What’s the rush? Calderdale NHS commissioners go ahead with Strategic Review “Engagement” despite not agreeing the Engagement Plan

Members of the public were puzzled and cross after attending the April 14th Calderdale Clinical Commissioning Group Governing Body meeting, where it seemed that the NHS commissioners had lost the plot over the Calderdale and Greater Huddersfield Strategic Review of the future of the NHS and social care.

Members of the public, including two Calderdale Councillors, attended the meeting to hear answers to questions they had sent to the Governing Body, and to find out about the Commissioners’ Strategic Review Engagement Plan.

This Plan lays out the timetable, rationale and script for presentations which the CCG is giving, in order to honour its legal duty to find out what the public, NHS and local authority staff and local politicians and members of the Health and Wellbeing Board think about the Strategic Outline Case.

The Chief Finance Officer Julie Lawreniuk and Penny Woodhead, the lead officer for the Strategic Review Engagement Plan, told the Governing Body that the CCG had decided, with advice from the Commissioning Support Unit, to re-spin the “engagement” plan by:

  • removing references to the Strategic Review, replacing them with references to Right Care Right Time Right Place and only referring to the Strategic Review in internal business work
  • refocussing the “engagement” message to make it simpler and more accessible and to distract from proposed changes to emergency care services, which haven’t gone down well
  • concentrating on the “whole system transformation” of integrated NHS and social care in the community

Penny Woodhead told the Governing Body that the CCG was not ready to sign off the Engagement Plan until those changes had been made, but the CCG was still going ahead with the original Engagement timetable.

After the meeting, a member of the public said,

“So they have started the engagement process before they have agreed the engagement document, which seems somewhat indecent haste!”

(Both the Governing Body and the Commissioning Support Unit (CSU) are welcome to exercise their right of reply to this article and Plain Speaker will publish any reply on the website.)

Bland handout that ignored public’s questions

As members of the public entered the room to attend the Calderdale Clinical Commissioning Group Governing Body meeting, a communications officer from West & South Yorkshire and Bassetlaw Commissioning Support Unit told them that there would be no public questions at the meeting.

Since this is what most members of the public had come for – and some had even taken unpaid time off work for – they were cross.

Handing out a two page summary of the Strategic Outline Case to irritated members of the public, Antony Rider said it answered most of the the questions the public had sent in, and told people that written answers to each question would be posted on the Calderdale CCG website within a week.

Members of the public told him that the hand out did not answer their questions. Mr Rider said it did.

He added that the public had sent in so many questions there was not going to be time to answer them all.

I asked Mr Rider why the meeting couldn’t answer as many as possible in the 15 minutes allocated for public questions, and then post the other questions and answers online. Mr Rider said there had not been time to send the questions off to the right officials who would be able to answer them, and that it was essential to do this.

Why can’t Governing Body members answer the public’s questions?

If the GPs and various NHS bureaucrats and communications officers sitting round the Governing Body table don’t know enough about the Strategic Outline Case to answer questions from members of the public who are eager to find out more about it, are they really a competent group?

Or are they not allowed to speak freely in case they deviate from the spin?

Public protests

At the start of the meeting the Chair, Dr Brook, repeated Antony Rider’s message and then began to read out his handout. I asked Dr Brook not to insult the public’s intelligence since we were able to read and had already read the handout.

Dr Brook went on reading aloud. Gary Scott stood up, gave him a piece of his mind, and said he was going back to work since he was wasting his time at the meeting. One of the NHS bureaucrats followed Gary out of the room and in the exchange that followed admitted that he didn’t know enough to answer Gary’s questions.

After Gary had left the room, Dr Brook told the meeting that the Calderdale CCG had had no input to the Strategic Outline Case, and neither had either of the local authorities.

A member of the public, Paul Clarke, asked Dr Brook to allow each of the Governing Body GPs to say what they thought about the Strategic Review.  Only 5 or 6 of the 13 GPs who are members of the Governing Body were present, so this would not have taken long.

Dr Brook refused, saying that the CCG was not at a stage where they can declare their own judgement and they were deliberately preventing the possibility of making a premature decision.

CCG Chair says there is no proposal to close A&E in any option and the CCG had no role in writing the Strategic Review

Dr Brook said the A&E proposals were only a small part of the Strategic Outline Case proposals and he didn’t want to get drawn into a discussion of A&E. He went on,

“There is no proposal to close A&E in any option. Option 2 is to downgrade 1 A&E and improve the A&E at the other site. It’s a distraction to get drawn into talking about A&E.”

Dr Brook said that the CCG had had no input to the Strategic Outline Case and neither had the local authorities.

A look at the minutes of Strategic Review Executive Steering Group meetings going back at least a year shows that this cannot be true.

Both CCGs and local authorities attended regular meetings together with staff from CHFT, Locala and SWYFPT and the consultancy company PA Consulting, to steer the development of the Strategic Review. The minutes show that the role of Calderdale CCG’s Chief Officer was clearly formative and that Calderdale CCG staff were working regularly on Strategic Review matters between meetings.

Dr Brook would not allow me to make this point at the meeting. He said I had been talking enough.

Paul Clarke told Dr Brook that he’d been at Strategic Outline Case engagement events where the presentation had included a slide with all seven organisations listed as if they had all written the Strategic Review. Paul said if it was true that the CCGs and local authorities hadn’t had input to the Strategic Review, they should take their names off that slide.

Councillor tells Dr Brook his A&E comments are disingenuous

Dr Brook allowed Cllr Megan Swift to speak. Cllr Swift said,

“The Council does not support the Strategic Outline Case at this point in time. What Dr Brook said about A & E is disingenuous. At the Strategic Review briefing at the Health and Wellbeing Board, we were told that the A&E would become a Minor Injuries Unit and that they can’t guarantee a 24 hour service.”

New Spin for Strategic Review Engagement Plan

Chief Finance Officer Julie Lawreniuk presented the Chief Officer’s report in Dr Walsh’s absence.

She summarised the current state of the Strategic Review Engagement Plan.

With the help of the CSU,  Calderdale CCG has agreed to “refocus” the “engagement” programme to make it simpler and more accessible and to distract from proposed changes to emergency care services, which haven’t gone down well.

It has decided to stop talking in public about the Strategic Review and only talk about it in internal business work.  In place of the “strategic review”, the CCG engagement will “re-promote” Right Care, Right Place, Right Time.

Penny Woodhead, the lead on the Strategic Review Engagement Plan, said the CCG were not yet ready to sign off on it.  She said they need to remove the references to ‘Strategic Review’ from the document because it is confusing people and making it look as though the CCG is consulting on the preferred option in the SOC when in fact they are trying to make it clear that they have not decided on the SOC yet, and are simply consulting around the issue of their commissioning, whatever that turns out to be.

Calderdale CCG is “working to deliver its specification for community/locality delivery”.

The CCG would have a development session on 17th April about this, Ms Lawreniuk said later in the meeting.  When it has decided on the community care services it wants to commission, the CCG will decide on whether to privatise these services or not.

A member of the public said after the meeting,

“So they have started the engagement process before they have agreed the engagement document which seems somewhat indecent haste!”

Penny Woodhead said they are analysing the feedback as they go along and that this will take 6-8 weeks and will end in early June.  No-one else said much.

The new Communications and Engagement Strategy is “to shift the focus away from specific focus areas”, onto:

  • The system-wide nature of the changes
  • Commitment to getting local views
  • Addressing the “challenges of growing need and smaller budgets” by doing more to provide the right care at the right place and right times (Why don’t they just come out and say NHS and social care funding have been drastically cut since 2010 and care in the community is way cheaper than hospital care?)
  • Laying the foundations for transformation of the whole health and care system, involving 7 partners (But according to Dr Brook, Calderdale CCG and three of the other partners had nothing to do with the Strategic Review – oh, of course, we’re not talking about the Strategic Review any longer.)
  • The fact that in one year the CCG made over 44K contacts with people and the current engagement phase is about telling people what the CCCG heard from them and listening to people’s views on final options for change (How are they going to do that if they can’t talk about the Strategic Review, because that’s where the options are laid out?)

Better Care Fund – deciding soon whether to privatise new community care services

Ms Lawreniuk reported that Calderdale Council and Calderdale CCG had both been told by NHS England’s West Yorkshire Area Team to strengthen the links between the Better Care Fund and the proposed NHS and social care transformation – particularly the shift from unplanned hospital care to planned, integrated NHS and social care in the community.

The Better Care Fund is a £3.8bn pot of money that NHS England has transferred from the NHS to local authorities in England. The aim is to make up for some of the massive cuts to social care funding by setting up integrated NHS and social care in the community, using existing NHS funds – ie this is not new money. Calderdale Council Calderdale CCG have had to jointly bid for a share of the fund, to what Cllr Tim Swift has called a very tight schedule.  You can read more about the BCF here.

Ms Lawreniuk said that the CCG would have a development session on 17th April to develop the community care model and would then have to decide if the CCG would “go to market with it”, or not.

In the March Governing Body meeting, I asked if it was the intention to put the integrated NHS and social care community services out to private tender and Dr Walsh said the CCG did not intend to do that, although the CCG would have to follow Monitor’s guidelines on competition.

GPs’ conflicts of interest over community care

Dr Peter Davies declared an interest as a GP but went on to say that clarity about the community care model is very important and the CCG needs a clear system vision.

This declaration of interest raises the question of how the CCG can make a decision about commissioning community care, because all its GP members have a vested interest.

Dr Davies spoke in favour of running the system so that “particularly complex patients with co-morbidity” get care at home, not in A&E.

Dr Brook said the care in the community system wasn’t just about responding to the providers’ offer.

Dr Cleasby said that, regardless of what the SOC says, for the last 3-4 years the Primary Care Trust and then the CCG have spoken about preventive upstream community based models. He said he was absolutely committed to primary and community care delivered by integrated GP teams based in GP practices and they shouldn’t get derailed by the Strategic Outline Case.

Dr Brook said that people are so unwilling to go to hospital they don’t come forward for treatment until too late and then end up in hospital.

(This is strange – the public meeting in Halifax the other Saturday was full of people saying how grateful they were that Calderdale Royal Hospital is there and that they have received wonderful, often life-saving treatment there. And even when a family member had died, they truly valued the  care they’d received and wanted this to continue to be available for others.)

Dr Davies said that there was a need to move away from acute reactive medicine and a need for a lot more care and maintenance medicine to reduce the need for acute reactive medicine.

Performance report

Ms Lawreniuk said that there was an overspend on the hospitals Foundation Trust contract that would need to be reduced in order to be able to invest in the community care model.

Dr Cleasby said that they were struggling with primary and community care out of hours service for people with long term illnesses because patients weren’t aware of care plans. Only 20% had care plans compared to 50% nationally. The CCG was building in training for written care plans for GP staff. He said the CCG has a responsibility for the quality of GP care and this was reflected in the Improving Patient Experience in Primary Care survey.

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