Calderdale and Kirklees Joint Health Scrutiny Committee met on 4 July 2019, in order to examine the Calderdale and Huddersfield Hospital Trust’s financial update and its revised Strategic Outline Case for the transformation of hospital and community services.
There were deputation statements to the Committee from Colne Valley Councillor Warner, Mike Forster, Cristina George and Steve Slator (all three from Hands Off HRI), Jenny Shepherd, Chair of Calderdale and Kirklees 999 Call for the NHS and Rosemary Hedges, an elected Governor of Calderdale and Huddersfield hospitals trust.
The hospitals trust has had to produce a revised Strategic Outline case because the Secretary of State found that its previous business case for the transformation of hospital and community services was not in the interests of the people of Calderdale and Huddersfield.
He asked the NHS organisations to reconsider their proposals and in particular to look again at out-of-hospital care (aka care closer to home), hospital capacity and the availability of capital funding.
In December 2018, the Department of Health and Social Care gave the hospitals a £197m capital loan – £20m for urgent maintenance of Huddersfield Royal Infirmary and the rest to expand Calderdale Royal Hospital so it can take all acute and emergency patients for both areas.
Here are Jenny’s and Rosemary’s statements.
Hospital trust’s Strategic Outline Case – FINANCE (Jenny Shepherd)
We still dispute that there is a compelling case for change for cutting and centralising our 2 District General Hospitals. Because this case for change is based on successive governments’ ill-advised political choice to cut public spending, following the global financial crash and the bankers’ bailout.
2 full District General Hospitals remain the best option for the people of Calderdale and Kirklees and we have the money to pay for them. As a country with a sovereign currency, the government creates money by spending it, as it did to bail out the bankers.
If it can bail out the bankers, it can and should bail out the NHS.
And in doing so it would multiply by 3 times the amount of its investment that circulates in the economy, since this is the multiplier effect of spending on health services. Unlike the bankers who just sat on their bailouts and did nothing economically productive with them
The hospitals trust financial update
- What opportunities for cutting costs are provided by Model hospital, Carter (which we thought had now been superseded), Getting it right first time and NHS Benchmarking?
- How much additional commercial income is projected from Huddersfield Pharmacy Specials, the Health Informatics Service and the WOS?
- Is additional income projected from patient-funded elective procedures, as was stated in the previous Full Business Case?
- Does the pressure resulting from being unable to make the required CIP savings last year threaten CHFT’s ability to meet its control total this financial year?
NHS England and Improvement have said they will devolve powers of regulation, oversight and assurance to West Yorkshire and Harrogate Integrated Care System
The West Yorkshire and Harrogate Integrated Care System Partnership Board Memorandum Of Understanding shows that these powers include:
- making recommendations on recovery plans for NHS organisations that are in “deficit”
- appointing a turnaround Director/team and
- restrictions of access to discretionary funding and financial incentives.
The overall intention is to cut costs and restrict patients’ use of the NHS – and to make the unaccountable Integrated Care Systems responsible for doing this, not the NHS quangos.
An example of discretionary funding and financial incentives is the £28.2m of funding this financial year that depends on Calderdale and Huddersfield NHS Foundation Trust meeting its financial control.
How is it right that the Integrated Care System – an organisation with no statutory powers or existence – has these regulatory powers over our hospitals? What is that going to mean for democratic, accountable, transparent control of our public organisations?
THE TRANSFORMATION OF PRIMARY AND COMMUNITY HEALTH SERVICES IS ABOUT CUTTING HOSPITAL COSTS (Rosemary Hedges)
The Strategic Outline Case says that the only way the hospital can meet its financial control total is to transform hospital and community services.
Without any public consultation – or even consultation with GPs – the Clinical Commissioning Groups have rushed to set up 14 Primary Care Networks in Calderdale and Kirklees. These are to provide cheaper alternatives to a range of hospital services and cut hospital admissions and use of outpatients.
The 5 Calderdale Primary Care Networks are key to a new Calderdale Integrated Care Alliance, according to the Calderdale Care Closer to Home Commissioning Prospectus.
The Prospectus includes the rather baffling statement that under the Integrated Care Alliance, clinical responsibility for all patients within their own homes (including residential and nursing) will no longer sit by default with the patients’ registered general practice.
So who WILL be responsible for patients in their own homes?
Hebden Royd Town Council was bothered enough about the transformation of primary and community services to write to Calderdale Clinical Commissioning Group asking them to put the important topics of primary and community health services on the agenda for conversations at the Brighouse stakeholder engagement event on 11th June.
The topics Hebden Royd Town Councillors wanted to know more about were:
- What is going to change about access to GP’s and to consultations with GP’s. This has changed significantly of late with new models being introduced. Have these models been evaluated and what lessons have been learnt and will they be applied? How will the introduction of the Primary Care Network contract affect patients’ right to continuity of care with their named GP?
- Is access to elective services going to be restricted further? this development in recent times has caused much concern.
- We are seeing a shift to self-care and the placing of more responsibility on the shoulders of the individual. Can you explain why this model is being applied and why it is felt that individuals are not already taking responsibility for their health and wellbeing.
- As we see an increase in the use of third-party apps, is access to healthcare likely to become conditional on the use of this equipment? and will the privacy of the individual be respected if this use does grow?
Since these topics weren’t discussed at the stakeholder engagement event, please will the scrutiny committee make sure they are discussed here and now?