Calderdale and Kirklees Joint Health Scrutiny Committee questioned revised hospitals plans update

At the end of the Calderdale and Kirklees Joint Health Scrutiny Committee meeting on 19th March 2021, the co-Chair Cllr Elizabeth Smaje told Calderdale and Huddersfield hospitals Trust managers that for the next meeting in June (now re-scheduled for 4th Aug), they needed to produce:

  • A written report on the financial case for change in the Outline Business Case for the centralisation of acute and emergency services at Calderdale Royal Hospital, including the contract change to block funding.
  • Revisited travel arrangements and the carbon budget for the “reconfigured” hospitals.
  • Capacity planning data and quantified capacity for the revised plans for Huddersfield Royal Infirmary and Calderdale Royal Hospital, taking account of Covid19, in relation to Care Closer to Home data.
  • Revised Yorkshire Ambulance requirements .

At the previous meeting of the Joint Health Scrutiny Committee on 25th September 2020, the co-Chairs had grilled the local NHS organisations about their prolonged failure to provide data that would allow the Committee to carry out its task of identifying whether and how the capacity is there in community services across the whole area served by the hospitals trust, to make it possible for the hospitals changes to go ahead, and to understand the impact on the hospitals’ redesign.

Campaign groups’ deputations – no evidence that the revised hospitals’ capacity plans are safe and fair

Campaigners from Hands Off HRI and Calderdale and Kirklees 999 Call for the NHS made four deputations at the start of the 19th March 2021 meeting, that scrutinised:

  • revised plans for Huddersfield Royal Infirmary and Calderdale Royal Hospital and
  • the Trust’s Future Plans public engagement about the related upcoming planning applications for new buildings a Huddersfield Royal Infirmary and Calderdale Royal Hospital

Based on the Clinical Commissioning Groups response to a Freedom of Information request in December 2020, Calderdale and Kirklees 999 Call for the NHS warned the Scrutiny Committee that there is no evidence that revised plans for Huddersfield Royal Infirmary and Calderdale Royal Hospital are safe and fair.

The Clinical Commissioning Groups had failed to answer Freedom of Information questions about:

  • Care Closer to Home performance data since the start of 2018 that shows the services’ impact on A&E attendance and emergency admissions, and on cost savings.
  • Whether Commissioners have the skills and resources to examine and interpret the data.
  • The dodgy economic case for change that would shrink the local economy

As a result, campaigners considered the hospitals Trust Future Plans public engagement to be invalid, since NHS organisations have failed to provide evidence that their hospital plans are safe.

Campaigners asked Councillors to grill the Trust for the missing evidence and told them if this didn’t work,  they would ask the Health Secretary’s Independent Reconfiguration Panel to step in.  

Anna Basford, the hospital Trust’s Director of Transformation and Partnerships, said she knew the Joint Health Scrutiny Committee would want more information about how the Trust have assessed the ‘reconfigured’ hospitals’ capacity, but she hadn’t got it at her fingertips.

She only talked about capacity/activity modelling – seeming to sidestep the need for Care Closer to Home performance data that show the impact on actual A&E attendance/admissions and acute bed/days.

(1) https://www.cht.nhs.uk/fileadmin/site_setup/contentUploads/About_us/Publications/BoardPapers/BOD_2017/FINAL_SOC_18_April_2019.pdf
(2) Bed Availability and Occupancy Data – Overnight

Calderdale and Huddersfield hospitals trust spoke to an Update Report on the hospitals ‘reconfiguration” – the report is downloadable (pdf) here:

Scrutiny Committee will look at hospital capacity and Care Closer to Home programmes in the meeting after the local elections.

Co-Chair Cllr Colin Hutchinson noted that Planning Applications are a different matter than building capacity decisions. Calderdale and Kirklees Joint Health Overview Scrutiny Committee will look at questions of the hospital capacity and Care Closer to Home programmes in the meeting after the local elections.

Co-Chair Cllr Elizabeth Smaje added that the NHS needs to increase capacity in future, and asked the hospitals trust if they can quantify their calculations about how they’re deciding capacity, for future meetings.

The hospitals Trust said they will submit their response to engagement as evidence of public involvement, in a planning application pack that they will send to the Councils’ planning departments in May 2021.

Cllr Will Simpson said the Scrutiny Committee hadn’t yet seen clear and sustained data on the real impact of Care Closer to Home and they need to do so. He asked,

“Is CHFT confident that they can provide Care Closer to Home data in good time and when will we receive it?”

Carol McKenna replied that last year’s data would be skewed because of Covid 19. A lot of Care Closer to Home has been Covid-related, eg: pulse oximetry at home; Long Covid services; and the community phlebotomy service.

Locala October 2020 Briefing

Carol McKenna added that in the last Joint Health Scrutiny Committee meeting they talked about each Clinical Commissioning Group’s strategy for Care Closer To Home and what they were investing in. She claimed that they went through quite a lot.

In future they will go back to the McKinsey modelling report which recommended 13 best practice interventions eg remote consultations. C19 has meant remote consultations have been immediately implemented and they will be able to retain these.

McKinsey Modelling Report, Right Care Right Time Right Place
The out-of-hospital opportunity, Final report and Annexes, 16th November 2018

Carol McKenna said they were measuring the impact as far as they could, and added that Calderdale and Kirklees Councils’ “place based” scrutiny panels were also looking at the impact of Care Closer to Home.

Cllr Hutchinson pointed out – as he has in successive meetings over the years – that the Calderdale and Kirklees Joint Health Scrutiny Committee have to look at those data in their meetings, because Calderdale and Huddersfield hospitals trust provides part of the integrated services for both areas. He added,

“This committee is the place to look at quantitative aspects of Care Closer to Home and the impact on hospital capacity, as well as qualitative information, and dealing with the backlog of Covid 19 work.”

Cllr Simpson agreed with Cllr Hutchinson. He appreciated Carol McKenna’s information about investment in Care Closer to Home, but worried that these investments would pick up previously unmet needs and so may not lead to the planned reduction in hospitals activity. So it was vital for this committee to have the evidence base about impact on hospitals.

Cllr Alison Munro said that house building policy means there will be an influx of people into Calderdale and Kirklees. In the light of this new demographic influx into the area, she asked how the strategic assessment could be revisited. She added that theJoint Health Scrutiny Committee want hard data.

Scrutiny need Care Closer to Home hard data and details of financial case for change before the Outline Business Case is sent to NHS regulators/Treasury

Cllr Anne Collins said that the Joint Health Scrutiny Committee need Care Closer to Home performance data in time to make any changes to the plans where necessary, because if they don’t get Care Closer to Home reductions in A & E attendance and unplanned hospital bed/days in Calderdale, it’ll be a disaster.

Cllr Hutchinson confirmed,

“Yes, we need that data in good time before the Outline Business Case.”

Co-Chair Councillor Smaje agreed with those Care Closer to Home questions. She added that the Joint Health Scrutiny Committee also need:

  • An update on the details of the financial case for change.
  • To know why Calderdale and Huddersfield hospitals trust are not doing an Outline Business Case for HRI but going straight to the Full Business Case (FBC).

She asked,

“You will need the data for the FBC, so why haven’t you already got it?”

Stuart Baron, Associate Director of Finance at Calderdale and Huddersfield NHS Foundation Trust (ex-PWC), said the Trust was starting financial modelling for HRI in the next couple of months, with a deadline the Trust to approve the Full Business Case in May.

NHS England/Improvement’s guidance is that investment below £15m can go straight to a Full Business Case. There is £30m overall for HRI but they have pulled forward the HRI investment in A&E and it’s around £10m. The residual HRI investment will be picked up in the Calderdale Royal Hospital Outline Business Case..

Financial modelling for the Outline Business Case will be carried out over summer for CHFT Board approval in August.


Revised programme timeline, Calderdale and Huddersfield Service Reconfiguration
Update Report for the Calderdale and Kirklees Joint Health Scrutiny Meeting 19th March 2021

Anna Basford, the hospital Trust’s Director of Transformation and Partnerships, said those documents won’t be publicly available at those times.

Cllr Hutchinson asked:

“When are you submitting the Outline Business Case and the Full Business Case to this committee?”

Anna Basford said the Trust have to submit them to NHS England/Improvement and possibly the Treasury. When the documents are submitted to this Committee, they will contain redactions because of future competitive tendering. They will bring the documents to Calderdale and Kirklees Joint Health Scrutiny Committee in late autumn.

She added that in terms of the business cases, that’s the score – but in terms of data about Care Closer to Home and transport & sustainability, the Trusts is happy to come to scrutiny as requested.

Cllr Hutchinson said the clarity is appreciated.

Cllr Smaje said Scrutiny should be looking at going through the Full Business Case in tandem with it going to NHS England/Improvement. In terms of financial modelling, Scrutiny needs to see that data too. There’s a need to find way of scrutinising the Full Business Case asap. Cllr Hutchinson, she and Trust need to discuss that.

At the end of the meeting, Cllr Elizabeth Smaje told the hospitals Trust managers that for the next Calderdale and Kirklees Joint Health Scrutiny Committee meeting in June (now scheduled for 4th Aug), they needed to produce:

  • A written report on the financial case for change in the Outline Business Case, including the contract change to block funding.
  • Revisited travel arrangements and the carbon budget
  • Capacity planning data and quantified capacity for the future, taking account of Covid19, in relation to Care Closer to Home data.
  • Revised Yorkshire Ambulance requirements.

Scrutiny Councillors want clarification of category of HRI A&E

Cllr Colin Hutchinson also asked which NHSE A&E category (ranging from 1-4) the new HRI A&E would fall into. This related to a deputation from Hands off HRI asking the Scrutiny Committee to:

  • look again, as a matter of urgency, into the revised plans’ downgraded provision of emergency care at HRI and
  • recommend that the necessary, and fully-staffed, clinically co-dependent services for a full A&E department be provided on site at HRI.”

Mark Davies (Calderdale and Huddersfield hospitals trust consultant in emergency medicine) said that they haven’t defined what category would be. He pointed out Type 1 is consultant-led for patients presenting with all conditions, 24/7, but

“HRI A&E won’t have ability to deal with all patients, as is the case in most A&Es which is why we have specialist A&Es like in Leeds.”

Cllr Hutchinson said the Scrutiny Committee would like further clarification of this.

Info source: NHS England

Inequalities

Scrutiny Committee Co-Chair Cllr Elizabeth Smaje said scrutiny is about evidence and needs and detail, beyond presentations. She asked how the hospitals Trust was going to address Calderdale and Huddersfield inequalities – both pre-Covid and widening inequalities since Covid. She said this needed a quantified response.

The hospital Trust’s Director of Transformation and Partnerships, Anna Basford, said that inequalities required a whole-system approach (presumably meaning across the West Yorkshire Integrated Care System), not just from the hospitals Trust. They were learning from the pandemic, and were:

  • Looking at waiting lists in the light of inequalities data to make sure access to care is equitable for all communities including learning disabled people – using argeted approaches to increase their access.
  • Working with Councils on their plans for inclusivity, eg BAME action plan to better understand BAME experiences and improve access as required.

Carol McKenna, Chief Officer of Greater Huddersfield and North Kirklees Clinical Commissioning Groups, said that Kirklees Integrated Health and Care Board has health inequalities as a standing agenda item for monthly meetings.

The Board has looked at inequalities in relation to cancer. Calderdale and Huddersfield hospitals trust has provided data on access to hospital services by different population groups.

Primary care networks have been very focussed on inequalities in access to C19 vaccination.

This has been in the context of West Yorkshire and Harrogate Integrated Care System work on inequalities over the past year.

Cllr Hutchinson said it was important that digital exclusion didn’t compound other inequalities – we have seen impact of digital exclusion on education during covid19, and on retail banking.

Cllr Smaje added that their report a few years ago said reconfiguration should not worsen inequalities.

November 2020 transport survey didn’t get a good response

Responding to a question from Cllr Andrew Cooper, Stuart Sugarman (CHFT Board lead for Travel and Transport and Managing Director, Calderdale & Huddersfield Solutions Ltd (the CHFT subco), said the transport survey was started in Nov 2020 and it did ask for responses about typical transport use pre-pandemic, but only got a 25% response from staff.

In addition, about 240 visitors and patients responded. It was not a good response although they had tried to get good response. Pre-pandemic, patients had routinely travelled to hospital outpatient appointments.

Mark Davies said that many Huddersfield residents already go to Halifax and vice versa. They can get an estimate of the net movement of patients between Calderdale Royal Hospital and Huddersfield Royal Infirmary.

A Councillor asked:

  • If the new Calderdale Royal Hospital car park will accommodate extra staff as well as patients
  • How the Hospitals Trust could reduce its carbon footprint because ill people can’t use bikes, foot or buses. Quantitative data on reducing the carbon footprint is needed, because of huge numbers of people travelling between hospitals.

Stuart Sugarman did not produce any quantitative data but said that “hopefully”, encouraging staff and some visitors to cycle and walk etc will reduce car use. There will be Electric Vehicle charging on both sites and park and ride for staff.

Climate change reduction and sustainability are being incorporated into design stage. The new estate will meet BREAM standard – it is on track to achieve a very good standard, with air and ground source low carbon heating.

A Councillor asked why the updated travel survey was very sketchy. It contradicted previous surveys as to distance travelled, the numbers of people travelling and doesn’t take account of Transport Group’s recommendations.


Calderdale Adults Health and Social Care Scrutiny Board received report on Calderdale and Kirklees Joint Health Scrutiny Meetings

At the Calderdale Adults Health and Social Care Scrutiny Board meeting on 8 April 2021, the Senior Scrutiny Officer gave an oral report on Calderdale and Kirklees Joint Health Scrutiny meetings. He advised that the Joint Health Scrutiny Committee’s meeting in June – now rescheduled to 4th August – would be looking to pick up on some of the aspects of the community services that needed to be in place to support the hospital reconfiguration.

Councillor Hutchinson advised that they had been waiting for an update on the financial case for the reconfiguration. It had been advised that quite a number of changes had occurred within the financial structure of the health services.

He further stated that with regards to the West Yorkshire discussion of the integration of the white paper, there had been concerns raised as there was no mention of any role for scrutiny. It was agreed by the Joint Committee that they would draw this to the attention of the Secretary of State and a draft letter is being prepared.

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