Campaigners’ meeting with hospitals Trust bosses confirms dire situation of acute services

After meeting with Owen Williams and other bosses at the Calderdale and Huddersfield hospitals trust on 6th February, campaigners from CK999, N Kirklees Support the NHS and Hands off HRI say there is no socially just alternative to 2 Towns 2 A&Es.

The meeting was held to clear up some questions that Calderdale and Kirklees Joint Health Scrutiny Committee had been unable to answer about the state of play with the revised plan for cuts and changes to our hospitals and care in the community.

The hospitals Trust sent an update on the revised plan to the Secretary of State on 29th January. It raises many questions, that we asked in the meeting.

Head of Estates Chris Davies gave us a grand tour of the main bits of Huddersfield Royal Infirmary that need fixing – although the £20m loan the Department of Health has allocated for that purpose is apparently nowhere near enough.

NHS campaigners and hospitals trust Chief Exec, Chair and Director of Transformation

After the meeting, Nicola Jackson from Hands Off HRI said,

“I don’t feel any more confident or safe than I did before the meeting. It’s just been confirmed for me what the dire situation is with acute services. Austerity is driving a really dangerous machine.”

Christine Hyde from N Kirklees Support the NHS added,

“The new plans and arrangements the hospitals trust executives revealed in the meeting seem set to make existing health inequalities worse. All the NHS authorities locally and regionally are claiming that their aim is to reduce health inequalities. But if these revised plans for our hospitals, GP, community health and social care services are anything to go by, this is nothing but hot air.”

We don’t think this update from the Trust delivers the goods, in terms of a service that meets the health needs of the Calderdale and Kirklees public

We don’t think Scrutiny should let the hospitals Trust’s current update go to the Sec of State without sending some serious warnings about its shortcomings, and spelling out that they must be remedied in the Strategic Outline Case that the hospitals Trust is due to send to NHS Improvement in April this year.

The Strategic Outline Case is the first step in enabling the hospitals Trust to access the £196m capital loan that the Department of Health has allocated for the revised hospitals plan.

Calderdale and Kirklees Joint Health Scrutiny Committee meets on Friday 15th February, 20pm at Halifax Town Hall. Everyone is welcome and if you want to make a deputation statement you need to let the Scrutiny Officer know beforehand.

Our questions focussed on these issues

  • What’s going on with the revised Strategic Outline Case?
  • Revised proposals for hospitals cuts and changes
  • Continued lack of evidence to support Care Closer to Home “aspirations”
  • Money

You can read the notes of the questions and answers here.

Key shortcomings in the update that must be remedied in the Strategic Outline Case

Digitisation is not a panacea

Owen Williams apparently thinks the combination of Cerner’s Electronic Patient Record and remote/wearable digital technology is going to solve just about everything – from shortages of consultants, to shortages of GPs, to making sure patients at home do their physical exercises right.

But the Electronic Patient Record doesn’t even seem to be able to get outpatients’ appointments right, so that looks a bit over optimistic. And there are huge problems of invasion of privacy – both through patients’ wearable technology to allow remote monitoring of their bodily functions and activity; and from the sale of patient data that is a key aspect of the digitisation of the NHS.

Care Closer to Home still seems as aspirational and un-evidenced as it was in the original plans rejected by the Independent Reconfiguration Panel

Worryingly, the update to the Secretary of State spells out that Care Closer to Home is already being implemented by an Integrated Care System in Calderdale and Kirklees. These huge changes have never been publicly consulted on.

At least CHFT has decided not to cut any CRH beds if Care Closer to Home doesn’t reduce A&E admissions – but that doesn’t justify significant change to primary, community health and social care services without any reliable evidence these changes will deliver either improved quality of care or cut costs. Recent reports from the National Audit Office and the Nuffield Trust say there is no such evidence.

The future of HRI seems really unclear

The update sent to the Secretary of State says Huddersfield Royal Infirmary will continue to be used for hospital services for the foreseeable future.

At the meeting, we were told that Huddersfield Royal Infirmary beds will be used for acute patients transferred from CRH who aren’t ready to go home.  How many people at any one time is that likely to amount to?

And Owen Williams told us frail elderly care will be consolidated at Huddersfield Royal Infirmary .

Are those types of patients going to fill all the Huddersfield Royal Infirmary beds? Or is the ultimate intended destiny of Huddersfield Royal Infirmary to become a huge care home?

In 2014, when the preferred option was for Huddersfield Royal Infirmary to become the acute/emergency hospital and Calderdale Royal Hospital to become a small planned care clinic, the Outline Business Case proposed a possible future for the “redundant” space in the rest of Calderdale Royal Hospital as a care home and hospice. It said:

“There is potential to link up with other Care Home or Hospice providers” (p141)

Is this now the plan for Huddersfield Royal Infirmary?

Is the revised proposal for Huddersfield Royal Infirmary any more than a stop gap until Calderdale Royal Hospital as the acute/emergency hospital is up and running? By which time it seems likely that key elements of Huddersfield Royal Infirmary such as the pipeworks system will be close to collapse – if Chris Davies’ tour is anything to go by.

£22m of the £196m Department of Health loan is potentially available for HRI essential maintenance before 2022/23 – but that is nowhere near enough to pay for the 3 key maintenance priorities – securing the hospital cladding, meeting current fire safety standards and updating ancient pipework that is coated with asbestos. And the hospitals Trust doesn’t yet know what the process is for getting approval for spending the money.

The update to the Secretary of State says nothing about travel difficulties caused by greater distances to centralised hospitals

Patients will have to travel further to receive both acute and emergency and planned hospital treatment. This has a disproportionate impact on people on low incomes, to the extent that people are refusing to call A&E in case they are taken to a hospital outside their town because of the difficulties this would cause their families. This is going to make health inequalities worse.

And the update to the Secretary of State says nothing about the fact that centralising the A&E means people will die because of longer distances to travel. This is set against the greater number of people’s lives that are anticipated to be saved from the centralisation of A&E. He needs to be told.

Will regulation of the revised plan be affected when some NHS Improvement and NHS England functions transfer to the West Yorks & Harrogate Integrated Care System?

Owen Williams said that working with NHS Improvement and NHS England involves a lot of “flexing”, so the status of any given planning document isn’t always clear. What happens to oversight of the revised plan when some of NHS Improvement’s and NHS England’s regulatory functions are transferred to West Yorkshire and Harrogate Integrated Care System? Which functions are to be transferred? Is this going to complicate things more?

To us, the meeting showed that hospitals Trust bosses lack understanding of ordinary people’s lives and needs – both patients, their families and front line staff

They are insulated by their salaries and power. Somehow they need to find ways to broaden their experience and understanding. We are confident that they would not be making the decisions and plans they’re now making, if they had a real practical understanding of how they will further disadvantage people who are not in their position.

Thanks to hospitals trust staff for making the time to answer our questions

We’d like to thank Chris Davies, Chief Exec Owen Williams, Chair Philip Lewer, Director of Transformation Anna Basford and Nicola Bailey for answering our questions. We found out quite a lot. But the answers were not reassuring.

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