Calderdale & Kirklees Health Committee must urgently scrutinise revised plan to centralise and cut hospital services – please sign open letter

On 19th December, Calderdale and Kirklees 999 Call for the NHS is going to send this open letter to the Co-Chairs and members of Calderdale and Kirklees Joint Health Scrutiny Committee.

If you would like to sign it, please add your name (and postcode) in the comments box at the bottom of this page, by midnight on 18 December.

Sorry it’s long – but all the essential points are in the first (short) section. The remaining sections give detailed information about the reasons why we are asking these questions.

STARTS

Dear Cllrs Smaje,  Wilkinson and members of Calderdale and Kirklees Joint Health Scrutiny Committee

Please meet asap to scrutinise the hospital Trust’s Strategic Outline Case, clinical and financial sustainability documents and local NHS organisations’ updates to the Secretary of State.

We are writing to ask you to urgently schedule a meeting in public of Calderdale and Kirklees Joint Health Scrutiny Committee in the New Year;  and in the meantime to answer these questions:

  1. What are your plans for further scrutiny of the revised proposals for the Right Care Right Time Right Place hospitals cuts/reconfiguration?
  2. Have you sent these plans to the Secretary of State?
  3. If so, when? And what was his response?
  4. Is the £196m capital funding from the Department of Health a loan? And if so, on what terms?
  5. Why did you cancel the the November Calderdale and Kirklees Joint Health Scrutiny Committee meeting – which meant that you failed to scrutinise the Strategic Outline Case in public before Calderdale and Huddersfield hospitals Trust sent it to NHS Improvement?
  6. Did Calderdale and Kirklees Joint Health Scrutiny Committee see and comment on the hospital Trust’s Strategic Outline Case in private, before the hospital Trust sent it to NHS Improvement?
  7. If so, please send us your comments and the minutes of the private meeting.
  8. Did Calderdale and Kirklees Joint Health Scrutiny Committee also see and comment on the clinical and financial sustainability documents that it was meant to scrutinise at its November meeting?
  9. If so, please send us both the documents and your comments.
  10. Please confirm that Calderdale and Kirklees Joint Health Scrutiny Committee will meet in the New Year, in time to scrutinise the Clinical Commissioning Groups’, CHFT’s and the Local Authorities’ updates to the Secretary of State before they are sent in January 2019.
  11. Is Calderdale and Kirklees Joint Health Scrutiny Committee sending their own update to the Secretary of State in January 2019?  If so, please make this public.

These are the reasons why we are asking these questions:

  • You failed to scrutinise the Strategic Outline Case before the hospitals Trust sent it to NHS Improvement.
  • There is an urgent need to schedule public, democratic scrutiny of the hospitals Trust’s Outline Business Case and Full Business Case – and to identify the funding source/s for the conditional £174m capital allocation announced by the Department of Health and Social Care.
  • There is an urgent need to scrutinise local NHS organisations’ and Local Authorities’ updated responses to the Secretary of State, before they are sent.
  • The revised hospital cuts plan was cobbled together by local NHS organisations and the Local Authorities in a 3 month review that excluded the public. Any further failures to inform and involve the public would be disastrous.
  • Calderdale and Huddersfield Foundation Trust should not make the the same errors as Dewsbury District Hospital.

More information about these reasons follows.

Failure to scrutinise the Strategic Outline Case

Calderdale and Kirklees Joint Health Scrutiny Committee cancelled its November meeting,  which had been agreed at its 7th September meeting.  The cancelled November meeting was to have reviewed the Strategic Outline Case (which was due in October), along with clinical and financial sustainability documents.

Without any public scrutiny, Calderdale and Huddersfield NHS Foundation Trust has sent the Strategic Outline Case (SOC) to NHS Improvement, according to information in the High Level Risk Register for the Calderdale Clinical Commissioning Group Governing Governing Body meeting on 13.12.18. This states:

“CHFT has produced the SOC and has submitted it to NHSI. The SOC includes the provision of funding to develop the OBC and FBC Partnership transformation Board (PTB) established, supported by a System Recovery Group. One of PTB’s responsibilities is delivery of System Financial Sustainability.”

It is completely unacceptable that Calderdale and Huddersfield NHS Foundation Trust has sent the Strategic Outline Case to NHS Improvement without any democratic scrutiny or public information.

Urgent need to schedule public democratic scrutiny of the Outline Business Case and Full Business Case –

The 7th September meeting of Calderdale and Kirklees Joint Health Scrutiny Committee agreed that the Co-Chairs would send the Secretary of State an update on plans for further scrutiny of the revised proposals for the hospital cuts/reconfiguration and provision of out of hospital services.

Your plans for further scrutiny should immediately be made public – particularly since West Yorkshire and Harrogate Integrated Care System (formerly Sustainability and Transformation Partnership) recently announced that it has secured approval of £196million funding from the Department of Health and Social Care:

“to fully fund the changes needed to improve and make sustainable [CHFT] hospital services while also delivering more care in the community and in our patient’s [sic] homes. This will require further work with local people, staff and partners and business case approval. Some £22million is being [sic] available in the current spending review period.”

About £174m of the allocated capital funding for Calderdale and Huddersfield NHS Foundation Trust is conditional on approval of the Full Business Case. The Risk Register for High Level Risks for the Calderdale Clinical Commissioning Group Governing Body meeting on 13.12.18 identifies as a serious risk (level 16)

“… that the Full Business Case does not secure the funding required, due to an inability to deliver financial sustainability, resulting in the implementation of the transformational changes required to address the Financial and Quality and Safety case for change being stopped and the whole system becoming financially unsustainable.”

Urgent need to identify the funding sources for the conditional £174m capital allocation

Not only is most of the capital funding conditional on approval of the Full Business Case – but  a 17.12.18 update to the Department of Health and Social Care Press release  states that, of the £196m capital funding for CHFT, only £22m is STP capital funding to 2022.23. The rest includes

“investment outside of the period to 2022/23, and contributions from other funding sources.”

The public and Councillors urgently need to know what these other funding sources are, whether they are loans or grants – and if loans, what the terms are.

Particularly since the Independent Reconfiguration Panel review demanded that

“the terms of availability, timing and cost of potential capital financing must be clearly signalled by NHS Improvement.”

Urgent need to scrutinise local NHS organisations’ and Local Authorities’ updated responses to the Secretary of State

In January, local NHS organisations and Local Authorities are due to send updated responses to the Secretary of State for Health, about how they are addressing the issues about the Right Care Right Time Right Place hospital cuts plan that the Independent Reconfiguration Panel raised earlier this year.

The Independent Reconfiguration Panel’s first issue was about the need for:

“clarification of the programme for changes in out of hospital services and the likelihood of achieving the targeted reduction in demand for hospital care.”

In response to this, the Calderdale Clinical Commissioning Group High Level Risk Register  for the 13.12.18 Governing Body Meeting states:

“In support of the response to the Secretary of State regarding delivery of Out of Hospital care, the CCGs have procured external support to strengthen their position on the quantification of the delivery of reduced demand over the next five years.”

How much is that costing, who is providing the “external support” and when will the work be done?

The Calderdale CCG High Level Risk Register  for the 13.12.18 Governing Body Meeting also admits:

“The Quality Impact Assessment in relation to the revised proposals has not yet been considered by the CCGs’ Quality Committees.”

This is incredible.

These and other issues need public, democratic scrutiny before the local NHS organisations send their updated responses to the Secretary of State in January.

Revised hospital cuts plan cobbled together in 3 month review that excluded the public

We are particularly worried by Calderdale and Kirklees Joint Health Scrutiny Committee’s failure to meet in November, as had been agreed, since the revised hospital cuts plan was cobbled together  behind closed doors, with no public input or information.

This was done on the basis of an entirely inadequate response by the Secretary of State/Independent Reconfiguration Panel, to the rejection of the original plans by the Calderdale and Kirklees Joint Health Scrutiny Committee.

The Independent Reconfiguration Panel refused to accept that there was an alternative to the centralisation of acute and emergency services in one hospital and planned care services in the other.  They also refused our request for them to visit the area and hold public meetings to hear the views of the public, patients and staff.

We protested about this at a campaigners’ and MPs’ meeting in the House of Commons on 10th September, hosted by Paula Sheriff MP.  This meeting discussed and agreed possible actions to remedy systemic failings of the Scrutiny and referrals process.

The Department of Health’s £196m capital funding for the Right Care Right Time Right Place revised proposals is being spun as an “investment” – but it would result in cuts to hospital services and their replacement by out-of-hospital services that are not clinically or financially evidenced, or publicly supported.

It seems clear to us, in the light of the revised proposals, that the Department of Health is trying to do to Huddersfield what Hunt tried to do to Lewisham Hospital – close it as an acute hospital under cover of false story about keeping a 24-hour ‘small A&E’.

This urgently requires public scrutiny.

We are also concerned that  Calderdale and Huddersfield Foundation Trust should not make the the same error as Dewsbury District Hospital

Dewsbury District Hospital has already suffered a similar fate to that proposed for Huddersfield Royal Infirmary, with very dubious results.

Dewsbury District Hospital received a £20m capital grant to make changes deemed key to Care Closer To Home and to “reconfigure” its blue light 24/7 A&E as an Urgent Care Centre with defibrillator,  3 resuscitation beds for adults and one for a child. But we fear this £20m was wasted.

We have been told that the newly built Midwife- Led Unit has been working sub-optimally with as few as 48 births in the second year, (after 400 in the first year).  The Ambulatory Care Unit – a keystone service for Care Closer to Home –  has been suspended due to fewer patients than anticipated and lack of staffing. The new Frailty Unit has been put in place with GPs being able to refer straight there rather than go through a consultant, but it has a shortage of nurses and so we believe it can not pick up all the slack from the suspension of the Ambulatory Care Unit.

We look forward to your answers to our above questions and comments, and to a meeting of Calderdale and Kirklees Joint Health Scrutiny Committee before the submission of the local NHS Organisations’ updates to the Secretary of State that are due in January.

Signed:

Jenny Shepherd (Chair, Calderdale and Kirklees 999 Call for the NHS)

Andrea English (ck999)

Rosemary Hedges (ck999)

Christine Hyde (N Kirklees Support the NHS)

Chrissie Parker (CK999)

Jenny Pyrah HD4 7WQ

Carol Rowe HX 7 5 RF

Polly McGrail, Greater Huddersfield

Chayley Collis HD9

 

 

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