• Pressures on Calderdale A&E and the  likely merger of Halifax and Huddersfield A&Es into one department in Huddersfield are the result of systemic problems caused by the removal of the NHS from democratic control and its current backdoor transformation into a privatised health care market.
• This is the view of groups who are calling for the NHS to remain a public service, in the face of the Health and Social Care Act 2012 reforms to the NHS.
• Calderdale NHS 38 Degrees are anxious that Calderdale residents’ lives and health will be put in danger if Calderdale A&E is closed or downgraded.

Matt Walsh, Chief Officer of Calderdale Clinical Commissioning Group (a membership organisation of local GPs that is responsible for commissioning a range of NHS services in the area), told the Group’s Governing Body meeting on November 14th that Calderdale Clinical Commissioning Group had asked Calderdale and Huddersfield Foundation Trust (CHFT) to commission the National Clinical Advisory Team to review urgent and emergency care, and to report on recommendations for the Trust to consider.

This review took place over the summer and autumn, within the hospitals Foundation Trust.

Calderdale Clinical Commissioning Group expects the recommendations to come through to its Strategy Review committee some time in December.

Dr Walsh said,

“Significant change needs to be made in ways services need to be delivered. So Calderdale CCG will listen to the provider’s [CHFT’s]  recommendations and then consult with the public on their decision on the provider’s recommendations.”

For months before Matt Walsh updated the 14 November CCCG Governing Body meeting, the Halifax MP and Calderdale Councillors have been trying and failing to find out what was going on with the National Clinical Advisory Team (NCAT) review of CHFT A&E.

The creation of NHS Foundation Trusts has put hospitals beyond the effective scrutiny of their local MPs. As a result, local MPs have no access to the NCAT report, CHFT’s recommendations or Calderdale Clinical Commissioning Group’s discussion of the report and its recommendations. The National Clinical Advisory Team report is not in the public domain.

Monitor, the national health market regulator, advises hospitals that are seeking Foundation Trust status as required by the Health and Social Care Act 2012,  to cut back or close services, such as A&E, that do not contribute positively to the financial balance sheet.

[more on Make NHS Foundation Trusts democratically accountable]

NHS funding cuts put pressure on Calderdale Accident & Emergency services 

In addition to NHS England’s requirement that Calderdale Clinical Commissioning Group cuts its spending on Calderdale NHS by 4% of its budget each year, through so-called efficiency savings, West and South Yorkshire and Bassetlaw Commissioning Support Unit have planned an extra £160m cut.

West and South Yorkshire and Bassetlaw Commissioning Support Unit Executive Steering Group (ESG) plan to  achieve savings of £160m over five years.

At the May 2013 meeting of the Calderdale Clinical Commissioning Group Governing Body, Calderdale 38 Degrees NHS Group asked how this would be likely to affect A&E services, given that there has been a significant increase in emergency admissions during 2012/13 with a combined over-trade in emergency short and long stay admissions of £1.6m. (An overtrade is when the cost of a particular service is higher than the budgetted amount.)

This ‘overtrade’ is a significant issue for Calderdale and Huddersfield NHS Foundation Trust. Year on year there has been a 3.8% increase in emergency admissions.

Calderdale Clinical Commissioning Group replied that they were working on this and that they were studying in particular, primary care costs and community care options. In addition, Dr Chris Day of Calderdale 38 Degrees NHS Group reported,

“Matt Walsh referred to Dr. Majid Azeb of Southowram Surgery, Care Quality Commission member  (and  of  M & N Medicals Ltd ) in response to our questions and he talked enthusiastically about apparent concessionary streams which seemed to mean a lot to him but was incomprehensible to me.”

These funding cuts do not include the costs of implementing the 2012 Health and Social Care Act, which take a sizeable chunk out of NHS spending on health care services.

Dr Louise Irvine, chair of Save Lewisham Hospital Campaign, has estimated that the administrative costs of managing the full-blown competitive provider market unleashed by the 2012 Health and Social Care Act could rise to over 20% of the NHS budget for England.

That would mean that over £15 billion a year would be spent on managing the market – money that will have to be found in addition to the £20 billion over 4 years so-called efficiency savings.

Additional NHS funding cuts imposed by NHS England in July 2013 – £30bn ‘Nicholson Challenge’

In July 2013, NHS England told Clinical Commissioning Groups (CCGs) to save £30bn over the next 3-5 years, in addition to the £5bn/year efficiency savings they already have to make over 4 years. As already noted, these efficiency savings represent 4% of the CCGs’ annual budget.

The NHS England document, laughably called “The NHS belongs to the people: a call to action”, tells Clinical Commissioning Groups to come up with new 3-5 year commissioning plans that will fill a £30bn “funding gap” by 2020/21. Clinical Commissioning Groups are supposed to consult with charities and patient groups to find ‘local solutions’ to cutting their share of the £30bn.

Presumably this will fall somewhat short of throwing patients out on the street. Although, given the record of the Bedroom Tax, I wouldn’t bet on it.

NHS England Chief fails to tell MPs of spending plans

Talking about the £30bn NHS “funding gap” that will open up by 2020/21, NHS England Chief Sir David Nicholson said,

“This gap cannot be solved from the public purse but by freeing up NHS services and staff from old style practices and buildings.”

Called to give evidence to the House of Commons health committee, Sir David Nicholson was forced to admit that NHS England had put aside £3m of taxpayers’ money to produce ‘materials’ for a public ‘consultation’ on how to solve the funding gap, without telling MPs. An article in Pulse said that he then

“remained coy with the committee about exactly what it would entail.”

Costs of Private Finance Initiative – aka Perfect Financial Incompetence

Calderdale Royal Hospital is notorious for being one of the most costly, least accountable Private Finance Initiatives in the NHS.

Repaying the ever-growing PFI debt currently takes about 10% of Calderdale Clinical Commissioning Group’s annual budget, and this is set to rise.

At the April 2013 meeting of the Calderdale Clinical Commissioning Group Governing Body,  it was noted that Private Finance Initiative payments for Calderdale hospital will be £24m this year (they increase each year) – almost 10% of the 2013 annual budget of £256m.

Details of the Calderdale Royal Hospital contract are on a PFI list compiled by the Treasury and reported  on by the Guardian in 2012.

The 2012 Guardian report says:

“…details of the contracts compiled by the Treasury make clear that some NHS organisations will end up paying almost 12 times the initial sum over what is usually a 30-year contract.

“For example, while the capital cost of rebuilding Calderdale Royal Hospital in Yorkshire is £64.6m, the scheme will end up costing Calderdale and Huddersfield NHS Foundation Trust a total of £773.2m.”

[more on Calderdale Royal Hospital PFI]

Cuts to social care services

The final item in this little shop of horrors is the fact that cuts to social care funding and services are a major cause of rising use of A&E.

You can read about this here.

Restoring social care funding and services seems like a no-brainer. It would not only cut A&E admissions, it would put wages into the pockets of social care staff that would in turn fuel the economy. It would also put taxes into the Treasury coffers to pay for A&E and other NHS and public services, and reduce the public deficit while we’re about it.

System-wide transformation of urgent and emergency care

The Phase 1 Keogh Report wants a “system-wide transformation of urgent and emergency care services”.  

An official mantra is that the A&E problem is due to the increasing age of the population. Loads of old people with multiple health problems are forever streaming into A&E and overloading it.

It’s true that we have an ageing population and this puts extra demands on the NHS. But the real problems in providing adequate A&E care where it’s needed (ie not at a long distance down congested roads), lie elsewhere:

• the NHS democratic deficit, as described above
• the accelerating stealth privatisation of our NHS
• massive Private Finance Initiative re-payments for the Calderdale Royal Hospital
• 4% “efficiency savings” cuts to Calderdale NHS funding each year and other NHS funding cuts
• cuts to social care services
• the introduction of NHS 111 and cuts to primary care services

Edited 17 Jan, with a rewritten headline, and some style and structure changes.