Calderdale and Greater Huddersfield’s Right Care Right Time Right Place plans are profoundly wrong

Calderdale and Kirklees 999 Call for the NHS

Report on Reconfiguration of Calderdale and Huddersfield NHS Foundation Trust Hospital Services Full Business Case

This is draft of what we’re planning to send to the Independent Review Panel, telling them why we are calling on them to carry out a full review of the plans and tell the Secretary of State to stop them and reconsider the government’s NHS policies that are driving them.

In his talk at the Royal College of Medicine a week ago, Stephen Hawking said:

“The question is whether democracy can prevail and the public can make its demands for proper funding and public provision undeniable by any government.”

We are making our demands for proper funding and resourcing of both Huddersfield and Calderdale District General Hospitals, complete with 24/7 Type 1 A&Es.

We entirely reject the NHS and social care reconfiguration proposals that the Calderdale and Kirklees Joint Health Scrutiny Committee have referred to the Independent Review Panel.

As a key part of West Yorkshire and Harrogate Sustainability and Transformation Plan, they are “merely the vehicle for delivering cuts to services that the government’s ongoing underfunding of the NHS has made inevitable” – as Unison has described the STPs.

We shall urge the Independent Review Panel to tell the Secretary of State to listen to Stephen Hawking and to us and to properly fund and resource the NHS so that our District General Hospitals can stay open and meet all required standards of patient care and staff terms and conditions of work.

Once that is guaranteed we can begin to look at ways of improving and modernising the NHS and social care.

There is no doubt that, as a result of the government’s underfunding of the NHS and failure to come up with a decent NHS workforce plan, the NHS and social care in Calderdale and Huddersfield are fighting a losing battle to provide adequate care for patients and decent working conditions for staff.

But having thoroughly examined the Full Business Case, 999 Call for the NHS (Calderdale and Kirklees) finds that Calderdale and Greater Huddersfield’s Right Care Right Time Right Place plans for reconfiguring NHS and social care services are profoundly wrong.

The reconfiguration will not solve the root problems of lack of staff and money. These are entirely the result of government decisions to cut public spending, increase NHS privatisation and, in 2010, to cut the number of places at medical schools by 3.6% and to slash the number of places on undergraduate nursing courses by a massive 13%.

The proposed reconfiguration would just serve to entrench these decisions.

Even if we were to accept the plans on their own terms – which we clearly don’t – it is worth pointing out that they are largely un-evidenced, have evaded proper scrutiny by Councillors and are deeply flawed. This is another good reason for rejecting them.

We explain these failings in this report which examines the Full Business Case through the lens of its Workforce plan.

Workforce plan and implications

Monitor and PwC have told the Trust to tackle the high workforce spending required by two District General Hospitals (and also to deal with the massive PFI costs), by turning one District General Hospital into a small planned care hospital and the other into an acute and emergency hospital, while optimising the utilisation of the Trust’s PFI and non-PFI estate.(Full Business Case, p95)

Calderdale and Huddersfield NHS Foundation  Trust’s (CHFT’s) Full Business Case notes workforce “challenges” due to national staff shortages and NHS underfunding, but – obedient to Monitor and PwC – misattributes the cause of their staff recruitment and retention problems to the fact that the Trust runs 2 District General Hospitals each with a 24/7 Type 1 A&E.

As a result, their workforce plan is about controlling the symptoms, not tackling the cause of the disease of underfunding, stealth privatisation and a total lack of effective workforce strategy that that the government has inflicted on the NHS.

By workforce “challenges”, they mean they haven’t got enough staff, they have problems with recruitment and retention and they are spending A LOT on agency staff and have been told to cut that drastically starting this year.

The Workforce plan aims to solve the problem of not having enough staff and money by a 479 reduction in CHFT Whole Time Equivalent staff over next 10 years, through natural turnover. This will save CHFT about £30m on its paybill.

It also states that recruitment and retention will be improved by dismantling the two District General Hospitals and replacing them with one small planned care hospital with outpatients and urgent care centre and one acute and emergency hospital, as this will make CHFT a more attractive place for doctors to work.

But this has not been the case at Pinderfields Hospital iin Wakefield, where the Mid Yorkshire Trust is a few years ahead of CHFT in a similar reconfiguration and is now “haemorrhaging” consultants, in the words of N Kirklees Support the NHS deputation to Calderdale and Kirklees Joint Health Scrutiny Committee at its July 21st 2017 meeting.

Other cost-cutting measures – including “delivery of skill mix” (in other words replacing highly qualified clinicians with new grades of less qualified staff) – mean that workforce spending goes down year on year for the next 10 years and by 2042 is only slightly higher than it is now. (In contrast, the drugs bill more than doubles over the same period.)

479 is a lot less than the 966 whole time equivalent reduction modelled in CHFT’s 5 year strategic plan, which does make you wonder if they are just pulling figures out of a hat. Because what has happened to change the number of necessary staff, between now and the preparation of the 5 Year Strategic Plan last year?

CHFT’s Full Business Case says the following measures would make it possible to do with 479 less staff than at present:

• service reconfiguration and redesign;
• recruitment and retention;
• new professional roles;
• job evaluation;
staff utilisation and productivity.
(FBC pages 9 & 72)

The CHFT workforce plan is inadequate in the following respects

It has next to nothing on a community services workforce plan.

Key assumptions of the workforce plan are questionable:

  • There is no evidence that cutting 105 hospital beds is feasible (which would account for 150 WTE job losses, or 22%.)
  • The reviewed skills mix/ new professional roles are unlikely to provide good quality, safe patient care.
  • Job evaluation, say nurses we have spoken to, is likely to destroy everything that epitomises nursing – that is, to provide all nursing care from basic care upwards. To nurse the whole person, whatever their needs.
  • Increased use of voluntary work and community involvement in both hospitals is part of the workforce plan.

It includes significant workforce changes based on new West Yorkshire and Harrogate Sustainability and Transformation Plan schemes that have not been consulted on and have not been scrutinised by Councillors.

Each of these shortcomings is described in separate reports, links coming soon.

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