRH as the Emergency Centre would be £470m, compared to £501m if we were to develop HRI to be the Emergency Centre. These figures (£470m and £501m) include £179m that is needed to support the hospital deficit position. In the five years following the changes, if CRH were chosen as the Emergency Centre the cumulative deficit at Calderdale and Huddersfield NHS Foundation Trust would increase by £47.5m, if HRI were chosen the cumulative deficit would increase by £108m’
Why does the answer just repeat the extracts from the consultation document that the question describes as misleading, but not address the main point made in the question?
Why cannot the CCGs change one word to be more honest i.e. change ‘close’ to ‘reduce’?
(It has to be said, throughout the CCGs’ response, the suggested answers given have refused to use the word ‘close’ in another context.)
At the Hebden Bridge consultation drop in, Dr Alan Brook told a member of the public that CHFT expected to go into surplus at some point after the whole Care Closer to Home scheme had kicked in. Please provide the modelling for this expectation and show when the surplus is expected to occur.
Dr Brook cannot remember the exact details of the conversation but it was a conversation which explained that the financial projections are based on current activity but when we succeed moving Care Closer to Home then the numbers should look even better.
Is this a retraction? Their reply is hopeful but without evidence.
The Consultation Document says that “These proposed changes would secure the future of health services for both areas for the next 20 years.” But according to Monitor, it isn’t true that the proposed changes would secure the future of health services for both areas for the next 20 years. Monitor told the Joint Health Scrutiny Committee on 9 March that “Running a £9.5m deficit/year that can’t be funded by the Trust or the Clinical Commissioning Group, that’s not a sustainable position.” And that at the end of the 5 year period of the proposed hospital cuts and changes, the hospitals Trust will: “obviously be unsustainable in the longer term unless the government changes its funding policy.” The Monitor rep continued, “We’re heading into an unprecedented phase of the NHS, with many Trusts going into deficit this year. We’re looking at wider footprints now than individual Trusts.” We need the CCGs to spell out Monitor’s warning that these proposed changes won’t secure the future of health services for both areas for the next 20 years, and your reaction to it.
The £9.5m deficit/year – is outlined in the Consultation document on Page 12 – where it is stated as a cumulative deficit (i.e. 5 x 9.5):
The total funding required, including the funding to develop CRH as the Emergency Centre would be £470m, compared to £501m if we were to develop HRI to be the Emergency Centre. These figures (£470m and £501m) include £179m that is needed to support the hospital deficit position. In the five years following the changes, if CRH were chosen as the Emergency Centre the cumulative deficit at Calderdale and Huddersfield NHS Foundation Trust would increase by £47.5m, if HRI were chosen the cumulative deficit would increase by £108m.
The full meeting of the Calderdale and Kirklees Joint Health Scrutiny Committee, outlined the full extent of Monitor’s comments is available as a webcast here: http://www.kirklees.public-i.tv/core/portal/webcast_interactive/215866/start_time/3000
The answer does not address the question, again.
Monitor clearly states that carrying an annual deficit that cannot be funded is unsustainable.
The answer does not comment on this.
Monitor goes on to say that after all the changes, the hospital Trust will be unsustainable in the longer term unless the government changes its funding policy.
The answer does not comment on this.
Monitor’s comment about “looking at wider footprints than individual Trusts” seems to be a reference to Sustainability and Transformation Plans. The CCGs need to explain these Plans to the public as part of this Consultation, since they are going to determine the future of our local services. The implications for the likely future of our hospitals need clarifying – particularly the implications of the fact that each STP “footprint” will have to make sure that the sum of plans for individual areas stick within the allocated budget – meaning it will not be possible for a “footprint” go into deficit. Given that the hospital cuts proposals will not return the Hospitals Trust into the black even by 2025/6 (when a cumulative deficit of £47.5m is predicted), this surely has to put a question mark over whether the proposed hospital clinical model will be acceptable under the terms of the STP; and if it is, what other service will have to be cut to carry that £47.5m deficit – let alone the current deficit. The CCGs need to explain this to the public.
We cannot answer on behalf of Monitor or speculate on what they were thinking at the time they made their comments.
In relation to Strategic Transformation plans (STPs), we can confirm that the CCGs are closely involved in the conversation and planning in relation to STPs.
This is a parallel process to these proposals and the CCGs are briefing in public at their Governing Bodies and Health and Wellbeing Boards as those plans become clearer.
Are the CCGs making arrangements for the patients, carers and members of the public in the populations they serve to be involved in the drawing up of the STP for the West Yorks and Harrogate ‘footprint’ the two CCGs belong to?
CCGs have a legal responsibility to involve the people they provide services for in the commissioning of those services.
The STP will impact on commissioning decisions that both CCGs will make in the near future.
There is a moral duty, if not yet a legal one, for both CCGs to involve – not just ‘brief’ – people who will be directly affected by the implementation of the STP.
The inability of the STP ‘footprint’ total budget to go into deficit is a significant risk to the implementation of this proposal.
The CCGs need to adjust their plans to account for these new circumstances and requirements
Without accurate financial information, the public cannot possibly judge whether this proposal represents good value for money. But the Consultation Document doesn’t provide this. It says (p 12) that the total funding required to develop CRH as the Emergency Centre and HRI as a new planned care hospital would be £470m, and that that figure includes £179m to “support the hospital deficit position.” So £179m of the “financial gap” reduction would come from outside funding – not from any “efficiencies” generated by the proposed hospital clinical model. £291m would be needed to cover the capital costs of the hospital changes (Consultation Document p 6).
The Consultation Document is vague about the sources of finance for the £470m. It says (p12) that the sale of either the HRI main site or the Acre Mill site wouldn’t pay for the capital costs of the hospital changes, but it would make it easier to get the extra funding needed for this. The Consultation Document (p9) says that HM Treasury is the intended source of the £470m additional funding and that if this isn’t forthcoming the proposed changes can’t go ahead.
It doesn’t explain that Monitor has, with “some caveat” put in an application to the Department of Health for what it considers to be “extraordinary funding of £470m for a single Trust reconfiguration” – extraordinary in that it compares with £300m that it cost for a Northern Trust to build a whole new hospital, according to Monitor. Monitor told the Joint Health Scrutiny Committee on 9 March that the Department of Health is liaising with the Treasury and that there is no indication of the time frame “or what they’ll stomach”. What is this “extraordinary funding” from the Department of Health? There is nothing in the Consultation Document about this. And how confident are the CCGs that this funding will be forthcoming, and why?
The Pre Consultation Business Case (p97) identifies these sources of the £470m external funding:
- loan funding to support the capital requirement
- non-recurrent reconfiguration revenue costs funding
- non-recurrent deficit support funding
The public needs to know on what terms and conditions the Department of Health would provide “extraordinary funding”. Is it from a loan and/or Public Dividend Capital? https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/365134/SofS_Finance_Guidance_under_Section_42A.pdf
What is the rate of interest and how long would it take to repay the loan and interest charges?
At the Halifax public consultation drop in, Owen Williams said there are 3 potential funding sources:
- A capital pot between the DoH and the Treasury, which would require repayments
- The DoH/Treasury could give CHFT a borrowing limit to get the loan on the commercial market and the DoH would pay the interest
- PFI 2 – could be required to go down that route.
The CCGs need to provide clear, accurate financial information that makes sense.
We cannot answer on behalf of Monitor or speculate on what they were thinking at the time they made their comments.
In relation to Strategic Transformation plans (STPs), we can confirm that the CCGs are closely involved in the conversation and planning in relation to STPs. This is a parallel process to these proposals and the CCGs are briefing in public at their Governing Bodies and Health and Wellbeing Boards as those plans become clearer.
The financial information is as accurate as it can be at this stage. As detailed above, the purpose of these proposals is to save more lives, keep people healthy, make services safer and improve quality of care.
The Consultation Document is clear that the bid for additional funding includes £179m to support the hospital deficit position. The remainder of the £470m would be used to implement to arrangements proposed as part of this consultation.
As referenced earlier, we believe that the proposed clinical model, that we are proposing would configure services in a way that would enable us to generate efficiencies to close the financial gap.
CHFT have submitted to the Department of Health, what we believe to be the best case for financial support, in that it would provide the least expensive way to deliver the requirements of our clinical model.
We have been clear that progression of the proposed changes is dependent on additional funding being secured.
We will not know if our submission has been successful until after the consultation has finished. If the conclusion of the consultation process was that we were to proceed with the proposed changes this could only be a recommendation pending the successful outcome of the request for funding.
The further detail in relation to the terms and conditions provided by the Department of Health is not known at this stage.
It is pretty incredible that the CCGs sat through a meeting and don’t know what Monitor meant by what they said at the meeting. Do you expect us to believe that you can’t speculate on what they meant? Surely a failure to find out what Monitor meant is negligence of your duties. If you didn’t understand what Monitor meant, you should have asked them.
Why are the CCGs not advocating the involvement of patients and the public in the STP, rather than just ‘briefing‘ them?
The financial information given presents a very weak case for value for money.
The CCGs still maintain they will close the financial gap, not reduce it, but this will be by borrowing the money (£179m), not by ‘efficiencies’.
The funding information IS very vague. Some simpler explanations are needed, not just repeating the vague statements, yet again.
The figures repeated in the suggested answer do not make it clear exactly what the extra £179m is intended to cover.
QUESTIONS END – HERE IS THE SIGN OFF TO OUR REQUEST FOR INFORMATION ABOUT CONSULTATION DOCUMENT ERRORS AND OMISSIONS
As stated above, we have an absolute commitment to assessing if the Right Care Right Time Right Place proposal is right, once we have all the information about it. We can’t do that until and unless you give us and the rest of the public full, accurate information that is currently missing from the Consultation Document.
Paul Cooney, Huddersfield Keep our NHS Public
Nora Everitt, Barnsley Save Our NHS
Terry Hallworth, Huddersfield Citizen
Rosemary Hedges, Calderdale 38 Degrees NHS Campaign Group
Christine Hyde, N Kirklees Support the NHS
Jenny Shepherd, Calderdale & Kirklees 999 Call for the NHS