All is not as rosy with the new Huddersfield Royal Infirmary walk-in A&E – currently under construction – as the hospitals trust wanted Calderdale and Kirklees Councillors to believe at a health scrutiny meeting on Weds 26th October.
There are also problems with the proposed capacity of Calderdale Royal Hospital, as the future blue light A&E and acute hospital for both Calderdale and Greater Huddersfield.
Councillors from both areas have asked the hospitals trust to come back with a list of risks, as well as the benefits they claimed on the 26th October.
It’s important that the public in Calderdale and Kirklees knows about these problems, because they risk staff and patient safety.
And if not addressed, the issue of the proposed Calderdale Royal Hospital capacity could require the Secretary of State to refuse to approve the proposals.
Here are some of the risks.
Once the new A&E and specialist acute hospital is operating in Halifax, HRI A&E will only accept walk-in patients and won’t admit any into HRI wards
First, when the new Huddersfield Royal Infirmary (HRI) A&E opens it will at first continue to admit patients who arrive by ambulance – but this will only be for a year or so.
Until the specialist acute and emergency care hospital is built at Calderdale Royal Hospital in 2025, HRI A&E will provide physician-led inpatient care for people who do not require the most acute clinical inpatient healthcare. So until 2025 you could still be admitted as an inpatient to HRI, if your problem isn’t “most acute”.
But once the new A&E and specialist acute hospital is operating in Halifax, HRI A&E will only accept walk-in patients. And it won’t provide physician-led inpatient care for admission from A&E.
All Greater Huddersfield 999 ambulance patients will then be taken directly to other hospitals – the great majority to Calderdale Royal Hospital (CRH). As will HRI A&E walk-in patients who need admitting to hospital.
As already explained at the meeting in November 2021 – once the hospitals Trust has reconfigured services completely, part of the new A&E at Huddersfield Royal Infirmary will be repurposed to provide an element of observational beds, like a Clinical Decision Unit-type facility, for patients presenting to Huddersfield Royal Infirmary A&E who need a bit of a longer period of observation – but not acute inpatient care.
The list of treatments that the new walk-in HRI A&E will provide is not exactly clear. The 2019 Strategic Outline Case says that HRI will provide “medically led 24/7 urgent care and 24/7 consultant-led A&E services” – but not for patients with serious life-threatening conditions. And not for children under five.
These patients will either be blue lighted direct to Calderdale Royal Hospital in Halifax, or if they come to HRI under their own steam, they will be stabilised at HRI A&E and then transferred by ambulance to Calderdale Royal Hospital.
To enable patients to be safely stabilised before transfer, there will be 24/7 anaesthetic cover at HRI, as is the case now. This will consist of 24/7 presence of middle grade Anaesthetists, and Consultant staff on-site for a proportion of each day with 24/7 on call responsibility.
Yorkshire Ambulance Services reckons that there will be about 13 patients/day, who walk into HRI A&E and are then transferred by ambulance to CRH.
Delays in reaching A&E and increased demands on overstretched Yorkshire Ambulance Service
A second problem with this new A&E system is that it will place increased demands on the already overstretched Yorkshire Ambulance Service.
And the extra time needed to get the ambulance to Halifax will also delay Greater Huddersfield patients access to A&E.
Such delays cost lives – although the hospitals trust argues that the risks to patients from delays will be offset by the better treatment they will receive when they get to the new CRH A&E.
Yorkshire Ambulance Services has calculated that 59 Greater Huddersfield 999 ambulance patients/day will go directly to CRH, and 13 patients a day who walk into HRI A&E will be transferred by ambulance to CRH. A further 4 Greater Huddersfield patients will go to other A&Es – mostly to Barnsley.
In addition, Yorkshire Ambulance Services will have to transport patients who are being transferred from CRH to HRI, for step down care/rehabilitation which is to be provided there. Yorkshire Ambulance Services don’t seem to have calculated how many patients a day are going to need this service.
To provide the extra ambulance service, Yorkshire Ambulance Service figures that every day it will need another 116 hours of additional staff time and 40 hours 36 mins of additional ambulance time.
YAS says all this information is “heavily caveated”.
It doesn’t take account of handover delays – although Yorkshire Ambulance Services told Councillors at the Scrutiny meeting that not meeting handover target times isn’t a chronic problem for them.
Councillors said they were “pleasantly surprised” to hear this.
“Improvements are needed to reduce pressure on urgent and emergency care across West Yorkshire.” – Health services quality and safety regulator
However, handover delays have regularly been occurring at Calderdale and Huddersfield trust’s hospitals.
For example, according to NHS Digital’s Urgent and Emergency Care daily sitreps, in December 2021 ambulances took 3,505 patients to CRH and HRI A&Es. Of these, 191 (5.5%) waited between 30 and 60 minutes before A&E staff were able to take over from paramedics. 87 (2.5%) waited for more than an hour.
In March 2022, the equivalent numbers were: 3,257 patients arrived by ambulance, 113 (3.5%) waited between 30 and 60 minutes for handover to A&E staff and 17 (0.5%) waited for more than an hour.
A recent Care Quality Commission Urgent and Emergency Care inspection for the whole West Yorkshire Integrated Care System identified that
“Improvements are needed to reduce pressure on urgent and emergency care across West Yorkshire.”
“The [Yorkshire] ambulance service had an improvement programme in place focused on performance and staffing. While there was some improvement in ambulance response times and handover delays, performance remained below target.”
No mention was made at the Scrutiny meeting of,
“Significant cost pressure…due to Private Ambulance costs over and above CCG YAS commissioned service.”CHFT Integrated Performance Report-SWOT analysis July 2022
Hospitals plan can’t go ahead unless Scrutiny Councillors tell Health Secretary it meets key safety and capacity conditions
A third problem is that the complete reconfiguration of HRI and CRH can only lawfully go ahead if the hospitals trusts’ business cases satisfy conditions set by the Health Secretary, when he rejected the original proposals in 2017. These conditions are about hospital capacity – specifically whether there will be enough acute hospital beds at CRH for everyone who needs one.
CHFT has ditched their original plan to cut hospital beds, that the Health Secretary rejected. Now they say they will keep the same number of hospital beds as at 2019. Split disproportionally across the two hospitals, this means around 676 beds in CRH acute and emergency hospital and 162 in HRI planned care/rehab hospital.
However, the Greater Huddersfield and Calderdale population is rising.
And although Calderdale and Huddersfield hospitals trust say the revised plan is for more patients to be cared for at home, there’s no reliable evidence that this will reduce the need for hospital beds enough, so that current bed numbers will provide enough capacity for a significantly bigger population.
Unless the hospitals trust and the new West Yorkshire NHS Integrated Care Board produce reliable evidence that the new community services are reducing the need for inpatient hospital care, the Scrutiny Committee made it very clear at the 26th October 2022 meeting that they will have to tell the Secretary of State that a key precondition for his approval of the Trust’s business plans has not been met.
There is also the further fact that the 2019 Strategic Outline Case only proposes keeping current bed numbers “whilst services are developed in the community and demonstrate a sustainable reduction in the demand for in-patient hospital care.” It assumes this will happen, and that the Trust can then cut bed numbers.
But what if the financial projections assume an eventual reduction in hospital bed, and this proves impossible because new community services don’t sustainably reduce the need for in-patient hospital care? How will this affect the hospitals’ financial sustainability? Which is already under severe pressure, even when the cost-cutting hospitals reconfiguration plan is taken into account.
Here are all the documents for the Calderdale and Kirklees Joint Health Scrutiny Committee meeting on 26.10.2022, plus a webcast of the meeting.
Correction 2.11.2022 – This blog post incorrectly identified CHFT as serving Calderdale and Kirklees. In fact it serves Calderdale and Greater Huddersfield. I’ve corrected the blog post accordingly. Thanks to the reader who pointed this out.