For the record, here are the questions and answers from the campaigners’ meeting with hospitals trust execs on 6th Feb.
Because most people probably won’t want to plough through them all, I was going to relegate them a downloadable doc from the blog post about the meeting, but wordpress has changed the editing format and now I can’t figure out how to link to a downloadable document.
So this is the only way I can put them in the public domain.
Here are the Q&As.
Revised Strategic Outline Case
Q: Why were there about five different stories circulating among the local NHS organisations and the Calderdale and Kirklees Joint Health Scrutiny Committee about whether or not the hospitals Trust had sent the revised Strategic Outline Case to NHS England late last year ? And which story was true?
Anna Basford said the true version of the story is that CHFT will submit the revised Strategic Outline Case to NHS Improvement in April this year. December 2019 is the deadline for approval by NHS Improvement, the Department of Health and Social Care, Ministers & the Treasury.
Owen Williams said he couldn’t give an explanation about why we’ve had different messages from Calderdale Clinical Commissioning Group and Calderdale and Kirklees Joint Health Scrutiny Committee – but it could be because
“schemes of this size have built in flexibility.”
He added that they are working with the regulators (NHS Improvement and NHS England) about the content of the revised Strategic Outline Case. As part of that work the hospitals Trust have shared a draft document with the regulators that contains information and content that they already have. They are now revisiting that draft to develop it with recently released information about national prices and tariffs.
(In relation to this “draft document”, the notes of the meeting from Nicola Bailey at the hospitals Trust include this, which is more specific:
“Anna Basford advised that in December a draft document had been shared with NHSI that was based on the information that had been included in the Progress Report submitted to the Secretary of State for Health and Social Care in August 2018 (previously published).”)
Owen Williams said that working with NHS England, NHS Improvement and the Department of Health means that it’s not always very clear what the status is of any given document because the contents are not set in stone.
The hospitals Trust is sending these documents to Calderdale and Kirklees Joint Health Scrutiny Committee for the meeting on 15th February:
- The update for the Secretary of State – downloadable here
- A report with more info about engagement with the public
- Renewed Terms of Ref for Scrutiny (but it’s up to the Scrutiny Committee about whether they include this).
Revised hospital cuts and changes proposals
Q: We asked why nurses have been told that they’re not to talk to the public about the proposed changes.
Owen Williams said that he has sent out communications to staff about wanting an open dialogue.
There is a thing called “Ask Owen” on the CHFT computer screens which is a way for people to talk to him.
There are other routes for staff to raise issues of concern.
And failing all else, staff members can talk to the Care Quality Commission.
He said there are no gag orders on staff and he and the other Executives listen to what staff say. He gave as an example surgeons who spoke up at a public meeting in Golcar, and said their points led to changes in the reconfiguration proposals. (But why did the surgeons have to go to a public meeting to get their concerns heard?)
Owen Williams suggested we read the Care Quality Commission report which says the hospitals have an open and inclusive culture.
Anna Basford said that if there are pockets of staff that feel they can’t speak, they want to know.
Owen Williams said they wouldn’t want a situation where somebody couldn’t speak up if they feel what’s happening to patients is wrong. If staff have got reservations it’s important to capture them so the hospitals trust doesn’t introduce inappropriate models of care.
Q: We asked what changes are planned to services provided on the HRI site
Anna Basford referred us to the list in the Trust’s update to the Sec of State:
Owen Williams said there is a significant difference between where the hospital was 4 years ago and where it will be in the future, because of the the electronic patient record and digital technology.
He said that now, for example, a junior doctor on an inpatient ward can look at the same clinical record in real time with the on-call consultant, and have a conversation without the consultant having to come into the hospital. From a patient safety perspective they can always monitor the status of all inpatients.
This is extending further. They are about to pilot work where, for example, after a knee operation doctors will be able to make sure patients are doing their exercises properly, through requiring patients to use wearable technology to be monitored while doing the exercises.
(What crossed my mind was: Is there no limit to the state’s surveillance of citizens? What happens to people’s privacy if our intimate bodily functions are being recorded by the state and its institutions? What happens to this data once it’s been monitored by whoever checks it? Presumably it becomes part of the patient’s (not so) confidential medical record.)
Q: We asked what services CHFT was planning to transfer between the two hospitals in 2018/19 – specifically if chemotherapy was being transferred.
Anna Basford said she wasn’t aware of plans for any service transfers in 2018/19. Owen Williams said there had been three service movements in the last 6 months, that people already know about: Respiratory and Cardiology inpatient services had transferred to CRH and Elderly inpatient services had transferred to HRI.
He added that in 2005/6 a significant reconfiguration consolidated paediatrics in CRH and surgical trauma in HRI. He justified this as avoiding spreading services too thinly across two sites and said it has brought improved quality benefits to patients.
They are consolidating frail elderly care in HRI.
(So is the ultimate intended destiny of HRI to become a huge care home? We didn’t ask that in the meeting, but we will email it to the trust.)
Anna Basford said that the beds maintained in HRI would not be for A&E admissions as there wouldn’t be any. HRI A&E will only stabilise patients who need admission to hospital, before sending them on to CRH or another acute/emergency hospital. The beds would be for post-acute patients transferred from CRH if they don’t need acute care any longer but are not ready to go home.
Q: We asked about A&E consultants
Anna Basford said they don’t have consultants on site 24/7 now, but there are on-call consultants and they do come in.
Q: We asked what kind of digital technology will ensure that specialist advice will always be available across both A&Es.
Anna Basford said that currently patient records are fully electronic with real time data. Specialists in CRH will be able to remotely review patients in HRI and provide specialist advice on the phone.
Q: We asked why, if the electronic patient record system is so all singing and dancing, patients were receiving outpatient appointment letters with the wrong information about where they were meant to go, and after the date of their appointment.
Owen Williams said he would look into specific examples we presented, but he had no overall answer.
Q: We asked about data security and what proportion of the £196m will have to be spent on digital data security.
Owen Williams said that during the big cyber breach last year that hit the NHS, CHFT wasn’t affected. NHS Digital has assessed them as robust in cyber security. NHS England commissioned Deloitte to assess CHFT’s digital maturity and they judged CHFT to be the 3rd most digitally mature in the NHS.
Q: We asked why the update to the Secretary of State doesn’t mention the risks to Greater Huddersfield patients of extra travel time to A&E
We said that at a meeting of Calderdale and Kirklees Joint Health Scrutiny Committee, the hospitals trust Medical Director had admitted that there was a trade off between the benefits to patients of centralising A&E and the risk that some patients would die as a result of the extra ambulance travel time time to A&E. But on balance more lives would be saved than lost as a result of the A&E centralisation.
Owen Williams disputed that the Medical Director had said this and asked for our notes from the Scrutiny Committee meeting. We agreed to find and send them.
It turns out that the ck999 notes record that it was Dr Mark Davies, the hospitals’ Clinical Director for Emergency Care, who spoke at the Calderdale and Kirklees Joint Health Scrutiny Committee meeting on 19 April 2016. Not the Medical Director. This is the relevant extract from the notes:
Owen Williams thinks there have been changes to the travel plans and suggested we ask the CCGs for any updates.
Q: We asked how many CRH beds would be cut, if the CCGs realise their “aspiration”, (reported in the CHFT update to the Sec of State) that Care Closer to Home will reduce non-elective bed days for the population by 30% over 5 years.
We didn’t get an answer to that question in the meeting so we’ll email it to them along with other questions there wasn’t time to ask.
Q: What if there is no sustainable reduction in demand for in patient care, once the care closer to home services are in place?
Anna Basford said in that case there would be no acute hospital bed cuts.
Q: Is this possibility being factored into the financial projections?
Anna Basford said yes.
Q: We asked how patients on low incomes could afford to travel further for hospital treatment – whether this was people from Todmorden having to go to Huddersfield for planned care, or people from Huddersfield having to go to Halifax for acute care and children’s care.
We also said that for many patients on low incomes who rely on families for practical and emotional support, the problem is so great that it means they will not call an ambulance for fear of being taken to Halifax or Leeds, where their families would not be able easily to visit them in hospital.
For those who do find themselves or their children in hospital outside Huddersfield, they are unable to receive help from their families that is possible when the hospital is only a short distance away.
Owen Williams said this problem already exists and he knows it’s difficult for people on low incomes when they are in a hospital which isn’t in their own town or area. (He didn’t seem to appreciate that if it’s already difficult for people on low incomes, making it more difficult is not such a great idea.)
He also said that the reason the hospitals trust has a large deficit is because they have prioritised patient care and staff over money. He had just been in a performance review meeting with NHS Improvement and had had to argue with them about that.
We will leave that without much comment for now – apart from objecting that the reason the hospitals trust has a large deficit is because successive blasted governments have persistently underfunded the NHS and, via the quango NHS Improvement, forced hospitals to make spending cuts in order to “balance” their budgets.
However, it is true that in 2014 or 2015 (can’t remember when exactly) the hospitals trust refused to make all the spending cuts NHS Improvement was telling them to make, because they couldn’t do that without endangering patient safety.
And the finance director Gary Boothby has told us that in 2018/19 the hospitals trust refused to accept their control total.
Care Closer to Home
Q: We asked how they hope to persuade the Secretary of State that this is a “development” of the original Care Closer to Home proposals that the Independent Review Panel found lacking. And not just more aspirations?
Because there is no evidence in the update to the Secretary of State that the CCGs’ capacity modelling report has answered the misgivings of the clinical senate about the original care closer to home proposals – broadly, that they were vague, aspirational and unevidenced.
Anna Basford said we need to ask the Clinical Commissioning Groups about the modelling work they’ve had done to show estimated reductions in A&E admissions as a result of their Care Closer to Home plans.
She said the hospital reconfiguration isn’t reliant on Care Closer to Home because the hospital will keep all the CRH beds open if demand isn’t reduced by Care Closer to Home.
Owen Williams resumed evangelising for Cerner’s Electronic Patient Record.
He said there are 85 GP practices across the CHFT footprint. The Electronic Patient Record allows hospital doctors to see the GP record of patient data. Also the GPs can now also see the hospital records. CHFT has introduced a digital patient portal for about 10K patients across 8 specialities. Patients will be able to remotely update their data digitally from home, eg blood pressure. CHFT is working hard to make Care Closer to Home work.
(This is all part of the “left shift” of health care which ends up with the patients doing a lot of the work themselves – just as with all this digital stuff in all areas of our lives.)
And what about people who don’t have the internet or smartphones?
Q: We asked if the £20m capital funding loan for HRI extends to equipment such as scans etc. Or is it just to fix the maintenance backlog on the buildings?
Anna Basford said the Dept of Health cash flow means that £22m of the £196m capital funding loan is immediately available – subject to a business/approval process – up to 2022/23. The rest will be available after that – again, subject to a business process.
Because of building issues at HRI, there is an opportunity to access the £22m early, subject to a separate approval process, before the full business case process is completed in September 2022.
The hospitals trust are asking what the process is for getting approval for early access to the £22m.
Q: We asked what are the immediate issues with the building that they wanted to spend the £22m on.
Owen Williams said we would see when we did the walk round the hospital, but there are issues with falling cladding and fire safety. He plonked a broken wall tie on the table and said that recently the cladding had fallen off the wall outside the entrance to Trust HQ and if we’d come then we wouldn’t have been able to get into the building.
Chris Davies, head of estates, took us on a walk round the outside of the hospital and through the bowels of the hospital where all the boilers and pipework are.
He said there are three main problems with the building:
- The cladding is unsafe because it is held onto the building with wall ties that have reached the end of their life. The estimate they’ve had for replacing it is £20m so they’re looking for cheaper ways of doing it.
- There are not enough fire breaks for current fire safety standards in the long, long corridors that house all the pipework.
- The 1960s pipework needs updating but this is very costly because they are coated in asbestos and the corridors also have asbestos in the walls behind the pipework that are not really accessible. The risers that house the vertical sections of the pipework are inaccessible to maintenance staff beyond the 2nd floor because of asbestos and heat. To repair/replace the pipework they would have to close wards, which would mean building new wards outside so they could take existing wards out of use during pipework maintenance. They don’t know how much this work would cost.
The £20m earmarked for building maintenance is not enough. Anna Basford said it’s unlikely that more will be available. They don’t how long the maintenance work they can afford in the 3 priority areas will future proof the hospital for.
There are more questions that we didn’t have time to ask so we are sending them to the Trust for written answers.