On 6 July, Calderdale and Kirklees Joint Health Scrutiny Committee met for the first time in almost a year.
Last July they referred the hospital cuts plans to the Sec of State for Health and the Independent Reconfiguration Panel, as unfit for the Calderdale and Kirklees public and inconsistent with the proposals that the Clinical Commissioning Groups had publicly consulted on in 2016.
Both the Secretary of State for Health and the Independent Reconfiguration Panel identified key concerns with out-of-hospital care, hospital bed numbers and capital finance. They require the local and national NHS organisations to do further work on these 3 areas by 10th August, to see if the proposals are feasible before a final decision can be made.
The local and national NHS organisations have to keep the Joint Health Scrutiny Committee fully informed of progress with this work.
Calderdale Cllr Hutchinson pointed out that
“The IRP report endorses concerns raised by the JHSC and says out of hospital care must be greatly improved before hospital beds can be reduced. We would need extremely robust evidence that out of hospital care is delivering reductions in emergency admissions – but the National Audit Office report on Vanguards shows that this is not the case. Evidence of reduction in need for hospital beds has to be available.”
Kirklees Cllr Stewart-Turner added that the 3 areas review is only the starting point – not the end point of work needed on the hospital cuts plans.
There will be a private workshop for the Scrutiny Committee and NHS Organisations in late July to discuss the proposals, before NHS England and NHS Improvement send them to the Secretary of State.
The Joint Health Scrutiny Committee will also send in a report.
If the Scrutiny Committee can’t meet between the workshop and 10 August, the suggestion was that it delegates the response to the Secretary of State to the Co-Chairs.
This would leave the public in the dark about the NHS organisations’ and the Joint Health Scrutiny Committee’s submissions to the Secretary of State.
Public deputation statements
Cristina George of Hands off HRI and Jenny Shepherd of Calderdale and Kirklees 999 Call for the NHS both made deputation statements, calling for full public transparency and scrutiny and repeating the campaigns’ opposition to the hospital cuts.
Jenny Shepherd also pointed out the need to scrutinise any new proposals in the light of continued NHS under-funding, and significant cuts and redisorganisation from West Yorkshire and Harrogate Sustainability and Transformation Partnership (now Integrated Care System).
Cllr Smaje, Co-Chair, said that Calderdale and Kirklees Joint Health Scrutiny Committee needs to understand what’s happening in the West Yorkshire area in relation to these proposals and they will look at that.
Neither NHS England nor NHS Improvement bothered to turn up
Cllr Smaje said that NHS England and NHS Improvement had been invited, as the Joint Health Scrutiny Committee needs to hear from them as well as the Clinical Commissioning Groups and hospitals Trust.
Cllr Wilkinson added that they’d invited substitutes from NHS England and NHS Improvement, after hearing that they couldn’t attend, but none had accepted.
The Committee agreed to tell the Secretary of State for Health if NHS England and NHS Improvement don’t attend future meetings.
Extremely vague update by Clinical Commissioning Groups and hospitals Trust
The Clinical Commissioning Groups and the hospital trust’s Transformation Director Anna Basford were vague about their work on proposals for out-of-hospital care, hospital bed numbers and capital finance.
Councillors’ questions revealed:
The NHS organisations can’t make any cuts and changes while they’re still in this process.
The status of the hospital Trust’s Full Business Case (that was published after the JHSC referred the hospital cuts plans to the Secretary of State) has not changed. It was approved at the August 2017 Board.
If the Scrutiny Committee has problems with the Full Business Case, the Hospitals Trust will receive and consider them.
In response to the Secretary of State’s requirements, the NHS organisations are exploring aspects of double running hospital and out-of-hospital care – instead of simultaneously cutting hospital beds and introducing out-of-hospital care.
This means phasing capital financing. They are exploring the scale and source of finance.
They don’t yet know what the phases and timescales are.
Calderdale Clinical Commissioning Group Finance Officer said that they can’t tell how this phasing might affect the current financial position. Greater Huddersfield Clinical Commissioning Group said they only have “a high level figure” and have not yet identified the financial impacts of double running hospital and out of hospital care.
The NHS organisations want to explore the risks and benefits from the phased approach and see what is feasible to implement.
Their submission to the Secretary of State/Independent Reconfiguration Panel will answer questions about out-of-hospital care, hospital bed numbers and capital finance as best they can, and identify the next steps towards answering them.
Cllr Smaje questioned whether the same plan, but phased, would address the concerns raised by the Independent Reconfiguration Panel report and the Secretary of State
She asked what discussions the local NHS organisations have had about this with NHS England and NHS Improvement. Anna Basford said they were “seeking to satisfy those concerns” in their response.
Anna Basford has talked about hospital capacity (bed numbers) and financing to NHS England and NHS Improvement, the Clinical Commissioning Groups and senior clinical leaders. She will talk about this at the private workshop for NHS organisations and the Joint Health Scrutiny Committee in late July.
Asked by Paul Cooney if campaigners and the public would be able to attend the workshop, Cllr Smaje said no.
The Clinical Commissioning Groups are looking at the development of out-of-hospital services and will talk about this at the workshop. Carol McKenna, Chief Officer of Greater Huddersfield and N Kirklees CLinical Commissioning Groups, said they need to show how they have moved in the last 2 years since the consultation, with evidence of what new services they’ve commissioned and their impact, as well as plans for future.
Both Clinical Commissioning Groups said they are in regular contact with Kirklees and Calderdale Local Medical Committees about the proposals for out-of-hospital services.
NHS organisations haven’t considered openness, transparency and involving the public
Co-chair Cllr Wilkinson asked how the Clinical Commissioning Groups are going to meet the legal requirement to consult the public and involve them in future plans.
Carol McKenna said that depends on whether the phased approach involves significant service change. If it does, they would bring it to the Joint Health Scrutiny Committee.
Cllr Smaje asked,
“Are you expecting that any of the changes you’re proposing will follow the NHS’s needs to consult? Or will it depend on scrutiny to decide if it’s a significant change or not?”
Anna Basford said they haven’t considered those questions and until they’ve had dialogue with the Secretary of State, they won’t know the status of the proposals.
Cllr Blagborough asked how the NHS organisations were going to inform the public about where they are in the process and what the timescales are.
Carol McKenna said this was tricky and they could discuss it in the late July workshop, especially out-of-hospital care. She said they would use the Community networks they have, for one to one conversation and small group conversations.
Many of the community groups in the CCGs’ ‘community networks’ receive funding from the Clinical Commissioning Groups. They are hardly representative of the public and are unable to question or criticise Clinical Commissioning Groups’ proposals, for fear of losing their funding.
Clinical safety and robustness of proposals
Anna Basford said that they are looking to clinical advice from NHS England about safety concerns and the robustness of proposals. And later they will involve Clinical Senate.
They completely disregarded the Clinical Senate’s comments on the proposals before the 2016 consultation – so why they want to ask them again is anyone’s guess.
Penny Woodhead, the chief quality officer for both Clinical Commissioning Groups, said there was nothing to bring forward today, but that if any clinical quality patient safety concerns arise they will review them as quickly as possible.
How can we believe this? The Clinical Commissioning Groups have steadfastly ignored clinical quality patient concerns that the Clinical Senate raised two and a half years ago.