Thanks to all 81 people who signed the open letter calling on Calderdale and Kirklees Joint Health Scrutiny Committee to get answers from the hospitals Trust about its secretive Business Cases for the “reconfiguration” Huddersfield Royal Infirmary and Calderdale Royal Hospital.
The Scrutiny Committee finally met on 26th October 2022. Following deputations from Rosemary Hedges and me, on behalf of all the signatories to the open letter, some of our collective mission was sort of accomplished. But not our call for freedom of information about the secretive business cases.
Our deputations asked:
- That the Joint Health Scrutiny Committee now sets itself a deadline for informing the Health Secretary whether or not it can confirm that the hospitals trust’s business cases meet the three criteria required for his approval of the revised plans.
- That the hospitals trust immediately publishes both current business cases, acknowledging that the public interest overrides commercial confidentiality – as it already did in in 2014 and 2017, in respect of the Business Cases for the first version of the reconfiguration.
(To enlarge this and any of the following blue text boxes, just click on it. Then use the back arrow to return to the blog post. I have put questions and comments in these text boxes, to clarify they are not part of the record of the meeting.)
Our demand for publication of the current business cases was ignored by the Hospitals trust and the Councillors
The Joint Health Scrutiny Committee did not challenge the hospital trust’s refusal to publish the various business cases. They seem to accept the commercial confidentiality argument.
The Co-Chairs of the Joint Health Scrutiny Committee said they will have a planning meeting with the West Yorkshire Integrated Care Board and the hospitals Trust, to work out how the Co Chairs can see the Full Business Case, and Calderdale and Kirklees Joint Health Scrutiny Committee can scrutinise it, while maintaining commercial confidentiality.
Update 1 December. Calderdale and Huddersfield hospitals trust has responded dismissively to my request for an internal review of their refusal of my Freedom of Information request for the current Outline Business Case and the Full Business Case for the new HRI walk-in A&E. Their internal review has upheld their initial decision to keep the the business cases secret, and dismissed my questions about what has changed since 2014, when CHFT agreed that the public interest overrode commercial confidentiality in respect of the original Outline Business Case and agreed to publish it with redactions. They said these questions were not included in my FOI request – although they clearly are. The Information Commissioner’s Office has agreed to investigate whether the Trust has handled my request in accordance with the FOI legislation.
Partial success with our second demand: Joint Health Scrutiny Committee to set deadline for informing the Health Secretary whether or not it can confirm that the hospital trust’s business cases meet his three criteria for approval
At the 26.10.2022 Scrutiny meeting, the hospitals trust told the Councillors that:
- The Outline Business Case has been approved by NHS England and is waiting for Treasury approval.
- The hospitals trust wIll then move to the next piece of work to include procurement info.
- They will then move to the Full Business Case. Planning for the end 2023 but it depends on national approval.
The Co-Chairs instructed that:
- The next Calderdale and Kirklees Joint Health Scrutiny Committee meeting will be early in the New Year.
- It’s vital that West Yorkshire Integrated Care Board attends that meeting (after failing to attend on 26.10.22), as well as the hospitals trust.
- The hospitals trust must let Scrutiny have the workforce model as soon as it’s available, before the Full Business Case is completed.
- Need to progress very, very quickly whether there’s enough capacity in the system. That means both hospital beds and workforce AND care closer to home services in the community – with place Scrutiny Boards bringing their findings on care closer to home services back to Calderdale and Kirklees Joint Health Scrutiny Committee. Otherwise they can’t notify Sec of State whether the proposals meet his criteria or not.
- They need the updated travel plan.
- They need an update on capital financing after the hospital trust’s November 2022 review.
- They need an assessment of the reconfiguration’s risks and how they’re being mitigated.
The Co-Chairs said that after seeing the Full Business Case – or before – they reserve right to contact the Secretary of State with comments, in order to let him know if the NHS organisations don’t satisfy them that hospital capacity – including staff, not just bed numbers – is safe. And that care closer to home services are safe too, and also reduce the need for hospitals enough to cancel out the effect of the population increase.
They added that the hospitals trust must let them see the Full Business Case for the whole reconfiguration, as it’s developed. This is so they can have input into it, not just be told about it once it’s all written and completed.
Calderdale Scrutiny Officer’s report on an “informal workshop to discuss the Outline Business Case that relates to the plans to develop the sites at Calderdale Royal Hospital and Huddersfield Royal Infirmary on 22 June 2022.”
Turns out that at the private Calderdale and Kirklees Joint Health Scrutiny Committee workshop in June 2020, where all the members received info about the business cases – but didn’t get to see them, they’d expressed concerns about :
- High levels of inflation and construction costs
- Workforce issues
- Impact of climate change
- Hospital capacity – Clinical Commissioning Groups’ redistribution of beds across the hospital sites
- Activity growth assumptions
- Staff and buildings capacity
- Better ventilation
- Community services – should be mainly scrutinised by place scrutiny
- Impact of care closer to home schemes on suppressing demand is key to safe hospital capacity so Calderdale and Kirklees Joint Health Scrutiny Committee reserves the right to consider this info. But otherwise place scrutiny committees are responsible for scrutinising Care Closer to Home schemes in their boroughs.
They didn’t manage to get significant answers to these concerns at the 26.10.22 meeting in public. ( In our view, without access to the Outline Business Case, how could they?) The meeting touched on:
- Availability of capital – inflation and contingency,
- Future arrangements for scrutinising Care Closer to Home
Availability of capital – inflation and contingency
Scrutiny councillors and the public are worried that inflation will erode the capital budget and lead to a smaller build than is safe. But they were unable to get much new information at the Scrutiny meeting.
The hospitals trust told the 26.10.2022 Scrutiny meeting that their cost estimates are based on standardised rates for activity/square metre, and an “expert adviser”, IHP, is advising them on how these rates are changing ‘in the market’ as a result of inflation.
Stuart Barron, the hospitals trust finance guy, spoke in generalities, based on this slide:
Speaking to the slide, Stuart Barron said the Outline Business Case shows overall affordability, costed on August 2021 prices.
He added that the capital envelope allows for £40m inflation. NHS England and the Department of Health have approved this as sufficient.
The design work is validating that, activity data shows the building is right size.
Stuart Barron told Councillors the costs were last reviewed in March 2022, but that,
“I can’t remember off top of my head what the contingencies movements were”.
But cheaper actual design fees than planned mean they have some financial leeway. This has gone into the contingency allowance.
They have been doing a “costings refresh” using advisers like IHP to see what the current costs are on the ground.
They have been doing feasibility studies for costing the new Calderdale Royal Hospitals building and making sure it works with the current building as one building, as the basis for procurement “moving forward”
The next “costings refresh” is due in November 2022.
By then, the design/capacity work will have been done on the Calderdale Royal Hospital new build, which Emergency Care Consultant Mark Davies is working on with designers to work out the footprint.
Stuart Barron added,
“Costs are driven by market rate for a standard health facility square metre. We’re looking at whether it’s within overall affordable envelope. It was when they did it last time. It will depend on what contingencies there are.”
Director of Transformation Anna Basford said,
“The key test is whether we can guarantee prices at procurement… It’s an ongoing process of us forecasting how the market might move… we have experts – specialist advisers – supporting us in that work.”
‘Place’ scrutiny committees must satisfy themselves that Care Closer To Home is sufficiently reducing demand for hospital care to make current capacity safe
Calderdale and Kirklees Joint Health Scrutiny Committee asked ‘place’ scrutiny committees to look at capacity issues in detail and report back here on capacity in community services and the effects on hospital.
(The ‘place’ scrutiny committees are the individual Councils’ Adults Health and Social Care Scrutiny Boards. They only consider services within their own boroughs.)
Co-Chair Cllr Colin Hutchinson said this is because there are ongoing concerns about the adequate capacity of hospital.
According to Cllr Colin Hutchinson, the fact that the hospitals Trust haven’t been able to reduce beds in summer suggests that current capacity is not adequate. And now there is a national call to increase hospital beds.
Calderdale Cllr Howard Blagborough (Chair of Calderdale Adults Health and Scrutiny Board) said he was satisfied in Calderdale about capacity in community services and the effects on the hospital. But not about finances.
Kirklees Councillor Jackie Ramsay (Chair, Kirklees Health and Adult Social Care Scrutiny Panel) agreed with Cllr Colin Hutchinson’s concerns about the adequate capacity of the hospital and added that they also need to look at social care as well as out-of-hospital health care.
In Kirklees Health scrutiny committee last week, they heard that 100 hospital patients were medically ready for discharge but had nowhere to go. They heard workforce is the real issue – recruiting both in hospital and in community care is very challenging – and capacity has to be looked at through this.
She asked what hospital occupancy level has been modelled in the Outline Business Case?
Kirklees Councillor Alison Munro said that Care Closer To Home scrutiny needs to consider volunteers and their transport issues. Capacity has to be looked at through the workforce issue
Cllr Colin Hutchinson said that workforce is a key factor driving a lot of these changes. A recent staff survey illuminates factors contributing to the hospitals trust’s staff shortages. What measures are the trust introducing to retain staff and how effective are they?
And what about changes to the workforce model at Huddersfield Royal Infirmary to increase efficiency? And what kind of long term staffing arrangements are planned for paediatrics at Huddersfield Royal Infirmary A&E?
Mark Davies said there will be a “dedicated children’s trained nurse” in the paediatric area of the new Huddersfield Royal Infirmary A&E dept. They can’t do that at the moment because they can’t separate children out.
They are also amalgamating the roles of health care support workers for non-qualified nurse tasks, and porters to push A&E patients to the ward, making them as efficient as possible. It’s not a significant change to the workforce model.
Cllr Jackie Ramsay asked if overall the Huddersfield Royal Infirmary A&E workforce will be cheaper, and what key elements the hospital trust is looking at around transformation? Because we know at the moment there are trolley waits and ambulance waits.
Mark Davies said they’re looking at making the most of what they’ve got – not necessarily a cheaper workforce, but making the workforce model they’ve got more efficient. For example, all qualified staff working at top of their licence.
In terms of transformation – there will be increased streaming of patients from the front door. Patients will be sent straight from their first contact with a clinician to the team that needs to see them. For example, they will be sent straight to the surgical/medical assessment team so they don’t wait 4 hours in A&E. So the patient sees the right clinician earlier and decongests the A&E department and removes unnecessary steps. This means trolley waits and waiting to get into A&E from ambulances will reduce.
Cllr Mike Barnes asked if there would be a reduction in staff headcount? And he commented,
“What you’ve described isn’t really workforce transformation. Fast tracking patients through A&E is a process change. Can we have more on staff remodelling?”
Mark Davies said he can get “more detailed numbers of nurses, clinicians, or whatever, but the new HRI A&E is a small part of whole reconfiguration and transformation programme.”
He added that the Calderdale Royal Hospital new Emergency Centre will include a paediatric emergency department and a paediatric assessment centre, a new medical assessment team and new surgical assessment team all on one floor, plus 12 wards. Moving all acute services onto one site will increase the capacity to change the workforce and stream patients quickly out of A&E to other departments. It will improve care for significant group of patients whose care is currently delayed by being in an Emergency Department. He concluded that the big changes will happen when they do the full reconfiguration in a few years time.
Cllr Mike Barnes countered that getting this right at the new Huddersfield Royal Infirmary A&E affects what happens at Calderdale Royal Hospital.
But Mark Davies replied that the new Huddersfield Royal Infirmary A&E is only a limited trial because the space for the medical assessment team and the surgical assessment team is too small at Huddersfield Royal Infirmary A&E to test the whole transformation.
At the 26.10.22 Calderdale and Kirklees Joint Health Scrutiny Committee meeting, the hospitals trust also gave an update on the new Huddersfield Royal Infirmary A&E and Yorkshire Ambulance Trust gave an update on their revised modelling. These updates are reported here.
Here are the public deputations