Covid 19 has led to design changes for the rebuilding of Huddersfield Royal Infirmary and Calderdale Royal Hospital, since the revised Strategic Outline Case for the hospitals’ “reconfiguration” was approved by the Dept of Health and NHSEngland/Improvement in January 2020.
Anna Basford, the hospitals Trust Director of Service Transformation, told the virtual meeting of Calderdale and Kirklees Joint Health Scrutiny Committee on Friday 25th September that Calderdale and Huddersfield Foundation Trust have undertaken work with public, staff and stakeholders about how pandemic changes could be built into future plans.
Final design is not set – building in infection prevention measures is key
Presenting an update on the hospital cuts and centralisation plans Anna Basford, said that learning from the pandemic about infection prevention is being fed into future plans for both hospitals.
But Calderdale and Huddersfield Foundation Trust (CHFT) bosses at the meeting pretty much ignored Calderdale Councillor Colin Hutchinson’s question about whether changes to the February 2020 design brief incorporated learning about the need for increased hospital space and staff, to keep elective services running while responding to the Covid-19 emergency.
Referring to the the Trust’s inability to keep running elective services as well as the emergency covid 19 response, Councillor Hutchinson pointed out that the NHS was not in good place in January before the pandemic, with long waiting lists and Accident and Emergency not in a good place. Part of that could be put down to shortage of space in the hospitals as well as workforce shortages.
Anna Basford said that in the plan to change Calderdale Royal Hospital into an acute and emergency hospital for both Calderdale and Kirklees, they were looking at increasing the proportion of single rooms rather than bedded bays. Information from the pandemic is that infection prevention in hospitals is more resilient if they have more single rooms.
Cllr Hutchinson asked if any thought had been given to how to service single rooms, given that they place more demands on nursing/clinical staff. He added,
“Also, ventilation is particularly important as well as physical space – are these issues being given to architects and designers? We need to design new hospital accommodation for the post-covid world not the pre-covid world. What changes have been put in that are different from the Srategic Outline Case?”
Rob Moisey CHFT consultant and a clinical lead for reconfiguration said they had had stakeholder meetings about side rooms and open bays and he agreed with Cllr Hutchinson’s points. The architects have experience of designing hospitals with 100% single beds and there are ways of designing in patient observation. CHFT will build in a review of the staffing impact of these spatial changes. There is a lot of discussion of what wards would look like. The final design not set yet. Infection control is a key factor in design.
Mark Davies, another CHFT consultant, said they are planning to split Calderdale Royal Hospital into 2 parts (Covid and non-Covid – as far as non-Covid is possible to tell), each with a separate air handling system. They have been talking with staff about how to use pandemic experiences to make things better, eg how to engage people who aren’t keen on digital appointments.
Huddersfield Royal Infirmary walk-in A&E design changes
The design brief for Huddersfield Royal Infirmary’s downgrade to a 162-bed elective care hospital with outpatients and a walk-in A&E/urgent care centre entails “the build of a new A&E department”, according to the update report to the Scrutiny Committee,
CHFT’s clinical lead for reconfiguration, Rob Moisy, explained that as a result of the pandemic, the Huddersfield walk-in A&E majors and minors areas (ie areas for major accidents and minor accidents) are being changed into more generic similar-sized areas, so they can be split into Covid and non-Covid areas without losing capacity.
After the meeting, Hands off HRI Chair, Mike Forster, clarified on the group’s facebook page:
“The ‘brand new’ refurbishment is to build a smaller new department which will be a walk in centre. All emergencies will be blue lighted to Calderdale. The Trust have NOT changed their plans to downgrade our A & E. The spending proposed for HRI is only £20 million out of the £193 million. That money is to repair and maintain the hospital. The A & E will still lose all acute and emergency services to Calderdale.”
Speeding up the capital investment in Huddersfield Royal Infirmary
Anna Basford said that to speed up the capital investment in Huddersfield Royal Infirmary, the Trust are preparing a separate Full Business Case for the hospital. This will be based on costing done with the builder, and they anticipate this HRI Full Business Case will be confirmed by NHS England/Improvement and the Department for Health and Social Care in June 2021.
She explained the Outline Business Case for Calderdale Royal Hospital will also be submitted to NHS England/Improvement and the Department for Health and Social Care for approval in June 2021, along with the Huddersfield Royal Infirmary Full Business Case. The Outline Business Case will include summary of the reconfiguration changes for CHFT as whole but will detail significant capital investment at Calderdale Royal Hospital.
Scrutiny Committee to see Businesses cases before they’re confirmed
Cllr Elizabeth Smaje, the Scrutiny Committee Co-Chair, said the Committee would like to see the Business Cases before they are confirmed and subject to due diligence, in order to scrutinise their principles, including addressing health inequalities.
Health inequalities are an issue because the cuts and centralisation of hospital services mean many patients and their families will have to travel further to hospital and also use more digital services. People on low incomes may find themselves unable to do both of these things.
Skircoat and Lindley residents’ engagement before submission of planning application
Councillor Hutchinson asked if the anticipated time scale for Skircoat and Lindley residents’ engagement was still December 2020, and what information would be given to residents.
Anna Basford said the plan is to have “meaningful engagement with residents”, including the design proposals, before submission of a formal planning application. They want to start that dialogue around December, for submission of the planning application in February 2021. CHFT will write to local Councillors in those areas “to give information and talk about how to have meaningful pre-application engagement.”
Need for meaningful face to face public consultation
In a deputation to the Scrutiny Committee, Hands Off HRI Secretary Cristina George called for more information about how CHFT intends to involve more people in ongoing plans for the hospitals reconfiguration. She pointed out that so far there has been no meaningful consultation via the engagement events outlined in the update report and there’s a need to include meaningful contact with the whole community about health care plans across both areas. She added that it’s clear most of the public don’t think this is way forward.
She wants Hands Off HRI to be involved. Face to face consultation is vital. and Hands Off HRI want plans for this. She added that the Committee needs to investigate further the NHS England/Improvement Covid-19 reset directions, including the requirement to cut the number of Clinical Commissioning Groups to one per Integrated Care System.
Anna Basford said she welcomed the involvement of Hands Off HRI in future engagement/consultation.
Engagement and consultation on Care Closer to Home has dropped off the radar
There was no mention of any consultation on the cost-cutting move of services out of hospital and the capacity of community services to deal with this. But in July 2019, Calderdale & Kirklees Joint Health Scrutiny Committee said they needed:
‘hard information about care closer to home services, in order to consult the Clinical Senate, Primary Care Networks, Local Medical Committees and the public on definite proposals, not nebulous aspirations.’
Back in July 2019, Cllr Hutchinson said the Scrutiny Committee would assess which data they needed to test that the local NHS is on a trajectory that makes the planning assumptions valid.
He said an informal workshop with the Clinical Commissioning Groups and the Trust about the data dashboard would be useful. The-then Calderdale Clinical Commissioning Group Chief Officer, Matt Walsh, said they fully accept that. They need to do that work themselves.
But that assessment of the data the Scrutiny Committee needs did not take place.
In the October 2019 meeting, Calderdale Councillor Colin Hutchinson reminded the NHS bosses that Councillors still needed further information about progress to increase care in community settings that would allow the hospitals trust to work within the planned bed base.
They still needed to be assured that the rest of the integrated system is delivering the background on which the hospital reconfigurations can take place.
The NHS commissioners have still not come up with that data.
And what consultation about Care Closer To Home has happened since those 2019 Scrutiny Committee meetings, particularly with the public – but also with the LMCs and Clinical Senate?
The Care Closer to Home care model and its performance was not on the agenda at the Autumn 2019 Brighouse stakeholders engagement event on the hospitals reconfiguration, despite a written request from Hebden Bridge Town Council to include it.
Is any consultation/engagement planned to find out whether so-called Care Closer to Home services are meeting patients’ needs and providing an acceptable alternative to hospital? No one raised this in the meeting.
Update on changes to the delivery of Community Services in Calderdale and Kirklees
The Scrutiny Committee also discussed the update on changes to the delivery of Community Services. The Secretary of State has instructed the Committee to tell him whether they are satisfied about increased care in community settings that would allow the hospitals trust to work within the planned bed base.
This blog post reports on the care closer to home aspects of the scrutiny meeting.
Call for new build to be Passive House standard
Kirklees Councillor Andrew Cooper called for the new building to be Passive House standard, as in the new Frankfurt hospital. He pointed out there was nothing in the update about the West Yorkshire Combined Authority’s target of a zero carbon economy in 18 years time. They need better sustainability building standards for the hospital. Anna Basford said they would look into the Frankfurt Hospital’s passive house design.
How to improve Calderdale Royal Hospital’s Private Finance Initiative
Anna Basford said there is dialogue with the Department for Health and Social Care around arrangements for the existing PFI and how to improve on it, in a way that allows additional work on the Calderdale Royal Hospital site to happen. They want to minimise the burden of the PFI. She said it’s a more technical financial area that the finance director could provide info on.
Cllr Elizabeth Smaje asked CHFT to provide the Scrutiny committee with that information.
Quango’s recent directive for one Clinical Commissioning Group for each of the 42 Integrated Care Systems doesn’t apply to West Yorshire
Replying to a question in Cristina George’s deputation, Carol McKenna, Chief Officer for Greater Huddersfield and North Kirklees Clinical Commissioning Groups, said that West Yorkshire and Harrogate Integrated Care System was too big and too complex to have a single clinical commissioning group and that each local authority area (‘place’) would continue to have a clinical commissioning group.
Issues for further scrutiny
Summing up, Co-Chair Councillor Elizabeth Smaje said more scrutiny was needed on:
- Plans for improving engagement
- How will the capacity of community service work?
- Sustainability of buildings
- Digital inclusion
- Health inequalities
- Priniciples underpinning the business cases
- How has design adapted to Covid-19?
- Timeline for business cases coming to scrutiny
- Plus another point my notes missed.