People Scrutiny Committee must find out if #Mixenden Hub will benefit the community and how money stacks up

CK999 thinks that the People Scrutiny Board urgently needs to call in the Cabinet’s resolution to set up a Calderdale Accountable/Integrated Care System, and to investigate the role of the proposed Mixenden Hub in setting up a North Halifax Locality Integrated Care System using the Primary Care Home model.

This is currently the subject of discussions between Calderdale Council, North Halifax voluntary organisations and the Caritas Mixenden GP practice.

It seems that this North Halifax Primary Care Home Integrated Care System would serve the 44K patients of the Beechwood Medical Centre, Keighley Road Surgery, Lister Lane Surgery and Plane Trees Group Practice, as well as Caritas Mixenden Practice.

It is doubtful that these terms mean anything to most people and the People Scrutiny Board needs to find out what they would mean in practice and whether they are in the interests of North Halifax people.

Particularly since the Integrated Care System would be funded by a fixed per person budget. Such budgets are key to the operation of Accountable Care Organisations that provide Medicare and Medicaid state-funded healthcare in the USA. Evidence shows that they encourage cherry picking of patients who will be cheapest to treat and whose prognosis offers the best return on investment.

GP surgery to be anchor tenant for Mixenden development after NHS England grants £550K match funding

After Calderdale Council’s nine year search for funding to redevelop a run-down site in the centre of Mixenden, thanks to an NHS England £550K matching grant to Caritas Mixenden GP surgery, Calderdale Council has now put together the land and money needed to construct a £2.3m Council-owned building that will house:

  • An enlarged GP surgery for the Caritas Mixenden GPs, to provide the base for a new form of large scale GP and community care practice that will serve between 30K-50K registered patients in North Halifax and accommodate services taken out of Calderdale Royal Hospital. This “Locality Integrated Care System” will use new “models of care” and less qualified staff, as laid down by the government quango NHS England, to help carry Calderdale’s cost-cutting Sustainability and Transformation Plan.
  • A pharmacy
  • A radically cut public library scheme
  • Shops

The struggling regeneration scheme was rescued in 2016 by a match funding grant of £550K from the government’s quango NHS England, to Mixenden Caritas GP surgery.

Mixenden people need decent buildings and facilities – but on the face of it, the redevelopment scheme seems a hotchpotch, with little clarity about how the new Hub’s large-scale GP and out of hospital services would work – or how effective it would be as the anchor tenant for the proposed new hub.

In the public consultation on Mixenden Redevelopment carried out by Ovenden Initiative, apparently none of the 32 respondents mentioned the redevelopment of the GP surgery and there certainly seems to have been no mention or explanation of its use as a Primary Care Home Integrated Care System.

So Calderdale And Kirklees 999 Call for the NHS asked Calderdale Council:

  • How it will benefit the community
  • How the elements are intended to function as a unit
  • How the money stacks up.

The Secretary of State for Health has just told Calderdale and Kirklees Councillors on the Joint Health Scrutiny Committee that the Independent Reconfiguration Panel is concerned about the delivery of out of hospital care and whether the reduction in hospital beds as a result of changing hospital services could be justified.

These plans are now to be reviewed by the local NHS organisations and the Joint Health Scrutiny.

Since these are both key to the proposed North Halifax Primary Care Home Integrated Care System, we will be asking Calderdale People Scrutiny Committee to investigate how it proposes to address these criticisms.

How will it benefit the community?

Calderdale Council’s answer to this question was unclear. So here we try and clarify what is at stake.

NHS England’s match funding aims to make it possible to provide out-of-hospital services at new types of large scale GP practices.

Previously known as Care Closer to Home, this type of NHS and social care provision is largely un-evidenced and was seriously criticised by the Clinical Senate when it was included in the Calderdale and Greater Huddersfield “Right Care Right Time Right Place” Pre-Consultation Business Case.

The Independent Reconfiguration Panel has largely agreed with that assessment, after Calderdale and Kirklees Joint Health Scrutiny Committee referred the plans to the Secretary of State for Health and Social Care as unfit for the local populations.

In addition to transferring many specialist hospital services into large scale GP- based Integrated Care Systems, the Right Care Right Time Right Place plans are to:

  • knock down Huddersfield Royal Infirmary,
  • replace it with a 64 bed planned care clinic that would serve both Greater Huddersfield and Calderdale patients, plus outpatients and an urgent care centre;
    expand Calderdale Royal Hospital to take all acute and emergency patients from both areas – although not to normal clinical standards, as derogations would be sought to reduce clincal and ward space requirements
  • significantly cut the number of hospital beds and staff

The aim is to cut £100m NHS and social care spending in Calderdale by 2020/1 compared to what it would have been if spending (and funding) had continued on the same level as in 2015.

Large scale GP hubs are intended to be a key means of delivering these cuts.

How the money stacks up

The People Scrutiny Board needs to scrutinise how the money stacks up.

In October 2015, NHS England invited bids to its Primary Care Transformation Fund. The Economy and Investment Panel saw this as:

“a rare opportunity to secure much needed capital investment”.

In 2016/17 the Caritas Mixenden GP practice successfully applied to NHS England for £550K match funding for the Calderdale Council Economy and Investment Fund’s £550K.

The Minutes of the October 2017 meeting of the Economy and Investment Panel show that the Council sees the GP centre as the anchor tenant in the development. The development would be impossible to finance without:

  • NHS England’s £550k match funding for the development.
  • Payment of the Caritas GP practice rent to Calderdale Council (which Calderdale Clinical Commissioning Group will part-pay by supporting the additional costs which would be incurred as a consequence of the increased size and rental value of the proposed doctors surgery).

I have asked Calderdale Clinical Commissioning Group how much rent they will be paying to the Council on behalf of Caritas Group Practice.

Details of the finances and business plan for the Mixenden Centre Hub are not public. The October 2017 meeting of the Economy and Investment Panel excluded the public from its discussion on the grounds that it involved the likely disclosure of exempt information as defined in paragraphs of Part 1 of Schedule 12A of the Local Government Act 1972 Act.

The Minutes of that meeting show that Councillors asked to see the Business Case for the New District Centre and Officers advised that it could be circulated to them.

The Business Case should also be available to People Scrutiny Board and the public – with redactions if necessary to protect the Caritas GP surgery’s financial and business interests.

The Minutes of the October 2017 meeting of the Economy and Investment Panel include the estimated Total Scheme cost of £2,293,655 – as follows : –

GP surgery £1,158,200
Pharmacy £221,000
Library £217,000
Retail units £178,000
Site/Externals £200,000
Other £319,455
Total cost £2,293,655 inclusive of 15% contingency

Indicative breakdown of the overall scheme funding:

Total Scheme Cost £2,293,655
NHS match funding £550,000
Proposed Economy & Investment Panel funding £550,000
Remaining Performance Reward Grant £330,000
To be funded through prudential borrowing and repaid through rent stream £863,655

Calderdale Council intends to retain the property. The rent from the doctors’ surgery, pharmacy and retail units – estimated to be around £72,000/year – would enable the Council to repay an amount of prudential borrowing.

An earlier Report to the 19th March 2016 meeting of the Economy and Investment Panel said:

“…the prudential borrowing is predicated on rents received over 25 years. Lease terms are not currently known and there is always a danger that rent yields from units may fall below expectations. Rents would need to be secured in full for at least 17 years to cover prudential borrowing costs.”

Where will Calderdale Council borrow the £863,655 from and what interest will be payable, over what time period?

In view of the secrecy about finances, the apparent precarity of the development, the unevidenced nature of Care Closer to Home/Integrated Care Systems, and the unfitness of the plans to cut hospital beds and transfer specialist hospital services into large-scale GP hubs, what is the risk that the Mixenden Hub will be another white elephant like the Tod Health Centre?

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