Closing the A&E where admissions are rising? Where’s the sense in that?

I’ve just come across the interesting fact that while Calderdale A&E admissions are higher than they were in 2008/9, admissions to Huddersfield Royal Infirmary A&E haven’t gone up over the same period.

So Calderdale and Huddersfield NHS Foundation Trust’s  “preferred option” of closing Halifax A&E means closing the A&E where there are growing numbers of people who need emergency treatment. Where’s the logic in that?

Is Calderdale A&E department running at a loss?

I found this fact while trying to make sense of Calderdale Clinical Commissioning Group’s answer to a question I asked at the CCG meeting yesterday. The question was: is  Calderdale A&E department running at a loss?

The reason for asking this question is that Calderdale A&E admissions have gone up since 2008/9, but under NHS payment rules drawn up by Monitor and NHS England, Calderdale Clinical Commissioning Group is only allowed to pay Calderdale and Huddersfield NHS Foundation Trust (CHFT) 30% of the tariff for any Calderdale A&E admissions over 2008/9 baseline.

Last year, CCCG Chief Officer Matt Walsh told the CCG that this was a reason why he’d asked CHFT to come up with a plan for fixing Calderdale A&E. This led CHFT to commission the National Clinical Advisory Team Report that recommended closing Calderdale A&E, and making a huge number of other changes to Calderdale and Huddersfield NHS and social care services.

At the Calderdale CCG Governing Body meeting on 13th March 2014, the Finance Officer Julie Lawreniuk reported that according to CHFT,

“both A&E departments make a positive contribution to CHFT.”

She said this is because the 70% of the tariff that is withheld for any A&E admissions over the 2008-9 baseline is used by the Urgent Care Board, that is mostly managed by CHFT.

Not knowing what the Urgent Care Board is, this answer didn’t mean much to me.

Search engine time

A quick look at the 2013-14 Calderdale and Gter Huddersfield Urgent Care Recovery and Action Plan shows that the newly-relaunched Urgent Care Board will “provide a focal point for ensuring delivery of this plan.”  (What on earth does this mean? At a guess, “make sure this plan is carried out”.)

Once you’ve scrambled through the rest of the jargon bramble patch, the tasks that the Urgent Care Board has to make sure its underlings carry out, seem to boil down to:

  • making people “self care” with help from a community matron or case manager to help coordinate care, in order to stay out of hospital
  • if they come into A&E, don’t admit them to hospital unless they need acute care
  • start planning for discharge as soon as a patient is admitted to hospital from A&E and make sure people have somewhere to go when they’re discharged, where they can be cared for and rehabilitated
  • once people are discharged from hospital, make sure that people “self care” plus have GP and other primary health care support so they are unlikely to need readmission to hospital.

If this translation is inaccurate, I’m happy to be corrected. This is the head-scratching original in the Urgent Care Recovery and Action Plan:

  • “Ensure a focus on self-care, and primary care based case finding and care management to ensure patients are supported to remain as independent as possible, receiving care outside hospital in order to reduce exacerbations and the need for unplanned care.
  • Ensure that operational processes within hospital are optimised so that only those patients who need acute care are admitted to hospital.
  • Ensure that discharge planning starts at the point of admission, and that the system has a range of options to meet the needs of those needing on-going care and rehabilitation post-discharge.
  • Ensuring a focus on self-care and care management in primary care to ensure that patients are supported to remain outside hospital, avoiding re-admissions wherever possible.”

This is driven by NHS England’s A&E Improvement Plan

Three interesting factoids I picked up from the Urgent Care Recovery & Action Plan:

  • The two CCGs and CHFT made the plan on the instruction of NHS England, which told Area Directors (whoever or whatever they are) to come up with such a plan, based on NHS England’s A&E Improvement Plan. So this is a matter of national policy, not a local response to local needs.
  • The Urgent Care Recovery and Action Plan is clearly the skeleton which the new Strategic Review of NHS and Social Care fleshes out.
  • Unlike Calderdale CCG, Greater Huddersfield CCG doesn’t have to withhold  70%  of the A&E tariff from CHFT, because HRI A&E admissions haven’t exceeded the 2008-9 baseline. So CHFT’s “preferred option” of closing Halifax A&E in fact means closing the A&E where the rise in A&E attendances since 2008/9 has been greatest. Where is the logic in that?

Here’s the downloadable 2013-14 Calderdale and Gter Huddersfield Urgent Care Recovery and Action Plan

One thought on “Closing the A&E where admissions are rising? Where’s the sense in that?

  1. Apart from this being very shocking, this is very good stuff Jenny and very well put. I’m incensed and these alleged proposals need to be stopped

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