Halifax and Huddersfield Hospitals cuts and centralisation – where were we up to before Covid-19 hit?

Calderdale and Kirklees Joint Health Scrutiny Committee last met in October 2019. It questioned the NHS organisations’ Progress Report to the Sec of State on future arrangements for hospital and community health services.

Sorry for the VERY LONG delay in uploading our notes on that meeting – prompted finally by the upcoming (virtual) scrutiny meeting on 25th September 2020.

The 25th Sept meeting will look at a new update on work on the planned reconfiguration of hospitals services in Halifax and Huddersfield. The public can make deputations and ask questions. Here are the Ck999 questions.

Calderdale and Kirklees Joint Health Scrutiny Committee last met on 18th October 2019. Among other agenda items, it questioned the local NHS organisations’ Sept 2019 Progress Report for the Minister of State for Health on ‘Future Arrangements for Hospital and Community Services in Calderdale and Huddersfield’.

This covered updates on the plan to:

  • shift hospital services into ‘ care closer to home’, delivered by Calderdale and Huddersfield Integrated Care Systems/ Primary Care Networks, in order to cut unplanned hospital admissions
  • turn Huddersfield Royal Infirmary into a small planned care hospital for both areas, along with outpatients and a downgraded walk-in A&E,
  • turn Calderdale Royal Hospital into the acute and emergency hospital for both areas.

Scrutiny Committee has to tell Health Secretary if the revised plan meets his requirements

At the 18 Oct 2019 Scrutiny meeting, the Co-Chair, Cllr Colin Hutchinson, reminded the Committee that at some stage, they have to tell the Health Secretary whether or not they are satisfied that the revised plans meet his 3 requirements:

  • Further work focussing on out of hospital care
  • Hospital capacity
  • Availability of capital

He pointed out that the availability of capital has been sorted, but that the Scrutiny Committee needed further information about progress to increase care in community settings that would allow the hospitals trust to work within the planned bed base.

CK999’s main concerns

In ck999’s view, the revised plan – like the previous plan that the Health Secretary/Independent Reconfiguration Panel rejected in 2018 – is about shrinking NHS services in line with serious, chronic levels of underfunding in Calderdale and Kirklees – and national workforce shortages. This view has not been accepted by the Scrutiny Committee or the Independent Reconfiguration Panel/Secretary of State.

The hospitals’ “reconfiguration” depends on the effectiveness of ‘care closer to home’ plans – but the Joint Health Scrutiny Committee is struggling to review these, despite the fact that they have to report on this to the Secretary of State. Each Clinical Commissioning Group and Council is responsible for their own Care Closer to Home plans, and the Clinical Commissioning Groups seem to want scrutiny to be carried out by the relevant Council Health Scrutiny Committee – rather than by this Joint Health Scrutiny Committee. The care closer to home plans were not included in the public consultation and scrutiny of them has been an ongoing issue for years. It emerged again in this meeting.

Further scrutiny needed of ‘out -of-hospital’ care for the whole area served by the Trust

Cllr Hutchinson told the Clinical Commissioning Groups that the Scrutiny Committee needed to know about the increase in ‘care in community settings’. They still need to be assured that the rest of the integrated system is delivering the background on which the hospital reconfigurations can take place.

Matt Walsh replied that was fine, but countered,

“We need to think about the relationship between place and this committee.”

Translated, that means he wanted the “place” – ie individual Council – health scrutiny committees to scrutinise their area’s Clinical Commissioning Group’s care closer to home plans – rather than the Calderdale and Kirklees Joint Health Scrutiny Committee scrutinising both the Greater Huddersfield and Calderdale care closer to home plans.

Cllr Hutchinson replied,

“This committee has to respond to the Secretary of State. And we have no interest in duplicating work that’s going on in Councils’ scrutiny committees, but we do need to be able to respond to Secretary of State in due course.”

CK999 deputations sought clarification on CHFT bed numbers and McKinsey’s modelling report on cutting unplanned hospital admissions through ‘care closer to home’

Rosemary Hedges asked for urgent clarification on the number of extra beds that Calderdale and Huddersfield Foundation Trust (CHFT) would tell the architects to design for. She reminded the Committee that in February 2019, CHFT’s Director of Transformation and Partnership, Anna Basford, had told the Scrutiny Committee that they anticipated a reduction of 10% of bed days over 5 years. But now, on the basis of the McKinsey modelling study commissioned by Calderdale Clinical Commissioning Group, CHFT were proposing to cut non-elective bed days by 30% over 5 years.

She asked the Scrutiny Committee to examine the McKinsey modelling and see how this new big cut is safe. She also asked if this meant CHFT were now going to cut the number of extra beds to be housed in the expansion of Calderdale Royal Hospital.

Jenny Shepherd questioned the accuracy of the McKinsey modelling. Doctors in SE London and NHS campaigners in South Devon had both questioned McKinsey’s claims in the modelling report, that their local NHS and social care systems had made the biggest reductions in unplanned hospital admissions in England. They had also pointed out the damage to the local NHS, patients and their families that such cuts had caused.

She also asked the Scrutiny Committee to find out where the “Choice and recovery pathway” pilot for CHFT to buy rehab beds from private providers sits in relation to the April 2019 revised Strategic Outline Case proposal for 169 community beds and 13 thousand m2 of estate by 2025.

You can read the two deputations from Ck999 here:

Architects to be told to keep the number of hospital beds across both hospitals the same as now

Anna Basford, Director of Transformation at the hospitals trust, said that the architects would still be told to expand the number of beds at Calderdale Royal Hospital to 676.

This was the plan in the original public consultation and it was repeated in the April 2019 revised Strategic Outline Case.

She said that in order to keep the same number of beds as at present, across both hospitals, the commitment is for 162 inpatient beds at Huddersfield Royal Infirmary.

Anna Basford added that the Calderdale Royal Hospital hospital beds might not all be used, if it turns out that unplanned hospital admissions reduce (in line with the McKinsey modelling.) In that case, they would close wards.

Ck999 are worried about closing wards

We didn’t get the chance to say this in the meeting, because once you’ve made a deputation you can’t speak again – but if they close wards because they are not admitting so many patients non-elective beds, how will they reopen them if and when there is an increased need for the beds. Because where would they get the staff from?

And if they don’t find ways to reduce unplanned A&E attendances and hospital admissions, through effective Care Closer To Home schemes, where is the evidence that 676 beds are going to be enough?

The Independent Reconfiguration Panel has said that hospital capacity planning should be subject to sensitivity testing. Has it been?

High bed occupancy levels

Co-chair Elizabeth Smaje said it was concerning it was October and the hospitals were already experiencing high levels of occupancy.

Matt Walsh invited the Joint chairs to the A&E board to see trend lines and information.

Cllr Hutchinson accepted the invitation. He added that the hospitals do need to be able to flex, but previous bed modelling seemed to be based on higher bed occupancy levels than would give that flexibility. He asked why they had chosen 90% occupancy for certain disciplines

Anna Basford replied that the revised Strategic Outline Case assumes CHFT will keep 838 beds, 676 in HX and 162 in Hudds. They would be undertaking more detailed modelling.

“Ambition” to cut unplanned hospital admissions by 30% over 5 years is not a target or commitment

Matt Walsh, the Calderdale Calderdale Clinical Group Chief Officer, told the Scrutiny Committee that the McKinsey modelling report only authorises their “ambition” to cut unplanned hospital admissions by 30% over 5 years – it’s not a target or a commitment.

He added that to plan on the basis of full occupancy would be madness – the hospital needs to ‘flex’ capacity. The McKinsey report says that Care Closer to Home will give flexibility within the bed base.

There were 100 people in hospital currently who were medically fit for discharge, but were waiting for social care assessment and care home/care capacity.

They had made real progress on delayed discharge over last 2 years, until the last couple of months when they came under pressure.

Out-of-hospital outpatients

Cllr Hutchinson asked about running outpatients away from the main hospital sites. The Trust have previously run outpatients in Tod and Queensbury and this gives people better access, but it’s heavy on staffing. He questioned whether, when staff are at premium, it was viable to put staff in places which are less used. He asked what the Trust was doing.

Anna Basford said they were continuing to provide outpatients in Tod but were also using digital technology and online consultations. Working with Healthwatch, they had found people were not confident using their own devices at home and would like a hub in the community for help with that, possibly in GP practices, so you’d go there and have a virtual connection.

They are also doing virtual consultations for children and young people because it’s more convenient for parents, so they only need to come to hospital when absolutely necessary.

Cllt Hutchinson said that anything that needs physical consultation must be face to face.

Info requested on new privately-developed Brighouse health centre

Cllr Blagborough asked for an update on the new Brighouse health centre that’s being privately developed.

MW said he would do that.

Engagement and Travel and Transport issues

The Scrutiny Committee also questioned the NHS organisations about their engagement report and transport issues, particularly the A629 roadworks and the Travel and Transport Review – info in the Minutes, downloadable here

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