ck999 are writing to the Chairs of Calderdale and Kirklees Joint Health Scrutiny Committee, asking them to meet asap to scrutinise new developments have a bearing on the hospital, community and primary care services plans that they’ve referred to the Secretary of State.
We cannot quite believe the disregard for safety standards, let alone where we are headed on quality. What a disgrace these new developments are.
If you’d like to sign this open email too, please add your name in the comments box. We’ll be sending it around midday tomorrow (Tuesday 12th Dec). Sorry for short notice.
We’re glad to see that you’ve reminded the Secretary of State about the referral of the Right Care Right Time Right Place proposals and asked him to get a move on with passing the review to the IRP.
We heard that the CK Joint Health Scrutiny Committee intends to meet again shortly and we hope this will be sooner rather than later.
You probably already know of the following developments since the last CK Joint Health Scrutiny Committee meeting, but please will you scrutinise them as soon as possible? They have a bearing on the hospital, community and primary care services plans that you referred to the Secretary of State.
- Kirklees STP plans for integrated out-of-hospital services and adult social care
Kirklees Clinical Commissioning Groups and Kirklees Council are bashing ahead with plans for taking services out of the hospitals and integrating them with adult social care services (without saying where the community health staff are going to come from. They don’t grow on trees.) We feel these proposals for “integrated models of care provided by a collaboration of organisations” need scrutiny by the CK JHSC – particularly since one of the things the scrutiny committee complained about in referring the RCRTRP proposals to the Secretary of State was the lack of community and primary health care planning.
Kirklees Health & Adult Social Care Scrutiny Panel meeting on 14 November nodded through these plans for integrated out-of-hospital services. (They’re not calling it Care Closer to Home now.) But the Kirklees scrutiny committee only considers Kirklees issues, and seems to have overlooked the fact that Kirklees plans for integrated out-of-hospital services have a bearing on the Right Care Right Time Right Place plans, that have to be put on hold until the IRP has decided if they are fit for purpose or not.
2. Shrinking the size of clinical rooms at CRH
In response to a question to Calderdale Health and Wellbeing Board, about a vague Full Business Case mention on page 88 of derogating statutory building requirements, CHFT has explained which Hospital Building Notes, Health Technical Memoranda and statutory regulations they are planning to derogate (ie abandon):
“Derogation forms part of the Business Case development and design process for capital investment schemes and is detailed in relevant NHSI guidance.
“Wherever possible, architectural and building services/infrastructure should comply with the relevant HBN, HTM and statutory regulations. Where this is not possible, any such deviation should be agreed and signed off by the Project Director and/or Nurse/Medical Director in the case of major capital investment schemes, as part of the scheme of derogation.
Derogated standards must be identified and dealt with appropriately, the most common derogation in estates, in particular with refurbishment of existing estate, is reducing room size to less than the required m2. A quality impact assessment may be required to ensure that the derogation does not adversely affect the quality/safety of the patient/staff environment to ensure any risk issues are mitigated. In such circumstances derogation may be agreed if the consequences are identified, mitigated and managed.”
HBN stands for ‘Hospital Building Notes’ which are national standards for the design and equipment of rooms used for clinical care. The idea that the Medical Director, or the Director of Nursing, on their own authority, could shrink the size of clinical rooms, is scary. In particular, you need to be able to have space for wheel chairs and trolleys, particularly if a patient collapses. There are no patient sitting rooms or dining rooms, so the only space they have is the little area around their beds. The closer you pack patients, the greater the risk of hospital-acquired infections.
HTM stands for ‘Health Technical Memoranda’ which are also a set of standards for the design and equipment of rooms in medical facilities, especially regarding ventilation and sterilization.
It turns out the lack of sitting rooms is down to the Private Finance Initiative. As with most PFIs, the cost was directly related to the floor area (or perhaps the volume of the building). Anyway, it meant that, back in 1998, when the new Calderdale Royal Hospital was being designed, all ‘soft’ space was removed from the design – that is any space that is not absolutely critical to patient care, like patient sitting rooms, patient dining rooms, staff sitting rooms and storage space for equipment and supplies. The capacity of the hospital, including out-patient space and A&E, was restricted to what was absolutely essential at the time, with no account taken of future increases in demand.
The lack of ‘soft space’ has hampered the hospital’s ability to meet demand in a way that would allow staff to work efficiently, because of space constraints preventing ergonomic design of work areas. This was a major problem on many wards and in busy areas such as the Eye Clinic. It also limits the ability to make best use of the work-force – there have been many times when a consultant had clinicians available, but no consulting rooms or operating theatres for them to work in.
The original design constraints mean that the current buildings are limited in their capacity to absorb patients displaced by the demolition of Huddersfield Royal Infirmary: the announcement in the Full Business Case that there would be minimal changes to the buildings at Calderdale Royal Hospital means that there would be no alternative apart from much greater care in the community.
This why the absence of meaningful capacity planning in the community is so scandalous.
3. The Calderdale and Greater Huddersfield NHS finances seem to be worse now than the Full Business Case anticipated, if Calderdale CCG’s Governing Body meeting in October is anything to go by.
As a result Greater Huddersfield and Calderdale CCGs and CHFT are considering a new form of cost cutting contract.
Although Calderdale CCG’s Governing Body voted that the RCRTRP Full Business Case is in line with the model they consulted on, is affordable to Commissioners, and improves and achieves the financial sustainability of the Calderdale and Greater Huddersfield system of care, the discussion indicated that this may not in fact be the case.
The Chief Officer, Matt Walsh, pointed out:
“The Calderdale CCG QIPP gap gets more challenging whether or not the FBC is supported. But it becomes harder to deliver without reconfiguration. Savings for the CCGs would be halved without this.”
All three NHS organisations are in special measures, as they are not in a position to meet harsh financial controls imposed as a key part of the West Yorkshire and Harrogate Sustainability and Transformation Plan.
The two CCGs and the hospitals Trust are working together on a Health System Recovery Plan, to deal with their “unmitigated” financial risk.
The Chief Finance Officer, Neal Smurthwaite, said that both Calderdale and Greater Huddersfield Clinical Commissioning Groups are discussing new contracting arrangements with the hospitals Trust, in order to make savings.
The Calderdale and Greater Huddersfield CCGs and CHFT Recovery Plan report in the Governing Body meeting papers, says both CCGs and the hospitals Trust are looking at the Aligned Incentives Contract that is in use in Bolton.
In Portsmouth, where an Aligned Incentives Contract has been introduced in preparation for becoming an Accountable Care System, instead of being paid for every treatment for every patient, the hospital gets one payment for the year. That has to cover everything that comes through the door. Raising the question of what happens if more comes through the door than the one-off contract can cover.
Was this part of the Full Business Case financial projections? And if not, what changes now need to be made to them?
The Calderdale CCG Governing Body meeting in October also heard that problems thrown up by the public consultation about lack of resources for Care Closer to Home have been resolved by “revising” assumptions about “the pace and scale of delivery of community capacity from the CCGs’ Care Closer to Home programme.”
What does this even mean and what are the revised assumptions? Jen Mulcahy said that they have reduced the need for Care Closer to Home primary care. How? What have they reduced it to? What are they replacing it with? None of the Governing Body asked. Surely this needs scrutiny.
4. West Yorkshire and Harrogate STP intends to set up a shadow Accountable Care System from April 2018
How would this affect the Right Care Right Time Right Place proposals?
Ck999 hopes you will meet soon to thoroughly scrutinise these new developments.
Andrea English, Rosemary Hedges, Colin Hutchinson, Christine Hyde, Chrissie Ann Parker and Jenny Shepherd