Hunt backs Independent Reconfiguration Panel’s call for three month’s further work on hospital cuts proposals

Ck999 are pleased that Jeremy Hunt has told the Chairs of Calderdale & Kirklees Joint Health Scrutiny Committee that he has accepted the Independent Reconfiguration Panel’s advice, that the Right Care Right Time Right Place proposal for future arrangements for hospital and community services in Calderdale and Greater Huddersfield is not in the best interests of the people of Calderdale and Greater Huddersfield.

And that

“a wide variety of failings…call into question the benefits of this scheme and the way in which the process has been managed so far.”

BUT we do not agree with the Independent Reconfiguration Panel’s statement that despite all these failings,

“…it is only reasonable to continue to pursue the proposals in more detail in the interests of local health services.”

The Independent Reconfiguration Panel takes it as read that keeping two District General Hospitals, each with full 24/7blue light A&E, is not an option and accepts as inevitable that there should be one emergency care hospital and one planned care hospital.

We do not agree. Two towns, two 24/7 full bluelight A&Es is what we’ve campaigned for from the start. We see no reason to abandon that goal now.

Hunt’s letter singles out failings identified by the Independent Reconfiguration Panel as:

• a lack of consistency with the original proposals
• scepticism about whether proposals of this scale and complexity are actually deliverable
• concern about the delivery of out of hospital care
• whether the reduction in hospital beds as a result of changing hospital services could be justified
• lack of clarity about the availability of capital financing of this scale for a project of this type.

Hunt has asked NHS England and NHS Improvement to work with the relevant Clinical Commissioning Groups and the Joint Health Scrutiny Committee on further action that needs to be taken before a final decision is made about the future arrangements for hospital and community health services in Calderdale and Greater Huddersfield, and to report back to him in three months on progress with implementing the Independent Reconfiguration Panel’s recommendations.

You can read Hunt’s letter here.

The Independent Reconfiguration Panel report has not acted on our request
to carry out a full review of the Right Care Right Time Right Place proposals, and also to investigate the wider context and drivers for these plans – namely:

• the governmentʼs “austerity” policy and its effects on the NHS and social care; and
• the Sustainability and Transformation Partnership that the Right Care Right Time Right Place plans are a key part of

-despite the fact that both of these issues surface in the Full Business Case for the Right Care Right Time Right Place reconfiguration, particularly in The Economic Case for Change and in The Strategic Context, respectively.

Summary of Independent Reconfiguration Panel report

They accept that no change is not an option, and support the proposal to replace the two District General Hospitals with  one emergency care hospital and one planned care hospital – although they don’t think the current proposal is in the best interest of the people of Calderdale and Huddersfield.

They say, given the absence of an alternative model for acute hospital services,

“…it is only reasonable to continue to pursue the proposals in more detail in the interests of local health services.”

They have not carried out a full review, as ck999 and others asked, because they say to do so would not be a review at all – but it would

“inevitably need to cover new ground that is the responsibility of CCGs, CHFT, NHSE and NHSI. At the moment it is not possible to know whether the disputed proposals are feasible. Further work focussing on out of hospital care, hospital capacity and availability of capital is required from the NHS before a conclusion is reached. The JHSC should be kept fully informed and involved throughout this work.”

They’ve basically told the local NHS organisations and CKJHSC to tackle these issues now:

• CHFT contingency plans for service changes to protect their safety & quality should be shared with Calderdale and Kirklees Joint Health Scrutiny Committee, since it has become increasingly difficult to recruit and retain medical staff across 2 sites
• The local NHS (Clinical Commissioning Groups, CHFT,  NHS England and NHS Improvement) and Calderdale and Kirklees Joint Health Scrutiny Committee should take stock of the current position to ensure a shared understanding as the basis to move forward.

Plus the Independent Reconfiguration Panel says the local NHS organisations and Calderdale and Kirklees Joint Health Scrutiny Committee should:

• Focus on the programme for changes in out-of-hospital services and the likelihood of achieving the targeted reduction in demand for hospital care. Hospital capacity planning should be subject to sensitivity testing.
• Make sure the fifth test for service change is met over the whole prolonged period of implementation – ie that out of hospital care services are in place before hospital bed numbers are cut.
• NHSI must come clean about the availability, cost and timing of capital funding

Other key points in the Independent Reconfiguration Panel report include:

• NHS organisations should from now on provide timely information to the CK JHSC and avoid repeats of things like their withholding of the Full Business Case until a private meeting with the JHSC immediately before the scheduled JHSC meeting.
• If the proposals change further, the NHS organisations recognise the need for continued public engagement and even a new consultation.

You can read the Independent Reconfiguration Panel report here.

What we want to happen next

We hope the Calderdale and Kirklees Joint Health Scrutiny Committee quickly reconvenes IN PUBLIC to act on the Independent Reconfiguration Panel’s recommendations. And we hope they also act on our request from last December,
that they scrutinise these issues that all have a bearing on the Right Care Right Time Right Place proposals:

• Kirklees STP plans for integrated out-of-hospital services and adult social care
• Shrinking the size of clinical rooms at Calderdale Royal Hospital
• Worsening finances and proposals for a new cost cutting aligned incentives contract between both Clinical Commissioning Groups and CHFT
• Establishment of a shadow West Yorks & Harrogate STP Accountable/Integrated Care System which is likely to happen in June

We agree with the Independent Reconfiguration Panel that the reconsideration of the Right Care Right Time Right Place proposals by Calderdale and Kirklees Joint Health Scrutiny Committee, NHS England, NHS Improvement and the Clinical Commissioning Groups must involve scrutiny of the programme for changes in out-of-hospital services and the provision of out of hospital care services,  before hospital bed numbers are cut.

Unlike the Independent Reconfiguration Panel, we think that this must mean scrutiny of the whole “new care model” of centralising and cutting hospital services, taking them out of hospital and putting them into so-called Locality Integrated Care Systems like the North Halifax Primary Care Home Integrated Care System proposed for the new (as yet unbuilt) Mixenden Hub, and setting up Calderdale and Kirklees Integrated Care Systems based on the USA’s Medicare/Medicaid business model.

This whole Accountable Care model (recently rebranded by NHS England as Integrated Care in order to avoid the connotation of the USA’s health care system) is un-evidenced and also subject to Judicial Review.

Where this care model is already being carried out, it is further destabilising already struggling hospitals (for example, the Retreat mental health hospital in York has announced it may have to close its inpatient services) and it is leading to restrictions and denials of care for patients and risking patient safety – as two recent whistleblowing reports from Bradford show. (Here and here.)

Unlike the Independent Reconfiguration Panel, ck999 do not support the proposal to replace two District General Hospitals with one emergency care hospital and one planned care hospital. We think this is ultimately driven by the government’s austerity agenda – which in turn is the pretext for the Sustainability and Transformation Plans.

Since the Independent Reconfiguration Panel has not reviewed either of these issues, as we requested, Calderdale and Kirklees Joint Health Scrutiny Committee need to include them both in its scrutiny as they take stock of current position  – which is what the Independent Reconfiguration Panel wants them to do, to ensure a shared understanding as the basis to move forward.

Of course it is always possible that no shared understanding will emerge.

We would like to make these additional points

Why has Hunt sat on the Independent Reconfiguration Panel report for two months? The Independent Reconfiguration Panel sent it to him on 9th March. We all along expected him to withhold it until after the May elections – but are not impressed that he did.

He has also dragged out the process at every stage. CK Joint Health Scrutiny Committee decided nearly a year ago, in late July 2017, to refer the proposals to Hunt. They sent him notification of this on 1st September 2017 but he did not commission the Independent Reconfiguration Panel to review the proposals until 26th January 2018 – almost 5 months after he had received the Councillors’ referral.

This delay has allowed Calderdale and Greater Huddersfield Clinical Commissioning Groups, Calderdale and Kirklees Councils and the West Yorkshire and Harrogate Sustainability and Transformation Partnership to steam ahead with enacting these plans -particularly the creation of Integrated Care Systems to carry out the contentious out of hospital services plans, prior to further scrutiny and next stage reviews in the light of the Independent Reconfiguration Panel’s recommendations.

CK999 now have to get our arses in gear to let Calderdale and Kirklees Joint Health Scrutiny Committee know what lines of questioning and scrutiny we think will best protect the interests of our NHS and social care services, and the interests of the people of Calderdale and Greater Huddersfield.

Ideas on a postcard, please.