Revised hospitals cuts plans STILL driven by NHS underfunding – and now Accountable/Integrated Care is the ‘solution’

Responding to the Secretary of State’s requirement for proposals to fix the seriously flawed hospital cuts plans, the local NHS organisations have basically come up with the same old same old – with a few concessions to the demand  that they:

  • 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.
  • NHS Improvement must come clean about the availability, cost and timing of capital funding

As far as we know, four responses have been sent to the new Sec of State, Matthew Hancock MP, from:

  • The local NHS organisations – Calderdale and Greater Huddersfield Clinical Commissioning Groups, the hospitals Trust and West Yorks and Harrogate Integrated Care System (formerly Sustainability and Transformation Partnership)
  • The regional bits of the 2 NHS quangos – NHS England  and NHS Improvement   – basically endorsing the local NHS organisations’ waffle, and saying that an “enclosed paper gives details of the enhanced plan”. Except the enclosed paper is nowhere to be seen.
  • Calderdale Council  – saying the local NHS organisations’ proposals are the bees knees
  • Kirklees Council Health Proposals advocating a new District General Hospital with full blue light A&E somewhere between Huddersfield and Dewsbury.

The public silence from Calderdale and Kirklees Joint Health Scrutiny Committee is deafening

The Councillors’ group with the duty and power to make sure that any significant NHS or social care change is fit for the local NHS and the public, must surely have told the Sec of State what they think of the local NHS organisations’ revised proposals.

But we can’t see this anywhere in the public domain.

Significant service changes are NOT meant to be driven by financial considerations

The NHS organisations’ and Councils’ responses are still driven by the government’s ongoing “austerity” rubbish.

They point to the hospitals Trust’s “significant financial deficit” and reliance “on financial support from the Dept of Health to provide the cash to pay creditors and staff.” This financial year, the hospitals trust has to make 4.9% (£20.8m) “efficiency” cuts – a huge amount after years of such cuts.

The Clinical Commissioning Groups say they can’t afford the future cost of commissioning services and it is

“increasingly difficult to maintain access to NHS services and quality of care.”

But the local NHS organisations want NHS Improvement and NHS England to help them make further cuts to operational costs!

This is to make up for the extra costs of meeting the Sec of State’s requirement not to cut hospital beds until/unless effective out of hospital services are in place, reducing the need for hospital inpatient admissions.

The local NHS organisations provide no evidence about the likelihood that this will achieve the targeted reduction in demand for hospital care.  They admit that reducing hospital admissions to this level  “is very challenging”. And they say nowt about sensitivity testing hospital capacity planning.

We are sick of all these cuts and privatisations

Already in 2014 the hospitals Trust was warning that it couldn’t safely make the cuts needed to balance its spending with the inadequate amount of funding it received – a situation worsened by Clinical Commissioning Groups and Calderdale Council contracting with private companies for services that the hospital trust had previously provided.  And by the Better Care Fund’s diversion of NHS funding, to social care.

When we started campaigning to protect the NHS, the local NHS chiefs claimed that the Trust’s financial problems were nothing to do with the hospital cuts plan. We didn’t believe them – and now they are admitting that underfunding of both the hospitals Trust and the Clinical Commissioning Groups is a key driver of the plans.

Waffle about new out-of-hospital integrated care models – formerly called “accountable care”

All the responses assume that new care models – copied from the USA’s Medicare/Medicaid system, that provides limited state-funded health care for people who can’t afford private health insurance – will provide adequate out-of-hospital services to replace the cut hospital services. There is no evidence to support this claim.

Out-of-hospital services are to be delivered by large scale GP networks, known as Primary Care Homes, running as integrated care systems (formerly called accountable care systems), each serving 30k-50K patients.

These integrated care services are driven by the government’s rubbish “austerity” agenda.

The local NHS organisations’ response boasts of

“over 5,000 MSK patients in Greater Huddersfield treated by a GP led community service rather than being sent to hospital”.

But this service – far from being GP-led – requires GPs to refer their patients to a private company, Pain Management Solutions.

Calderdale Health and Wellbeing Board recently discussed cuts to hospital outpatients clinics – but there is NO adequate Calderdale workforce plan for staffing out of hospital replacements. Questioned about this, the Calderdale Clinical Commissioning Group Chief Officer, Matt Walsh, replied that in 15 years time most healthcare will be delivered by technology in patients’ homes.

The local NHS organisations make great claims for keeping patients out of hospital through the combination of the Electronic Patient Record with the enhanced summary record (potentially vast amounts of information extracted from your GP record and uploaded) – but provide no evidence that this is going to work.

Meanwhile patients and their families in Calderdale report under-the-radar cuts to community health services. For example, the daughter of a woman who had a hip replacement recently reported:

“There is now no district nurse, no wound check, remove your own steri strips and no follow up for blood pressure medication stopped other than see your GP. (How, after a hip replacement?) Had it not been for a relative happening to be a district nurse and coming and re-dressing the wound I’m not sure how she’d have managed. Mum also bought herself a BP machine! What are older people or those who are a bit confused supposed to do/manage?”

Stay of execution for Huddersfield Royal Infirmary

For the time being Huddersfield Royal Infirmary would go on providing inpatient care,  until they reckoned they could do without it, once effective out-of-hospital services were in place.  Then they would “review” “hospital capacity”.

For the duration, Huddersfield Royal Infirmary would keep the six recently upgraded main operating theatres, the three day-case theatres and beds for people recovering from acute medical conditions.

So Huddersfield Royal Infirmary would not immediately be turned into a planned care day clinic – although planned care for both Calderdale and Greater Hudds patients would still be centralised there.

This would reduce the amount of capital funding needed by £112m, to £197m, for both Huddersfield Royal Infirmary and Calderdale Royal Hospital sites,

“to enable adaptation of existing buildings and upgrade some vital service infrastructure”.

(But the total capital requirement in the Full Business Case was £302m not £309m, so what’s that £309m about?)

Acute and emergency care would still be centralised in Calderdale Royal Hospital

All acute operations would be done there and all patients in ambulances would be taken there to A&E.

Both hospitals’ urgent care centres would be medically staffed and HRI “A&E” would have a 24/7 consultant anaesthetist, so that any seriously poorly patients who turned up under their own steam could be admitted and cared for until they were fit to transfer to CRH A&E – but it would not accept patients brought in by ambulance, so would basically be a glorified urgent care centre.

Screen Shot 2018-08-10

NHS Improvement has NOT provided information about the availability, cost and timing of capital funding

NHS Improvement merely said:

“there is not a realistic opportunity to access the levels of capital required.”

The local NHS organisations have abandoned the idea of PFI funding in favour of a “priority submission” from West Yorkshire and Harrogate Integrated Care System, to the Sustainability and Transformation Plan capital allocation process.

They say local agreement is vital for the capital funding application to stand a chance of success.

Kirklees Council does NOT agree

As well as wanting a new District General Hospital with full blue light A&E, somewhere between Huddersfield and Dewsbury, funded by prudential borrowing, Kirklees Council also want “retention of services to be delivered locally in Huddersfield and Dewsbury”.

This proposal seems pretty incoherent – Kirklees Council could surely achieve its intended result by keeping HRI as a District General Hospital with full blue light A&E, rather than building a new one somewhere else?

House of Commons Independent Reconfiguration Panel lobbying meeting 10th September

The Independent Reconfiguration Panel has ignored our repeated requests to review the effects of the government’s sustained NHS underfunding and the related development of Sustainability and Transformation Partnerships – now morphed into Integrated Care Systems – although these are clearly the two main drivers of the cuts to our NHS in Calderdale and Kirklees.

Together with other campaign groups across England who are dissatisfied with the Independent Reconfiguration Panel’s responses to referrals of significant NHS changes in their areas, we shall hammer this home at a House of Commons meeting on 10th September, hosted by Dewsbury MP Paula Sherriff.

We will also repeat the need for the Independent Reconfiguration Panel to visit Calderdale and Kirklees and hold open public sessions to find out from local people what is really going on with our NHS and social care services.

If you have anything you’d like us to pass on to the Independent Reconfiguration Panel lobbying meeting, please let us know, in the comment box below or by emailing stpagony@gmail.com

5 comments

  1. Thanks Jenny, that’s a good summary I think. Interested in your comment that the £197m is to be spent on HRI maintenance and CRH increased acute facilities etc. Is what it will actually be spent on mentioned anywhere – I couldn’t see it – or is that your assessment?

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    • Thanks Steve. I’ve replaced the wording you questioned with an exact quote from the local NHS organisations’ response, in Section 7, p8. This says the (reduced) £197m capital funding is needed for both Huddersfield Royal Infirmary and Calderdale Royal Hospital sites, “to enable adaptation of existing buildings and upgrade some vital service infrastructure”.

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  2. Copied your paragraph re the daughter/mum/hip replacement to F/B page NHS and received this back despite me putting the word Quote and Unquote and showing quite clearly it from Calderdale/Kirklees….Hi Jeanne, I’m sorry to hear about your experience. If you wish to take this further then you should contact the Patient Advice Liaison service (PALs) team for the NHS service you were accessing. You can also visit this link for more information on NHS England’s complaints procedure. ^NG https://www.nhs.uk/nhsengland/complaints-and-feedback/pages/nhs-complaints.aspx
    Feedback and complaints – NHS in England – NHS Choices
    Find information about how to make a complaint about the NHS in England. This section also provides basic information about adult social care complaints.
    nhs.uk

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  3. This again is about making profits against patient care.
    The figures don’t add up and it’s totally ridiculous and unjustified to suggest building another hospital when NHS England has forced the downgrading of Dewsbury and still trying to dilute services and downgrade hospital. Surely it would be more cost effective and improve quality patient care to reinstate Dewsbury to a full functioning hospital and leave Huddersfield Royal as it is . Closing wards and reducing beds increases waiting times and delays treatment that’s already proving detrimental to our health.

    Liked by 1 person

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