The public does not have access to the National Clinical Advisory Team (NCAT) Report on the Calderdale A&E reorganisation. This report contains proposals about the future of Calderdale and Huddersfield A&E departments.
Dr Walsh, Calderdale Clinical Commissioning Group’s Chief Officer, told NHS Calderdale 38 Degrees that Calderdale and Huddersfield Foundation Trust (CHFT) has commissioned the NCAT report, and the report is internal to the CHFT.
It will be late spring before Calderdale Clinical Commissioning Group decides what it wants to do about the report’s proposals and then reveals this in a public consultation.
At the Calderdale CCG Governing Body meeting on 16th January, Dr Walsh said CHFT, South and West Yorkshire Foundation Trust (SWYFT) and Locala were the key local NHS organisations that had already seen and responded to the NCAT report on the re-organisation of Calderdale and Huddersfield A&E departments.
(Locala is the third sector health care company that now has the contract to run the Halifax and Todmorden walk-in centres. It also runs a big chunk of other NHS primary care services including health visitors, speech and language therapists, stop smoking support, district nursing, dental care, school nurses, foot care and physiotherapy, in Kirklees and beyond.
In May 2012 the Huddersfield Examiner reported that Locala had refused to answer Freedom of Information requests on the grounds that it is a social enterprise and so is not required to provide information under the FOI regulations.
This is despite the fact that FOI regulations require all public agencies and companies that deliver contracts for them to provide information when requested, with certain exceptions eg not releasing personal data.
However, this does not seem to extend to privatised bits of the NHS, whether they are run by social enterprises like Locala and CHFT, or by private companies with shareholders, like Virgin and Care UK.) Despite the fact that CHFT has a Freedom of Information Publication Scheme that commits it to
“make information available to the public as part of its normal business activities.”
Dr Walsh said
“This evening, CHFT, SWYFT and Locala will tell Calderdale CCG their response to NCAT and their proposals for the shape of services. There is some distance to go from there to the document where Calderdale CCG makes proposals, in the form of a consultation document. The timing for formal consultation is likely to be late spring.”
Our MPs won’t have access to the NCAT report until the public consultation
Like the public whom they represent, our MPs do not have access to the NCAT report either. Asked if they did, Craig Whittaker, Conservative MP for Calder Valley, tweeted:
“No. We will be briefed when the consultation comes out. CCG will consider the report then consult if they are happy with the proposals.”
Asked if he thought it was right to deny MPs access to the NCAT A&E report and CHFT’s recommendations, Mr Whittaker tweeted,
“We aren’t. We will be consulted when they have a plan to consult on. This is not a political decision but one from local clinicians.”
Before Christmas, Linda Riordan, Labour MP for Halifax, managed to call a debate in the House of Commons about the future of Calderdale A&E, after the Government and local health bosses had refused to guarantee that Calderdale’s A & E department is safe.
Passing the buck and washing their hands
In the debate, Ms Riordan accused the Coalition Government of passing the buck to local clinicians so Government can wash their hands of the matter, and said,
“I have asked in this House if Calderdale’s A and E is safe and no one has confirmed that it is…I have met the Calderdale and Huddersfield NHS Trust CEO and doctors and other clinicians. They say—and they gave out a document for me to read—that changes are afoot…So, again, I ask the Minister to rule out the possible closure or even any cuts. All I have been told is that a strategic document is available on the future of local services…
Let me be clear: the Government could and should have an important role to play in this decision. The buck should not be passed solely to local clinicians so that the Government can wash their hands of the matter…
I am very much hoping that the Minister is going to tell us that Calderdale Royal hospital’s accident and emergency department is guaranteed to stay open.
The Government set the policies, and they must also take responsibility for any decisions that will affect the A and E in Calderdale. Also, there should be no hiding behind a public consultation. The question is quite simple: do the Government support the retention of the accident and emergency department in Calderdale? If they do, there is no need for any consultation. If they do not, they should come clean and set out their position. This lack of clarity is causing a lot of worry, anguish and anger in my constituency and across Calderdale.”
Jane Ellison MP, the Conservative Parliamentary Under-Secretary of State for Health told Linda Riordan,
“The [CHFT] trust has, I believe, identified a need to co-locate acute services…”
In other words, to put them on the same site.
It’s clear from a statement in an online NCAT letter that the proposal is to co-locate Calderdale A&E and Huddersfield A&E on one site in Huddersfield.
Not passing the buck, but liberating professionals and providers from top down control
Ms Ellison explained the Coalition government’s policy on changes to NHS services. The Undersecretary of State for Health told Ms Riordan,
“It is important to understand the principles behind reconfiguration policy. This Government are clear that the design of front-line health services, including A and E, is a matter for the local NHS. That is for good reason, because those local leaders, working closely with local democratic representatives, local government and the public they serve, can come to better conclusions about the services for their area than a Minister sitting in Whitehall trying to decide policy for the whole country.”
In my opinion, it’s a bit of a moot point whether withholding information from the public until the local NHS leaders have decided on an issue, and then having a public consultation about the decisions that the Foundation Trust and Clinical Commissioning Group have already made, counts as “working closely with local democratic representatives, local government and the public”. But there you go.
Ms Ellison went on to say,
“All service changes should be led by clinicians, and be based on a clear, robust clinical case for change that delivers better outcomes for all our constituents. We have put patients, carers and local communities at the heart of the NHS, by shifting decision making as close as possible to individual patients, devolving power to professionals and providers, who also have patient care, safety and sustainable service at the core of their public service commitment,and liberating them from top-down control.”
What one person calls “liberating NHS professionals and providers” – who in the new stealth-privatised NHS may well be private companies that are not covered by the Freedom of Information Act – others would call fragmenting and dismantling the NHS. The 2012 Health and Social Care Act removed the Secretary of State’s duty to provide an integrated, comprehensive NHS across the whole country.
Ms Ellison encouraged our MPs to work with Calderdale NHS as it delivers its plans for reconfiguring A&E.
How can they, when MPs don’t have access to the report about the proposed re-organisation, the Foundation Trust’s response to it, or the Clinical Commissioning Group’s discussions and decision-making processes?
Democratic deficit built into Foundation Trusts
Until the New Labour government set up NHS Foundation Trusts, hospital managers had reported to the Secretary of State.
In turn, the Secretary of State was accountable to Parliament, so MPs could ask questions about their local hospitals. But once NHS Foundation Trusts were set up, hospitals were no longer accountable to NHS management structures, or to the Secretary of State.
Alan Milburn, the Labour Secretary of State who was responsible for setting up Foundation Trusts, told MPs that in future Ministers would no longer be in a position “to comment on, or provide information about, the details of operational management” within Foundation Trusts.
Before NHS Foundation Trusts were set up, NHS trusts that ran hospitals, mental health, community or ambulance services held their board meetings in public, published board papers and had an obligation to consult on major changes.
But NHS Foundation Trusts are run as businesses (‘independent Public Benefit Corporations’). Their boards are free to meet in secret, can choose not to publish their board papers and can take big decisions without reference to anyone except Monitor, the national healthcare market regulator. (Info source: NHS SOS, p 26)
An article in the British Medical Journal states that local control over foundation trusts is “rhetoric”. (BMJ 2005;330:1408.5).
A Nuffield Trust-funded report on the Governance of Foundation Trusts found that generally Foundation Trusts’ Boards of Governors do not exercise power, but seem to spend time discussing hospital car parking charges. Nor had they figured out how to represent the interests of the public to the Trust, or the Trust’s policies to the public. The report sees the New Labour government’s invention of Foundation Trusts as “an essential part of the strategy for creating a new-style NHS which is largely driven by market forces.”
So much for having “put patients, carers and local communities at the heart of the NHS”.
You can read the full transcript of the House of Commons debate on Calderdale A&E here http://www.theyworkforyou.com/debates/?id=2013-12-12a.447.0
You can download the Governance of Foundation Trusts report here http://www.nuffieldtrust.org.uk/sites/files/nuffield/publication/governance-of-foundation-trusts-jun05.pdf
CHFT FOI Publication Scheme is here:http://www.cht.nhs.uk/publications/foi-documents/foi-publication-scheme/
Updated 7th March 2014 with info about CHFT FOI Publication Scheme