Report of findings on hospital cuts consultation – comes with bullshit alert

Here is the Independent review of consultation findings (pdf) from the Midlands and Lancashire Commissioning Support Unit.

Reading it now. Warning: comes with bullshit alert.

Although the Commissioning Support Unit’s report on the consultation findings is described as “independent”, Midlands and Lancashire Commissioning Support Unit was privatised from 1 April 2016. Now Clinical Commissioning Groups that use its services have to hire them from a consortium of private companies that are on the Lead Provider Framework supply chain.

The company that heads up the Midlands and Lancashire Commissioning Support Unit consortium is United Health aka Optum: the American private health insurance company that the head of NHS England, Simon Stevens, previously worked for.

As Dr Brook, the Calderdale Clinical Commissioning Group Chair, has never tired of trumpeting over the last year or so, the Calderdale and Kirklees proposals for hospital cuts and care closer to home are taken straight out of Simon Stevens’ Five Year Forward View.

MOST PEOPLE SAID THEY WOULD BE NEGATIVELY AFFECTED BY THE PROPOSALS.

ACCORDING TO THE ‘INDEPENDENT REPORTERS’, WE ONLY SAID THIS BECAUSE WE DON’T UNDERSTAND THE DETAIL OF THE PROPOSED CLINICAL MODEL.

66.7% of respondents to the consultation survey said they would be negatively affected by the proposed changes overall (Section 3 , Question 10). 33% Calderdale respondents said this; 80% of Greater Huddersfield respondents said this.

And 64.4% disagreed with the proposed changes (Section 3, Question 10).

61% of Huddersfield respondents didn’t like anything about emergency care proposals, compared to 27% of Calderdale residents.

There was a low response to the question of what we dislike about planned care proposals – but key themes of responses were:

• waiting times will increase
• problems with travel time and access to services
• worries about source of financing the new Acre Mills planned care hospital

There were few comments on the maternity services proposals, but responses showed that people believe both towns need their own maternity units, and there’s not enough evidence that maternity care closer to home will work.

Respondents’ main worries about children’s services proposals were speed of being seen and ability to travel to receive treatment. Huddersfield residents were far more likely to have concerns and worries. Key themes in responses:

• travel times in an emergency
• putting children’s lives at risk

With community services proposals, respondents’ main concerns were:

• can they achieve what’s proposed
• questions about funding
• need for more funding for GP services

Bullshit alert: Report says reason respondents reject proposals is because we don’t understand them.

The Report identifies 6 key areas for focus –  for the Clinical Commissioning Groups to think about. This is where the first bullshit alert comes. Having found that we the public have said no to the proposals, the Independent Report says this is because we don’t understand them.

This is basically telling the Clinical Commissioning Groups that they don’t need to rethink their proposals, they just need to convince us we don’t understand them and then try and convince us to see them their way – which in their eyes will mean we then understand them.

It’s NOT that we don’t understand them. We do understand them, and that is why we reject them. Heyho. Here are the 6 issues.

1. Travel & transport

Greater Huddersfield residents are worried about the impact of increased travel times, especially to A&E in Halifax, and see this as a reason to keep A&E in Huddersfield.

Problems travelling between the two towns – congestion on Elland bypass, access to public transport, increased travel costs and car parking problems at CRH

People are worried that more demand on ambulances will slow response times and reduce availability of ambulances for life threatening conditions

2. Clinical safety & capacity

Respondents worried that increased travel times will increase mortality.

They are sceptical about quality of care and availability of treatment and that this could put patients’ lives at risk.

And that there is insufficient capacity to cope with population’s needs eg hospital beds, staff and knock on effects for other services and areas, eg Barnsley

The report says,

A lack of understanding about  the detail of the proposals and how they would work in practice is a key barrier to overcoming concerns (see point 5)

People want to know how urgent care centres would link to A&E eg if patient had to transfer to A&E.

And if impact of proposals on GPs and ambulance service has been properly considered.

3. Reason for change

The report says respondents questioned:

• whether the proposals are clinically or financially driven
• the role of the CRH PFI
• whether clinical and ambulance staff support the proposals

4. The consultation process

Respondents were critical and suspicious of:

• consulting on a single option – a “done deal”
• the consultation documents language and lack of clarity
• how the CCGs arrived at the final proposal and why they didn’t describe other proposals
• lack of evidence to support the proposals
• CCGs’ engagement methods
• lack of staff involvment in structuring and formulating plans

5. Understanding the proposed model

• Respondents didn’t understand the details of the proposed clinical model and how it could work in practice, because there was not enough information
• Respondents believe A&E is needed in both towns
• There is a lack of understanding of emergency care and urgent care.

CK999 thinks it is a cop out to say that respondents have rejected the clinical model because we don’t understand how it would work. Although it is true that the consultation documents and face to face sessions were vague about the details, there is enough information from elsewhere about how this proposed clinical model works, and enough professional and patients’ analysis of its shortcomings, for us to understand it all too well. And this is why respondents have rejected it.

6. Need for change

The report says there is evidence that many respondents accept the need for change.

So why doesn’t the report list the kind of changes advocated by the public at meetings and in the consultation responses? Like proper NHS funding and an end to NHS marketisation and privatisation?

More detailed report on rest of the Findings on the Consultation will follow.