Calderdale and Kirklees Joint Health Scrutiny Committee have voted 5-3 to refer the hospitals and community services “reconfiguration” to the Secretary of State for Health, on the grounds that:
- the Councillors were not satisfied with the Clinical Commissioning Groups’ consultation with their Committee
- the proposals are not consistent with the public consultation document
- the proposals are not in the interest of the people of Calderdale & Kirklees and not in the interest of the health service
It was a nail-bitingly close call. Before the Chair, Cllr Elizabeth Smaje, called the vote, three Calderdale Councillors on the Committee each commented they were not in favour of referring the proposals to the Secretary of State, because they feared that the Independent Reconfiguration Review Panel might impose something worse than the existing plans.
Councillors’ duty as members of the Scrutiny Committee is to refer proposals to the Secretary of State if they find they do not meet the health needs of the public. During the meeting, none of the 3 Calderdale Councillors suggested that the proposals meet the health needs of the public – indeed, Cllr Chris Pearson had a histrionic rant at the hospitals Trust about their failure to publish the Full Business Case.
When the vote was finally called Calderdale Councillor Adam Wilkinson, the Co-Chair, voted with the four Kirklees Councillors and cheers resounded round the council chamber and the overflow room.
The proposals will now be considered by the “Independent” Reconfiguration Review Panel; campaigners say they will bring pressure to bear on Jeremy Hunt to make sure that he and his Panel do not approve them, as they are clearly not in the health interests of the Calderdale and Kirklees public.
During the meeting many Kirklees Councillors, NHS campaigners and two Kirklees MPs demanded that these plans are thrown out and referred to SoS.
Paula Sherriff MP made the point that the continued existence of Huddersfield Royal Infirmary’s full A&E department had been a condition of the Secretary of State’s acceptance of the Mid Yorks reconfiguration plan in 2014. This included downgrades to Dewsbury District Hospital and its A&E – but Dewsbury hospital bed cuts plans have had to be shelved because they were unrealistic. Paula Sherriff said we have to learn from this. She unequivocally opposed the Calderdale and Kirklees proposals and said they must be referred to the Secretary of State.
Lack of involvement of Local Medical Committee
Dr Bert Jindal, secretary of Kirklees Local Medical Council (the organisation that represents the area’s GPs), wanted the proposals referred because the Local Medical Committee had not been involved in any discussions about the reconfiguration proposals or the hospitals Trust’s Full Business Case.
He said the Local Medical Committee had concerns about the finances, the unknown costs of a 2nd PFI and all other aspects of the finances. They were also concerned about the impact of a greater workload on GP services and community nursing. There is a GP workforce crisis nationally and not enough staff to run existing GP services and primary care, let alone the new Care Closer to Home services that will be required to make up for cuts to hospital services and beds.
Given enough rope to hang themselves, the NHS organisations strung themselves up
Cllr Smaje reported that before the meeting, the JHSC had had a brief presentation on the commercially confidential Full Business Case, but this had not reduced the Councillors’ frustration at the Trust’s recent decision to make the Full Business Case commercially confidential and to withhold it from the Scrutiny Committee.
The hospital Trust’s Chief Executive Owen Williams apologised that the Trust was trying hard to publish the Full Business Case – either in full or redacted – by next Thursday or Friday.
Replying to a question from Cllr Adam Wilkinson, Carol McKenna confirmed that the Clinical Commissioning Groups hadn’t yet seen the Full Business Case; she said when the Trust Board have made a decision about signing it off, the Trust will send it to NHS Improvement and NHS Improvement will seek the Clinical Commissioning Groups’ view. Then the Clinical Commissioning Groups’ Governing Bodies will discuss it, probably around September/October.
Cllr Smaje asked if the Full Business Case is in line with the clinical model that was publicly consulted on. The hapless Carol McKenna said she couldn’t comment because the Clinical Commissioning Groups haven’t seen Full Business Case.
Cllr Smaje asked if there is any discussion in the Full Business Case about a West Yorkshire-based approach to acute care collaboration across the Trusts.
Owen Williams said that part of the West Yorkshire and Harrogate Sustainability and Transformation Plan is the West Yorkshire Association of Acute Trusts, which Calderdale and Huddersfield Foundation Trust is part of. A Committee in Common oversees a number of clinical and non-clinical “workstreams”. He added that the West Yorkshire and Harrogate Sustainability and Transformation Plan is part of the Trust’s reality and NHS Improvement and NHS England expect it to be collaborating.
Cllr Smaje dismissed this information and said she’d been asking about collaboration between trusts in Calderdale, Kirklees and Wakefield.
Councillors’ questions and comments turned time and again to the failure to publish the Full Business Case, since without it there were no answers to questions about staffing, finance and how projected demographic change and population growth feed into modelling for future hospital services.
Reducing A&E admissions by the intended amount is a “challenge” for Care Closer to Home
Asked how confident the Clinical Commissioning Groups were about about whether Care Closer to Home can deliver the intended reductions to A&E admissions, Carol McKenna said that the target is a challenge – the Transformation Unit has said it’s a challenge but not impossible. She added that A&E admissions are not increasing and have reduced over the past few years.
Kirklees Cllr Julie Stewart Turner said the JHSC had asked for something to give them confidence about scaling up Care Closer to Home, as there was no evidence about this to reduce pressure on hospitals.
Carol Mckenna asked what the JHSC wanted. Cllr Julie Stewart Turner said that they wanted modelling and the Full Business Case and the full suite of documents to answer their recommendations.
Cllr Smaje said that the proposal to reduce A&E demand by 18% over 5 years was new information and asked if this is achievable.
Carol Mckenna said the Clinical Commissioning Groups would do everything they could and the Transformation Unit says it’s potentially achievable. They will share work done with the Transformation Unit about evidence of scaleability when it’s finished.
Non-existent primary care strategy
Cllr Adam Wilkinson was astounded that primary care had not been discussed. GPs and primary care were inextricably linked to the whole thing, it was absolutely crucial to get that right and he was disappointed that the Local Medical Committee had not been involved in the development of the Full Business Case. He added that for months the JHSC had been referred to the Primary Care strategy for Calderdale, which doesn’t exist.
The Calderdale Finance Officer said there was no strategy but they have a primary care plan that had been discussed with GPs and Calderdale scrutiny committee. He added
“I would question whether having it written down as a strategy matters.”
Cllr Wilkinson retorted,
“It doesn’t help us that you have it in your head.”
The Calderdale Finance Officer replied that they have a shared plan, a vision for primary care that has been shared; access is what they’re prioritising and will be over next 12-18 months.
Other problems with the proposals were also discussed, including the fact that doctors will not be present in urgent care centres 24/7, and all the transport problems associated with centralising acute and emergency care in Halifax and planned care in Huddersfield.