A member of the public who attended the “Right Care” drop in session at Salendine Nook
YMCA earlier this week was disappointed in its vagueness and its poor advertising, which
meant hardly anyone attended.

The drop ins are supposed to allow the public to take part in decision making about the
future of Calderdale and Huddersfield hospitals and community healthcare. This is an
urgent matter, because according to a Greater Huddersfield Clinical Commissioning Group (GHCCG) Freedom of Information response, the new out-of-hospital community healthcare “model” is intended to be in place by April 2015.

But the member of the public who contacted Plain Speaker said,

“In two words the drop in session could be described as shambles and farce. On the plus side, I did get a nice cup of coffee, but no biscuits.”

If anyone is planning to attend one of these drop ins, which are running throughout June
in various places across Calderdale and Greater Huddersfield, this is how they work.

There are 3 stands:

• Locala (the community healthcare company)
• the Clinical Commissioning Group
• the Hospitals Trust.

Each stand seems to be the same and is staffed by 3-4  persons. The stand shows bullet points of what the current situation is and what their proposed intentions are.

There is no formal presentation but members of the public can ask the delegates about the proposed changes.

“Staff were asking for feedback about the changes they could not tell me about“

According to the member of the public who contacted Plain Speaker to report on their
attendance at the Salendine Nook YMCA drop in,
“These points and graphics are vague and general in the utmost. The people who are staffing the stands seem to be a mix of PR, clinical and others who have been co-opted in
with no real idea of why.

“The delegates were extremely woolly and constantly said they would get me the information I asked for.  Some really had no idea but just wanted feedback about the
changes they could not tell me about.

“It seems that there is only one choice available and that is to put care into the community, reduce hospital attendance,  downgrade some hospitals and centralise specialised care and A&E in major hospitals. They mentioned hubs but could only provide two examples, Holme Valley Memorial and Todmorden. I pointed out that Locala had tried to close down Holme Valley a couple of years ago, but as it is in trust to the people of Holmfirth they were blocked.  They had no response.

“They kept banging on about coordinated care based around the patient. Specialists going
out to see each patient in their home or at a local hub, X-rays, blood tests, long term
care, GP’s being able to prescribe art, singing, gardening sessions. I kid you not.
I asked them if they were really serious and believed in what they were saying.

“As an example I pointed out that radiographers were in short supply already and the
equipment was bulky, fragile, expensive and required a specialised team to operate it.
They stated this would require investment and would be addressed. Pointing out that there
is already a shortage of funds seemed to confuse them.  I also gave another two
examples. Intravenous antibiotics need very careful monitoring and district nurses are
not trained to deal with this. Heart failure can bring on all sorts of secondary
conditions needing a large number of specialised clinicians. I am not sure if they don’t
have the answers, or if the delegates were simply ill informed and out of their depth.

“I pointed out the Locala staff shortages in the community and Holme Valley Hospital and
asked about whether there may need to be redeployment of staff from the hospitals.
District nursing is completely different than hospital nursing.”

“Do you think we have reflected the things people have already told us?”

This is the first question in the “Right Care” questionnaire about the future of
hospitals and community health care. It’s impossible to answer without knowing who has
told the NHS organisations what they think, and what these people said.

Logically enough, the member of the public who reported on the Salendine Nook drop in asked staff who they had already consulted and what the consultees said. Staff said that this information and raw data was on the GHCCG web site under a report, “Call to Action”.

The member of the public said,

“I can find no such report. I have asked for this information to be sent to me.”

Drop in poorly attended during working hours

The Salendine Nook drop in seems to have been poorly attended. The member of the public who contacted Plain Speaker said,

“In the first hour there were 3 attendees including myself, one from the Patient Advice and Liaison Service and one who was on some sort of NHS mailing list. After 3 hours there had been 10 attendees in total. Some were couples. All, including myself, were aged 60+. I asked about venues and times being mid week and midday to early evenings and they considered them to be the best times.”

Paul Cooney, a member of Huddersfield Keep Our NHS Public, commented,

“Weekday sessions which only go onto 7pm hardly allow for a full representation of the views of the community. How does anyone who works full-time have a chance to attend the events?”

I believe that this consultation exercise is a sham and is constructed in such a way as to minimize the opportunities for the people the NHS serves to share their views with the NHS organisations.”

Have the drop ins been properly advertised?

A single advert had been placed in both the Halifax Courier and Huddersfield Examiner,
but when asked about the advert, NHS staff at the drop in did not know what it had said.
They thought it was probably simply a list of times and dates and a copy of the leaflet
and wall poster they had with them.  Both of these state,

“We want to talk to you about the future of health and social care services in Calderdale and Greater Huddersfield. Come along to the following drop in sessions…”

…then a list of times and dates.

Staff at the drop in also stated that information about the drop ins had been at the
end of articles published by the Halifax Courier and the Huddersfield Examiner 2 weeks
ago, although they didn’t know exactly when. They also mentioned that Radio Leeds had
talked about the changes twice, but these were apparently only short sound bites.

There was a limited number of Right Care brochures available.  The brochure is a copy of the Right Care Time Place web site.

They did not even have a poster at the door.

Even GPs’ surgeries don’t know about “Right Care” proposals

The extremely diligent member of the public told Plain Speaker,

“I have now been to 3 GP surgeries and rung 5 more and talked to the practice managers or office managers. Not one of them had ever heard of Right Care Right Time Right Place or had a leaflet or posters available. Today I went to Dr Steve Ollertons’ who is the Chairman of the GHCCG. They had never heard of it or had any details!!!

When I asked about the lack of information at GP’s surgeries and general information,  NHS staff at the drop in said that all GPs had been informed. They also stated they would consider putting a stand in town centres and handing out the bland leaflets.”

In April 2015- the intended date for the redesigned community health care roll out – who will provide the new community services?

Locala, the main community health care company in Greater Huddersfield, was spun off from North Kirklees Primary Care Trust under a Business Transfer Arrangement, to considerable staff discontent.

Its three year contract is due to expire in September 2014, but it has been renewed until 2015.

North Kirklees Clinical Commissioning Group is the Coordinating Commissioner for Locala, and Greater Huddersfield Clinical Commissioning Group, Calderdale Clinical Commissioning Group and Kirklees and Calderdale Councils all commission some community health care services from Locala.

Councillor Tim Swift has confirmed that Calderdale Council has some public health contracts with Locala that relate to sexual health  (in particular chlamydia screening) and dental health survey work. These contracts date from the time when Public Health was the responsibility of the Primary Care Trust. The contracts came over to Calderdale Council after the Health and Social Care Act transferred responsibility for Public Health to local authorities.  The work around sexual health is due to be re-procured in around six months.

According to a Freedom of Information (FOI) response, the estimated annual contract value of GHCCG-commissioned Locala services is £14.5m.

The Freedom of Information response says that the GHCCG’s intention is that the new Right Care “redesigned out-of-hospital care” will be in place by April 2015. There is
a break clause in the new one year contract at March 2015, which would allow
Commissioners to abandon the Locala contract at three months’ notice.

The Freedom of Information response also shows that on 5th Feb 2014, NHS Greater Huddersfield CCG Governing Body accepted a report that stated,

“…a fundamental review is needed of how community services are provided and commissioned as the current model and practices will not facilitate this…considerably more work needs to be done in partnership with fellow commissioners, including North Kirklees, the local authority and other key stakeholders to establish what kind of service provision will be needed in future. Local people…need to be actively involved in that process.”

At the Salendine Nook drop in, Plain Speaker’s contact asked the Clinical Commissioning Group about the potential conflict of interest that Locala seemed to have, since Locala stood to gain a great deal of contracts from these proposals. He told Plain Speaker,

“The Clinical Commissioning Group stated it was probably best to work with the existing provider than involve others and that they knew Locala and it would be best if the community care stayed with them.

“They also stated that Locala was a relatively small company and that it needs to be
helped to grow.  I asked if this was against the Health and Social Care Act in regards
to competition but they seemed unaware of this. I told them the terms of the extended contract had been referred to Monitor and asked what would they do if they lost it. They seem both ignorant, shocked and unable to answer.

“They mentioned it would be a 5 year contract from North Kirklees Clinical Commissioning
Group, as the coordinating commissioner for Locala. I pointed out that if Locala did not
get any subsequent GHCCG contract then they would not survive and there would be massive upheaval to the staff in Greater Huddersfield and Calderdale. More stunned silence.

“All in all a shambles.

“I’m sure there were other items but I honestly lost the will to live after 3 hours.”

Plain Speaker will invite Locala to comment on this report and put its side of the story.

Here is the Freedom of Information response.

Here is the Right Care brochure (PDF)

Updated 3rd June with information from Cllr Tim Swift about Calderdale Council’s contracts with Locala.