Joint Health Scrutiny Committee – please refer the hospitals and community care reconfiguration to the Secretary of State

This is the email Calderdale & Kirklees 999 Call for the NHS has sent to Calderdale & Kirklees Joint Health Scrutiny Committee.

Dear Councillors

We’d like to draw your attention to two issues relating to the Clinical Commissioning Groups’ and Calderdale & Huddersfield Foundation Trust’s reports to the Joint Health Scrutiny Committee.

First, CHFT has not met your requirement to present the Full Business Case and associated documents, that were due at the end of June. Calderdale and Kirklees 999 Call for the NHS are worried that this may have made it impossible for you to determine whether or not CHFT and the CCGs have satisfied any of the JHSC’s recommendations. Please would you let us know if this is the case? And if so, which recommendations are you unable to form a judgement about their responses to?

Second, from careful reading of the CCGs’ and CHFT’s reports to the JHSC, it seems clear that they have not satisfied the JHSC’s recommendations. Since these recommendations were designed to make sure that the Right Care Right Time Right Place proposals would meet the health needs of the Calderdale and Kirklees population, we are extremely concerned that the NHS organisations’ failure to satisfy the recommendations means that these proposals won’t meet the population’s health needs.

Calderdale and Kirklees 999 Call for the NHS therefore asks you to refer the proposals to the Secretary of State for Health.

Here is a summary of the CCGs’ and CHFTs’ failure to satisfy the JHSC’s recommendations.

Recommendation 1 – not met.

Neither of the Clinical Commissioning Groups’ answers provides the recommended targets for better health outcomes for patients, including a target to reduce hospital mortality.

Recommendation 2 – not met.

The Clinical Commissioning Groups say that the Health and Wellbeing Boards and Better Care Fund are the means of partnership working. They have not developed anything new, as the JHSC recommended.

Recommendation 3 – not met.

CHFT’s workforce strategy does not include a plan for dealing with vital shortages of the more highly-trained and self-reliant community nurses, or indicate a plan for the restoration of the numbers of GPs, who will need to be prepared to be responsible for more acutely ill patients. It does indicate a 3.4% increase in Community Nursing staff, but that is totally inadequate for the task in hand, and it does not accept any responsibility for ensuring that training is available locally, because there is no pool of trained staff out there from which to recruit.

As for providing information about how increased partnership working across nearby NHS trusts could solve workforce issues and develop a financially sustainable future model, their Workforce Strategy admits (4.3), “the plans across West Yorkshire are not sufficiently well developed at this stage to provide a clear solution to these concerns.”

CHFT’s report just nods in this direction by saying that “clinical networks” and “a centres of excellence approach for higher acuity specialities” will allow it to make the proposed 479 staff cuts over 10 years.

Recommendation 4 – not met.

Because CHFT and NHS Improvement haven’t signed off the Full Business Case, the Clinical Commissioning Groups haven’t reviewed it yet. They say that they will only support CHFT’s Full Business Case if it forms part of a “coherent and jointly owned strategy to deliver system financial balance within an appropriate time scale.” – ie as part of the West Yorkshire & Huddersfield Sustainability and Transformation Partnership.

CHFT says that the Full Business Case details a financial plan that does what the recommendation requires – but who knows how sound this financial plan is? Because the Full Business Case isn’t signed off or available to the JHSC and the public.

Recommendation 5 – not met.

As with recommendation 4, because the Full Business Case isn’t finalised or made available to the JHSC and the public, there’s no way of judging the soundness of CHFT’s financial case based on PFI funding, and whether it really would eliminate the Trust’s underlying deficit in year 8 (2024/25) and then maintain a financial surplus of around £6m per year.

Recommendations 6 and 7 Reducing Demand – Not met

The Clinical Commissioning Groups say they haven’t yet figured out how they’re going to reduce unplanned hospital admissions by their target of 3.5%/year over the next 5 years (just over half their previous Pre Consultation Business Case target of 6%/year), because they haven’t yet done the community modelling work to identify how they will deliver this.

The Clinical Commissioning Groups say that their continuing work in relation to medicines management could impact on admissions, but at this stage they can’t give numbers or categories of admissions.

The NHS Transformation Unit has told them that the 3.5%/year reduction is a long shot, they have too many individual schemes and they need to put more emphasis on schemes which improve unplanned care and less emphasis on schemes which improve planned care.

The Clinical Commissioning Groups’ statement about measures to make sure 111 directs patients to the right place shows they haven’t yet clarified the new community “care pathways” and they don’t yet understand the changes to hospital service or when they’re to take place.

The Clinical Commissioning Groups refuse to discuss “improved access to GPs”, as they say Primary Care strategies and associated plans to provide improved access to GPs were not part of the consultation.

Recommendation 8 – Not met

The Clinical Commissioning Groups have refused to respond with any information, on the grounds that their Strategies for Primary Care are subject to Scrutiny by the respective Calderdale and Kirklees Scrutiny committees.

Recommendation 9 – Not met.

The Clinical Commissioning Groups have not developed a detailed description of NHS 111 and how it will be resourced. Their reply to this recommendation mostly rehashes the info in the public consultation document. This is unsurprising since the Clinical Commissioning Groups’ response to recommendation 7 said that the development of NHS 111 depends on new community care pathways which are currently unclear.

In particular the guidance about children under 5 is very unclear – it says the Children’s Emergency Centre at CRH will be clearly “marketed” as the place to take children who are clearly very unwell or need specialist treatment, but then it says parents should either call 111 or 999 depending on their childrens’ illness. It is absolutely unclear where a child under 5 should go if s/he doesn’t need to go to the Children’s emergency centre or why parents should have to call 999 rather than just taking their child there if that would be quicker. These questions were raised at the public consultation and a year later the CCGs have not answered them.

Recommendation 10 NOT MET

The Clinical Commissioning Groups can’t carry out this recommendation because they can’t give the Yorkshire and Humber Clinical Senate the information needed to confirm the required standards of care would be achieved, as it won’t exist until the implementation planning.

Recommendation 12 – Not met

The Clinical Commissioning Groups have not satisfied this recommendation. Instead they say “the specification and agreement of additional YAS resource would be undertaken as part of existing commissioning arrangements.”

Recommendation 13 Transport – Started but not completed

The Clinical Commissioning Groups say they are updating the Public Transport Analysis but the work is not complete and they have set up a Travel and Transport Working Group with an Independent Chair. It has met 4 times.

They say the main travel implications will be for those who would currently attend at Halifax for Planned Care who will now be required to travel to Huddersfield and those people who are visiting patients in hospital.

Kirklees parents whose children are inpatients at Calderdale Royal Hospital deserve special consideration but aren’t given it.

Rec 15 Estate – Not met

CHFT say they have the required evidence, but they’ve not provided it.

The JHSC must see the external estates advice and the feasibiity cost model. They cannot take it on trust that these confirm that the Calderdale Royal Hospital site is big enough to accommodate the additional new build and clinical capacity to deliver the service model for unplanned and emergency services.

Rec 16 Estate – Not met

CHFT’s report amounts to a set of assertions without any evidence.

Rec 17 Estate – not met

The Clinical Commissioning Groups wrongly say that their response to recommendations 6 and 7 provides the recommended plan. It doesn’t.

CHFT also wrongly claims that the Clinical Commissioning Groups have developed a plan to provide capacity in the community that will support the reduction in bed numbers.

Regarding the review/update of hospital activity, this is limited to a statement that the reduction in hospital length of stay will be enabled through actions such as implementation of seven day working and the SAFER programme.

As for their review and update of bed modelling assumptions, CHFT says that the key assumptions are that the development of care closer to home will enable a reduction in non-elective medical admissions and the Trust will achieve upper quartile length of stay (LOS) performance.

But we have already seen that there are no solid grounds for the assumption that care closer to home will enable the targeted reduction in unplanned medical admissions.

And where is the evidence that this revised 3.5%/year target has been used to re-run the bed-modelling exercise, which would have surely suggested that far fewer than 105 beds should be lost?

Also the NHS Transformation Unit are very doubtful that they could achieve these consistent reductions, when they have not managed it so far, and the Clinical Senate are still unable to endorse the “plans”, for lack of information.

The upshot of CHFT’s review and update of hospital activity and bed modelling assumptions is that there will be 738 beds across the planned and unplanned hospitals (676 at the unplanned care site and 64 at the planned care site).

The reduction in overall hospital beds to 738, for a population of 452,000 ( based on Greater Huddersfield and Calderdale CCG registered patients) equates to 1.64 beds per 1000 population, which is just above the OECD figures for Mexico and Colombia.

This is 4 more beds than the Pre consultation business case proposed – and about 60 more at Calderdale Royal Hospital than were in the Pre consultation business case and nearly 60 fewer at HRI.

There is no explanation of this. Although the increase in beds on the Calderdale Royal Hospital site could give slightly more flexibility to deal with fluctuations in the numbers of seriously ill people that occur through the year, how does this justify taking the 64 beds out of the Huddersfield planned care capacity?

Recommendation 18 – Not met

The Clinical Commissioning Groups’ reply referred to their responses to Recommendations 1, 9 and 10 – none of which shows that they’ve developed a framework that outlines the processes and protocols for dealing with a sick young child.

Recommendation 19 Kind of met in a vague fashion

The Clinical Commissioning Groups replied vaguely that they will seek to maximise the potential of any publicly owned premises in their area, and agree that opportunities to increase integration of the delivery of health and social care should be considered wherever possible.

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