Hospitals’ Trust Full Business Case based on “Austerity” bullsh*t

CK999 Bullsh*t Detected Report no.1

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

The NHS is not failing, it is being failed. We completely reject the NHS and social care reconfiguration proposals that the Calderdale and Kirklees Joint Health Scrutiny Committee have referred to the Independent Review Panel.

We hope the Independent Review Panel will carry out a full review of the plans and tell the Secretary of State to halt them and to reconsider the government’s NHS policies that are driving them.

Here’s the first in a series of Bullsh*t Detected reports on the Full Business Case for the hospitals’ reconfiguration.


Calderdale and Greater Huddersfield’s Right Care Right Time Right Place plans for reconfiguring NHS and social care services are profoundly wrong.

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.

We hope the Independent Review Panel will carry out a full review of the plans and tell the Secretary of State to halt them and to reconsider the government’s NHS policies that are driving them.

We appreciate Calderdale & Huddersfield NHS Foundation Trust’s (CHFT’s) decision to publish the Full Business Case in its entirety, without redactions, on the grounds that:

“the need for local people to know and scrutinise the detail of the business case takes precedent” [sic] over “the potential future procurement risk associated with full publication of the FBC.” (Full Business Case Report to Board, 3.8.17)

The Full Business Case is profoundly wrong, because it is based on a misdiagnosis of the problems that it is intended to solve.

“Austerity” bullshit

The Full Business Case normalises and accepts the government’s “austerity” bullshit – its economically illiterate, socially and environmentally punitive dogma that public spending cuts are good for the economy. More info here  and here.

As a key part of West Yorkshire and Harrogate Sustainability and Transformation Plan, the Full Business Case proposals 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.

National Treasure and brainbox scientist Professor Stephen Hawking recently wrote

“There is overwhelming evidence that NHS funding and the numbers of doctors and nurses are inadequate, and it is getting worse. The NHS had a £2.4bn shortfall in funding in 2015-16, bigger than ever before. NHS spending per person will go down in 2018-19. According to the Red Cross, the NHS is facing a humanitarian crisis. There is a staff recruitment crisis. The BBC reported that on 1 December 2015 there were 23,443 nursing vacancies, and a 50% increase in vacancies from 2013 to 2015. The Guardian reported in May that the number of nursing vacancies had risen further to 40,000. There are increasing numbers of doctor vacancies and increasing waiting times for GP appointments, treatment and surgery.”

This is the true strategic context and nature of the problems that need solving. Dismantling two District General Hospitals – as both Calderdale and Huddersfield NHS Foundation Trust and both Clinical Commissioning Groups intend – is not going to solve these problems, it is just going to enable and acquiesce in the government’s inadequate resourcing of the NHS.

To quote Stephen Hawking again:

“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, so that both Huddersfield and Calderdale District General Hospitals complete with 24/7 Type 1 A&Es, 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.

The NHS is not failing, it is being failed

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 is fighting a losing battle to provide adequate care for patients and decent working conditions for staff.

CHFT’s Full Business Case refers to this as “the strategic context”, and describes it in these terms:

  • The Nov 2016 National Audit Office report on NHS Financial Sustainability indicated the NHS is financially unsustainable (in other words, the government isn’t funding it properly);
  • The Full Business Case is a key part of the West Yorkshire and Harrogate Sustainability and Transformation Plan (which has to cut over £1bn NHS and social care costs by 2020/21, compared to current funding levels);
  • CHFT relies on the Dept of Health for cash to pay creditors and staff and the Clinical Commissioning Groups can’t afford the cost of commissioning services.

It says despite all this CHFT has done well in maintaining access to services but due to its problems recruiting and retaining staff, this depends on high agency staff costs – £20m in 2016/7.

To this we add: Clifton House and Nook Group Practice has just joined our hospitals Trust and the Kirklees community services provider Locala in receiving a Care Quality Commission judgment of “requires improvement” – while both Greater Huddersfield and Calderdale Clinical Commissioning Groups have been put in special measures by NHS England because of their inability to meet its harsh financial targets.

If multiple NHS organizations are “failing” their Care Quality Commission inspections perhaps this has a bigger meaning. Maybe it becomes impossible to provide decent and safe care when staff and services are being cut because of a shrinking budget.

CHFT nods towards the true source of these problems in the Full Business Case summary of the Clinical Case for Change, which says that CHFT can’t meet national guidelines for clinical standards regarding staffing and building standards without

“a major injection of permanent staffing and financial resources beyond that which is known to be available from government.”

In other words, if there weren’t massive PFI debt, a national NHS staff shortage and a mean government, both District General Hospitals could continue, each with their own 24/7 type 1A&E.

Those are the real reasons for the “reconfiguration”. And this is why we cannot accept the reconfiguration, because it will not solve these problems – it just normalises and accepts austerity bullshit, making us all accept these problems and the Full Business Case “solutions” as inevitable. We do not, and they are not – they are the result of the government’s political decisions, which we contest on the basis of solid economic arguments and values of social and environmental justice.

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