Growing disbelief and irritation were evident as around fifty people at yesterday’s Calder ward forum listened to a Calderdale Clinical Commissioning Group (CCG) presentation on the Right Care Right Time Right Place (RCRTRP) proposals for the future of the NHS and social care in Calderdale and Huddersfield.

Jeremy Hunt, Secretary of State for Health, has quite rightly called for nurses and doctors to act on their duty of candour to patients and their families, and explain honestly what is going on with their care, especially when things go wrong.

By the same token, NHS managers and politicians have a duty of candour to the public to explain honestly what is going on with NHS policies and management.

But Councillor Steve Sweeney told Calderdale Clinical Commissioning Group’s Strategic Review “Engagement” Lead, Dawn Pearson, that the first half of her presentation about the CCG’s “engagement” with the public over the RCRTRP proposals was less than candid.

Ploughing through the first few slides of her presentation, Ms Pearson explained that the Strategic Review had been going on for about 18 months. She went on at some length about “what engagement to date has told” the CCG, and how the Strategic Review gives people what they have said they wanted in the “engagement”.

Ms Pearson said the CCG had collected the views of 2,500 people across Calderdale and 1,700 people had completed an unplanned care survey about the services they wanted for sudden, unexpected health care needs.

Calderdale CCG had “engaged” with 500 staff.

(What this “engagement” consisted of and what the staff said are the subject of a FOI request from Calderdale 38 Degrees Chair Ken Cheslett. This FOI request follows the failure of Calderdale CCG Governing Body to answer Mr Cheslett’s questions at its meeting on 13th March 2014.

Calderdale CCG has forwarded the FOI request to West and South Yorkshire and Bassetlaw Clinical Commissioning Group, which suggests that either the CCG doesn’t know about its staff “engagement” exercise, or else it’s just messing Ken Cheslett around.)

Since most people in the room had not heard of the engagement activities Ms Pearson was talking about, many found it annoying to hear her constantly repeating that the Strategic Review/Right Care Right Time Right Place proposals gave “us” what “we” had said “we” wanted.

Cllr Sweeney told Ms Pearson,

“The first half of your presentation seemed quite irrelevant – it’s disingenuous to suggest that these consultations had anything to do with the RCRTRP proposals.

The consultation doesn’t really exist even with the partners.

And the consultation timetable is ridiculous.

The proposal you’ve got up here is for a few weeks’ consultation.”

Ms Pearson protested that the CCG had done a piece of unplanned care consultation with voluntary groups.

Cllr Janet Battye said that she had asked for the consultation findings but hadn’t received them.

Alan Stuttard, Parish Clerk of Erringdon Parish Council, said Erringdon Council hadn’t received any information about the RCRTRP proposals.

After the meeting, Cllr Sweeney said that the unplanned care consultation had been carried out by Cllr Jennie Lynn in order to find out what people thought about CCG plans to close walk-in centres in Park Ward and Todmorden.

Preferred option for Calderdale A&E closure

Paul Clarke, a member of the public clutching an obviously well-read copy of the Strategic Outline Case, said he had come to the meeting because the preferred option in the Strategic Review was for the closure of Calderdale A&E and its relocation to Huddersfield Royal Infirmary, leaving a minor injuries unit in Calderdale Royal Hospital and that was what he wanted to find out more about.

Failing to get a satisfactory answer, he asked who the two speakers were accountable to. Ms Pearson said she was accountable to Calderdale Clinical Commissioning Group. Asked who Calderdale CCG was accountable to, Ms Pearson said it was accountable to the public in Calderdale. Although she didn’t explain how it is accountable to us.

Lesley Hill, representing Calderdale and Huddersfield NHS Foundation Trust, said she was an Executive Director of the Trust and the Executive Directors were accountable to the Chair of the Trust Board.

Ms Pearson said that the RCRTRP proposals were needed because of “challenges” that include an aging population and increasing pressure on the NHS and social from patients with long term illnesses and lifestyle-related illnesses.

Ms Pearson didn’t explain that research by academics with no vested interest in cutting NHS services has found that increased health care costs associated with an aging population are around 1%/year; nor that dispassionate academic researchers view the so-called “demographic timebomb” argument as an apocalyptic rhetorical ploy that neo-liberals use to justify cuts to public spending on health and social care.

No mention that NHS England’s Call to Action was about how to cut costs to meet predicted £30bn NHS funding shortfall by 2020

Ms Pearson got to the slide showing 13 themes that had emerged from the Call to Action “engagement”, although she didn’t explain that the Call to Action was NHS England’s message that there would be a £30bn NHS funding shortfall in 2020, unless NHS managers found ways of cutting costs. Cllr Tim Swift has calculated that this would mean an £80m funding shortfall for Calderdale CCG by 2020.

Both Ms Hill and Ms Pearson seemed anxious to avoid any suggestion that the RTRCRP proposals were a cost-cutting exercise caused by cuts to NHS funding.

Paul Clarke pointed out that the Strategic Outline Case said that NHS funding had effectively been cut by 4%/year: NHS funding was increasing by 1%/year  (below the rate of inflation), while the NHS had to make “efficiency” cuts of 5%/year.

Ms Hill repeated that NHS funding was not being cut, but that the “challenge” was due to rising costs of drugs and treatments and increased numbers of patients.

Around this point in her presentation, Ms Pearson brought up a graphic that shows the patient at home, apparently with an ipad or some such electronic device. Money and control arrows point in to the patient, who is surrounded by a circle of home care (mostly volunteer community helpers, friends and family). Then by a circle of intermediate care, then by a circle of what Ms Pearson called “total health and social care”.

She repeated that the engagement process was to gather views at meetings like this, and said,

“Some media representations have not been accurate and we want to share what the position is.”

Paul Clarke, the man with the well-read copy of the Strategic Outline Case, said that he thought the Halifax Courier and Hebden Bridge Times had reported the issue well.

Lesley Hill, Director of Planning and Estates at CHFT and Executive Director on the CHFT Board said that closing Calderdale A&E was one of four options and that although it was the CHFT’s preferred option, no decision had been made that this option would be carried out.

Paul Clarke pointed out that there are 5 options not 4, asked why the “engagement” duo had come to the meeting without having done their homework and pointed out that the public paid their wages.

Ms Pearson put up the slide listing the 5 options and started reading them out.

I said I thought that CCCG and CHFT were being disingenuous in saying that no decision had been made about which option to carry out, but they had to say that because of the CCG’s statutory duty to allow the public to be involved in making the decision.

If it appeared that the CCG had failed to carry out a proper, meaningful consultation, they could end up in court.

But there are four pieces of evidence that strongly suggest the decision has already been made:

• As a CHFT consultant and senior manager told the 13th March Caldedale CCG governng body meeting, most of the proposed division between the two hospitals into an unplanned/routine care hospital and an acute care hospital has already happened, with unplanned care in Calderdale Royal Hospital and acute care in Huddersfield Royal Infirmary.
• Calderdale and Huddersfield NHS Foundation Trust has set up a joint venture property development company with Henry Boot Development and this company is already expanding Huddersfield Royal Infirmary.
• Calderdale Council and Calderdale Clinical Commissioning Group are ready to set up the low-cost community care system that’s designed to reduce A&E visits and hospital admissions. They will do this through implementing their Better Care Fund plan this year.
• Calderdale Clinical Commissioning Group has approved a 5 Year Strategic Plan that states that it is the CCG’s contribution to delivering the Strategic Review. This is the document that outlines the preferred option for closing Calderdale A&E, moving acute care and A&E to Huddersfield Royal Infirmary and cutting 100 hospital beds.The plan is due to come into effect this year.

Ms Hill said that Huddersfield Royal Infirmary was currently developing Acre Mill to re-site outpatient services there.

A member of the public said that looked like making way on the main site for buildings that would be needed for option 2.

(Following publication of this report, a member of staff at the Calderdale Royal Hospital
told Plain Speaker that at the staff briefing on the Strategic Review, the CHFT
Assistant Director of Strategic Planning told staff that the Trust want bulldozers on
site at Huddersfield by January 2015, and specifically stated they wanted bulldozers on
the site before the May 2015 general election.

Plain Speaker has invited CHFT to comment and will publish their side of the story if they wish to exercise their right to reply.)

Ms Pearson repeated that,

“The engagement process – part of what we want to do – is listen to what people say.”

She said she was trying to take notes of what people were saying, to take back to the CCG.

Paul Clarke said,

“The Strategic Review says that people will get services close to home, but an A&E in Huddersfield is not close to home.”

Ms Pearson said that at the moment there are not enough A&E consultants, the trauma department is in Huddersfield and they are already sending heart attack patients to Leeds, with improved results for patients.

One member of the public, not from Calder ward, spoke in favour of option 4, which was to close both Calderdale and Huddersfield A&E departments, and to send everyone to Leeds.

Planned “engagement” process

Ms Pearson put up the slide for the planned “engagement” process. This showed 5 drop-in sessions in Calderdale and road show activity in 5 locations in Calderdale, with dates to be publicised in the rightcaretimeplace website. There would be comments cards to put into boxes, for anonymity.

A member of the public asked how many people knew about the website and what people without internet access were supposed to do.

Ms Pearson said if anyone had ideas about how to publicise the website and engagement activities, to let her know.

Ali Miles, a community nurse of long standing, pointed out that over 200,000 people live in Calderdale so each drop in event would have to cater for 40,000 people.

Ms Pearson said the drop in events would last for 5 hours.

Ms Miles said that meant they would have to engage with 8,000 people an hour and asked which venues they were using.

The Chair, Cllr Dave Young, drew this agenda item to a close. At the end of the meeting it was agreed to invite Calderdale CCG back to the next Calder Ward Forum on 15th July.

Cllr Young summed up that was it the view of the meeting that Calderdale CCG and the CHFT should keep both A&E’s open and everyone agreed.

Updated 2nd April to include the Chair’s concluding comments. Updated 3rd April to include report of hospital staff briefing about intended date for start of building work on Huddersfield Royal Infirmary site.