Councillors demand Calderdale & Huddersfield Hospitals Trust abide by regulations about Scrutiny access to Hospitals’ Reconfiguration Business Cases

  • The revised ‘reconfiguration’ plan for Huddersfield Royal Infirmary and Calderdale Royal Hospitals, based on the 2019 Strategic Outline Case, may only go ahead if Councillors on Calderdale and Kirklees Joint Health Scrutiny Committee recommend it to the Secretary of State for Health.
  • This follows the Scrutiny Committee’s rejection in July 2017 of the hospital trust’s original reconfiguration plan, and referral of the plan to the Independent Reconfiguration Panel for review. The Independent Reconfiguration Panel confirmed the rejection of the original plan and directed that from now on, NHS organisations should provide timely information to the Calderdale and Kirklees Joint Health and Overview Scrutiny Committee. The Independent Reconfiguration Panel’s report specified the NHS organisations should avoid repeats of things like withholding the original Full Business Case from the Joint Health and Overview Scrutiny Committee, until a last-minute private meeting immediately before the scheduled public Joint Health and Overview Scrutiny Committee meeting in July 2017.
  • But when Calderdale and Kirklees Joint Health Scrutiny last met in public in November 2021, its Co-Chairs Councillors Colin Hutchinson and Liz Smaje were compelled to remind Calderdale and Huddersfield hospitals trust and Calderdale and Kirklees NHS Commissioners that they must comply with statutory obligations governing Scrutiny access to the hospitals reconfiguration plans and business cases.

Trust refused to produce its Business Cases for Scrutiny, on the grounds that they are not public documents

The hospitals Trust withheld its Business Cases for the revised hospitals and community health services reconfiguration plans from the Scrutiny Committee meeting, on the grounds that they were not public documents.

At the November 2021 Calderdale and Kirklees Joint Health Scrutiny Committee, the Trust’s Transformation and Reconfiguration team only presented slides summarising the Full Business Case for HRI local walk-in A&E and a summary of the strategic section of the Outline Business Case for Reconfiguration of CHFT Services and Estate Developments of both hospitals.

    Councillors repeatedly protested that, in order to discharge their scrutiny functions, they needed both Business Cases, with their detailed modelling and information

    The Scrutiny Committee Co Chair, Kirklees Cllr Liz Smaje, spelled out that,

    “There’s a specific regulation/duty to provide information that Councillors may reasonably need to discharge their scrutiny functions. With a caveat that financial information may be commercially sensitive and in such a case Councillors may receive the information in confidence, to inform but not be directly referred to in the Scrutiny Committee’s reports and recommendations.”

    She added that NHS England had told Councillors that they would see if there was information in the Huddersfield Royal Infirmary A&E Full Business Case that Councillors could see.

    Councillor Smaje asked Anna Basford, the hospitals trust Director of Transformation, to follow up with NHS England if any progress had been made, because there is onus on Councillors to make sure they are doing the scrutiny they need to do, to ensure the health services are delivering for the public of both Kirklees and Calderdale.

    Councillor Smaje added that this was really important regarding the Outline Business Case as well as Full Business Case, because the Outline Business Case is for the whole reconfiguration.

    But the Trust’s Director of Transformation, Anna Basford, said that the Trust wouldn’t be able to share and publish the Outline Business Case for Reconfiguration of Calderdale and Huddersfield NHS Foundation Trust Services and Estate Developments, even after Treasury approval, because it has commercial confidentiality.

    The hospitals trust did agree to provide the Scrutiny Committee with written information about most of the issues raised by Councillors, following the meeting – but we have no idea if they did, or of the adequacy of any written answers CHFT may have provided.

    The Scrutiny meeting on 16th November 2021 concluded with Co- Chair Colin HUtchinson directing that,

    “There will be further discussion of the regulations governing Scrutiny access to these [Business Case] documents.

    “We will schedule another meeting in the new year…”

    That was 9 months ago

    Since then, Calderdale Planning Committee has approved the Planning Application for the reconfigured Calderdale Royal Hospital, construction is well underway of the new local walk-in A&E at Huddersfield Royal Infirmary, and the Trust’s Annual Report 2021-22 announced that they were now working on the Full Business Case for the reconfiguration of both hospitals.

    This suggests that NHS England, the Treasury and the Department of Health have already approved the documents that the Trust withheld from the 16 November 2021 Scrutiny meeting.

    Update 13 October 2022 – in response to my Freedom of Information request to provide the November 2021 draft Outline Business Case, the hospital Trust has said that “The full business case for the new A&E at Huddersfield Royal Infirmary has been approved by NHS England and construction is in progress. This forms part of the outline business case for the reconfiguration of services and estate developments at Calderdale Royal Hospital which remains in draft pending approval by Treasury.”

    Many questionable aspects of the revised “reconfiguration” need full scrutiny

    But at the November 2021 meeting – and the many others that have preceded it – Councillors identified several aspects of the revised “reconfiguration” as questionable in terms of the health interests of the public, and the interests of the local NHS:

    • Whether as a result of construction costs inflation, the development of both the Huddersfield Royal Infirmary walk-in A&E and the Calderdale Royal Hospital acute and emergency hospital for both Calderdale and Kirklees would be subject to ‘value engineering’ – cost-cutting design changes to enable the new builds to come in within budget.
    • The cost of backlog maintenance of Huddersfield Royal Infirmary, in addition to the costs of the new walk-in Huddersfield Royal Infirmary A&E
    • The future model of care at Huddersfield Royal Infirmary
    • Whether the model would lead to sustainable staffing at both hospitals
    • How the reconfiguration would address health inequalities that had become very clear during the pandemic
    • Whether the model that’s being developed would lead to a sustainable staffing situation at Huddersfield Royal Infirmary and Calderdale Royal Hospital
    • The financial impact on the Trust of the full reconfiguration
    • What Clinical Commissioning Group and community services modelling has informed the Outline Business Case, in terms of modelling hospital bed/days capacity in the reconfigured Calderdale Royal Hospital acute and emergency hospital, based on investment in community services for the growing and ageing Calderdale and Kirklees population?
    • Whether the Outline Business Case includes or will include health needs information based on the 2021 census data, when it’s available. Have Calderdale and Kirklees health needs changed at all since the 2019 Strategic Outline Case, which was based on health needs information using 2011 census data?
    • How the hospitals trust will deal with loss of flexibility re using elective beds for acute activity in time of need, as a result of the split into hot/cold (acute/emergency and planned care) sites? How would Calderdale and Huddersfield NHS Foundation Trust deal with this when under winter pressure?
    • The use of use of reduced and alternative workforce models
    • How the reconfiguration will improve w/force productivity including theatre utilisation.
    • Changes to Intensive Care
    • Reassessing ambulance waiting times for handover of patients into the hospital

    The questions and answers about these issues from the Calderdale & Kirklees Joint Health Scrutiny Committee Meeting on 16 November 2021 are downloadable here (pdf file):

    In our opinion that we, the public, need to know what is going on with our hospitals – and with the changes to community health services that are needed to make the hospitals reconfiguration viable

    We think it is vital for public confidence and democratic accountability that scrutiny is done, in compliance with the regulations governing Scrutiny access to these documents, and that it is seen to be done.

    If you agree, please read and sign an open letter to Calderdale and Kirklees Joint Health Scrutiny Committee, before midnight on Sunday 11th September

    We are copying the letter to NHS England and the Department of Health and Social Care, Calderdale and Kirklees MPs and the West Yorkshire Integrated Care Board.

    Here is where you can read and sign it, before midnight on Sunday 11th September.

    The letter urges the Scrutiny Committee to urgently meet in public and explain how and whether it has managed to make sure that Calderdale and Huddersfield NHS hospitals Trust, and the successor organisations to the now-abolished Clinical Commissioning Groups, are now meeting their statutory obligations to allow effective Councillor scrutiny of the revised “reconfiguration” plans for Calderdale Royal Hospital and Huddersfield Royal Infirmary. And if not, what the Scrutiny Committee are doing about it.

    We have seen from the Covid-19 pandemic that designing and procuring vital NHS services in secrecy is seriously dangerous to public and NHS staff safety, and to acceptable standards of probity in public life.

    How come Business Cases are not public documents now, when in 2014 Calderdale and Huddersfield hospitals trust published its original Right Care Right Time Right Place Outline Business Case? (Albeit after four months of Freedom of Information request wrangles with the hospitals trust, on the part of Calderdale Councillor Tim Swift and Jenny Shepherd. This included a formal complaint to the Information Commissioners Office, from both Councillor Tim Swift and Jenny Shepherd, about the Trust’s failure to produce either the full or a redacted Outline Business Case. Soon after the complaint to the Information Commissioners Office, Calderdale and Huddersfield Hospitals Trust published the whole Outline Business Case in November 2014.)

    So, as the hospitals trust did publish the original hospitals reconfiguration Outline Business Case , why is the Trust now refusing to publish the current version of the Outline Business Case? What have they got to hide?

    NHS Matters is submitting a Freedom of Information request to the Trust to publish the current version of the Outline Business Case.

    3 comments

    1. Hello Jenny
      I live in London. I receive your blog because wanted to learn about your campaign when we were working to prevent the closure of Charing Cross Hospital.
      I am happy to sign your open letter if this is allowed and will be useful to you.

      Like

    2. Hello Una, thanks, if you’d like to sign and give your (short) London post code that’s great. I can add out of Yorkshire signatures in a separate set, so as not to confuse Scrutiny Councillors and local MPs, but still show that the NHS is national!

      Like

      • OK. I’ve done that.
        I wish you and Colin Hutchinson – both indefatigable! – continued courage and eventual success! I’ve concluded that it’s all in the election prospects: if they think you might vote Tory (in their dreams!) then they won’t close your hospitals…..

        Like

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