Hospital cuts and Care Closer to Home proposals found wanting by Joint Health Scrutiny Committee

The mood was sombre at the Joint Health Scrutiny Committee (JHSC) meeting this morning, where Councillors unanimously confirmed all the recommendations in their Response to the Right Care Right Time Right Place proposals for hospital and community community health services in Calderdale and Greater Huddersfield.

Their 19 recommendations highlight huge weaknesses in the proposals and ask the Clinical Commissioning Groups to rectify them.

Councillors spoke of the seriousness of the decisions they had to make, in terms of the impact they would have on the lives of Calderdale and Greater Huddersfield people.

The Co-Chair, Kirklees Councillor Elizabeth Smaje, said that as well as the recommendations, the JHSC had concerns about  low participation rates in Calderdale which could be due to the CCGs’ failure to clearly explain the impact of the proposals for Calderdale people, and the Clinical Commissioning Groups’ lack of attention to petitions.

She added,

“The JHSC want the CCGs to take the high level of public concerns, expressed in the consultation and petitions, seriously in their deliberations. That high level of concern must be taken into account.”

The JHSC recommendations will be sent formally to the Clinical Commissioning Groups on Monday (although they have them now). The JHSC anticipate that the Clinical Commissioning Groups will give their response to them at their meeting on 20 October, when the CCGs are to announce their decision on what to do after considering the consultation findings.

The JHSC also agreed to meet on 16th November to consider if the Clinical Commissioning Groups have adequately responded to their recommendations on 20th October.

The Clinical Commissioning Groups have their work cut out if they accept the JHSC’s recommendations.

They have three weeks to go back to the Clinical Senate and ask them to look at hospital and care closer to home proposals again,  because of the Clinical Senate’s strong reservations about whether the proposals could be delivered to the required standard. (Recommendation 10) Other recommendations call for the CCGs to:

  • Set targets for service quality improvement and better outcomes and details of how they will be measured.
  • Consider how increased partnership working across neighbouring NHS Trusts might help solve workforce issues.
  • Produce a financial plan with CHFT that addresses the Trust’s financial deficit and clearly identifies how local services will be delivered in a safe and sustainable way.
  • Give full assurance that the proposal for the new planned care hospital in Huddersfield will be fully financed without increasing the Trust’s deficit – and if they can’t give this assurance, the CCGs must inform the public and the Committee how it intends to proceed.
  • Develop a plan with CHFT that has clear targets to reduce attendances at both Accident and Emergency Units and outlines what will be done tomake sure that: the 111 service is effective at directing patients to the right place; there is improved access to GPs; and that CC2H programmes treat patients earlier, so fewer patients need to attend A&E.
  • Provide full assurance to the Committee and the public on how they will develop sufficient capacity in the Care Closer to Home programmes and Primary Care to reduce demand on hospital services and how this will be measured.
  • Further develop their Primary Care Strategies with the full engagement of GPs and other key primary care services in order to improve access to high quality primary care and help manage and reduce the demand on hospital services.
  • Develop a detailed description of the urgent care centre model and how it will be resourced, before they make a decision on hospital and community services
    together with Calderdale Council, Kirklees Council and West Yorkshire Combined Authority in conjunction with transport providers,  develop a clear public transport plan to improve the speed and frequency of bus services to both Calderdale Royal Hospital and Huddersfield Royal Infirmary. This should include introducing a “loop” that will not materially impact on the journey times to some existing services that includes at least one of the hospitals on their route.
  • Specify the additional resource that will be required by the Yorkshire Ambulance service to deliver the additional hours of journey time required as a result of hospital reconfiguration. This should include: where that resource will be found; a clear plan to ensure that the Yorkshire Ambulance Service meets its targets; and what measures will be introduced to support a significant improvement in service.
  • Commission an up to date Travel Analysis and Journey Time Assessment Study that details the absolute travel times and distances to both hospitals. The study should take account of: patients and visitors using their own private vehicles and public transport; and residents that live at the furthest outlying areas of Calderdale and Greater Huddersfield.
  • Produce evidence that Calderdale Royal Hospital can be improved so that it can provide urgent and emergency care services to mores than 100k people/year without detriment to the quality of service.
  • Develop a plan that shows how capacity in community services will be provided to support the reduction in hospital bed numbers. This must include details of the approach that will be taken to improving efficiencies in bed occupancy and the modelling and assumptions used in developing alternative provision in a community setting.
  • Develop a framework that outlines the processes and protocols for dealing with a sick young child. This should include details of the resources that will be made available to support the quick and easy access to appropriate clinical advice.
    consider developing plans to maximise the use of Todmorden Health Centre and Holme Valley Memorial Hospital together with other local facilities. This should include a focus on the provision of integrated and specialist services.

In addition the JHSC has recommended that:

  • CHFT produce a clear and costed Workforce Strategy, with timescales, that shows how the Trust will tackle shortages of clinical and other staff, and agree it with the CCGs
  • CHFT must prepare a clear costed plan that will ensure that there is sufficient parking available at Calderdale Royal Hospital; accessibility for the potential increase in the numbers of emergency vehicles is fully addressed; and impact on the surrounding neighbourhood is minimised.
  • Calderdale Council and Kirklees Council should work with the West Yorkshire Combined Authority to make improvements to the A629 a high priority in their road improvement programmes.

After the meeting, it was not surprising that the Clinical Commissioning Group and CHFT people looked very disturbed and glum. It is hard to see how they can do the work the JHSC has asked for in the recommendations, in the 3 weeks before the decision date on 20th October. In fact there is no way they can do the required work in that time. But it was always clear that their proposed post-consultation timeline was daft.

If the CCCGs accept the JHSC recommendations, and do the required work, they will surely have to postpone the decision date beyond 20th October.

Maybe they will ignore the recommendations, on the basis that this will mean the JHSC will refer the proposals to the Secretary of State for Health, but past experience shows that he will not stop them so the proposals will go ahead regardless, with a bit of delay for the Independent Reconfiguration Review Panel to go through the motions.

But there may be a risk that ignoring the JHSC’s recommendations could open them to a legal challenge from either or both of the law firms that are investigating whether there are grounds for a legal challenge to the consultation and/or the CCGs’ decision. We shall have to wait for legal advice on this.

So who knows how the CCGs will respond. If their past performance is anything to go by, they will resort to bullshit. So come to the 20th October meeting armed with Bullshit Alert placards.

The 19 recommendations are here.

Update 3rd Oct 2016

At the start of the meeting the co-chair Cllr Greenwood said,

“We received a letter three days ago from Irwin Mitchell acting on behalf of Hands Off HRI. Many of the points they make have been discussed by the Committee at previous meetings and are considered in our draft report. As a number of the points they make relate to duties of Councils and of Clinical Commissioning Groups, we have drawn their letter to the attention of Calderdale Council, Kirklees Council and the two Clinical Commissioning Groups. The initial view of the legal departments of both Councils is that there is nothing in the CCG proposals that would prevent the Councils from undertaking their duties under the Care Act 2014 and the Civil Contingencies Act 2004.”

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