A secret Hospitals Trust plan shows how the Trust is making government-imposed savings of £20m this year.

In April, the hospitals Trust agreed plans for £13.45m cuts this financial year.

Now it has come up with schemes to generate the extra £6.55m needed to make savings of £20m.

These schemes include raising an unspecified amount of new income from private patients and overseas visitors to the Trust.

And the Trust’s Commercial Team is to ask the Clinical Commissioning Groups to buy more orthopoedic services from the Trust.

Thousands of people in Calderdale and Huddersfield have protested against planned cuts to acute and A&E hospital services since the Trust revealed its plans in February.

Now there are figures to put on some of these cuts.

The secret plan, leaked to Plain Speaker,  shows the £13.45m cuts include around £3m cuts to the Trust’s paybill, unspecified £4.8m Efficiency Board Programme cuts and a £1.98m cut to the cost of inpatient hospital stays, achieved through cutting 66 gynecological and adult surgical and medical beds starting from October this year, and another 44 starting in April 2015.

You can find more details of the £13.45m cuts further on in this article.

Most of these cuts are part of the Strategic Review’s proposals and many will happen before the public has had their say

Most of the £13.45m cuts will be carried out between July and December this year, and the secret Plan says most of them are part of the Strategic Review’s proposals to cut acute and emergency hospital admissions and replace them by integrated care in the community for patients with long term illnesses.

The public has a right to take part in decisions about such major changes to our NHS.

But it seems that many of the cuts will be made before the mandatory consultation on the Strategic Review’s proposals has been completed.

Calderdale Councillor Adam Wilkinson said,

“This document proves that there are massive cuts planned for our hospitals, regardless of the outcome of any public consultation. Many of the people I’ve spoken to on the doorsteps feel that getting involved in the consultation or in the campaign to save our A&E department is a waste of time, because the downsizing of our hospital is already a done deal. This leak goes some way to confirming those suspicions.”

Is the Hospitals Trust predetermining the outcome of the public consultation?

Making cuts and changes that only make sense as part of a proposed reconfiguration of services, before the public consultation on these proposals is completed, is to predetermine the outcome of the consultation.

Predetermination, when it occurs, is unlawful.

If lawyers judge that predetermination has occurred, it’s possible to put an injunction on the proposed changes, to stop them happening.

Plain Speaker is waiting for the Trust to answer to these questions:

• Which of the proposed spending cuts  will be carried out over July-September this year?
• Which of the proposed spending cuts will be carried out over September-December this year?
• How is it possible for the Trust to carry out changes that are part of the Strategic Outline case proposals, before consultation is complete?

How much of the £6.55m new income will come from private patients?

The Trust’s secret Plan says that the £6.55m new income will come from:

• additional orthopoedic income (from the Clinical Commissioning Groups, with the Trust’s Commercial Team identifying opportunities for this through a “scoping exercise”)
• overseas visitors to the trust
• private patient income

On the phone, a Trust spokesperson said there is a raft of proposals within these schemes for raising the £6.55m extra income, and that they are not all about generating income from private patients.

Plain Speaker is now waiting for the Trust to answer these questions:

• how much of the £6.55m additional income from these schemes is planned to come from private patients?
• how much additional orthopoedic income does the Plan aim to raise from increased commissions from the Clinical Commissioning Groups?
• what does appropriate income from overseas visitors to the Trust consists of?
• how much overseas visitors’ income does the Plan aim to raise?

Where the Trust’s £13.4m cuts will fall

Eight aspects of the hospitals’ work are to take the brunt of the £13.45m cuts:

£700,000 of the spending cuts will come from the doctors’ paybill, through:

• increased productivity in operating theatres and outpatients endoscopy and radiology
• cutting the use of agency locums and improving the use of internal locums.

£500,000 of the spending cuts will come from the nurses’ and therapy staff’s paybill. The cuts will come from:

• increased use of technology
• reducing the non-clinical work that clinical staff currently do, to free up time to focus on clinical work
• cutting the use of agency staff
• a 5% productivity increase by therapy staff, eg physio, occupational therapy, Speech and Language Therapy (SALT) dietetics, podiatry etc. This involves cutting 22 WTEs jobs.

The leaked document states that this 5% productivity increase by therapy staff “was part of the Strategic Outline Case plan where these posts would then have been reinvested in 7 day working”. It notes that the risks for this cut are that the Trust is unable to redeploy people whose posts are identified as “releasable”; that patients already complain about waiting for therapy services and this might make things worse; and that the Trust loses staff that they need to deliver the Strategic Outline Case proposals.

£1.18m will be cut from non-clinical work, through:

• IT innovations including the use of voice recognition, for which the Trust has secured funding and which will allow jobs to be cut
• outsourcing estates and immunology services, which will cut jobs and reduce the cost to the Trust
• “streamlining” outpatient staffing before  opening the new Acre Mill outpatient site at Huddersfield Royal Infirmary

The original target for “pay reform” was to cut £750,000 from staff pay through :

• Cutting enhanced pay rates for Saturday and Sunday working. The secret Plan shows that this will see recurrent savings of £950k/year, through using Saturday enhancement rates for both Saturday and Sunday working
• Reducing long term sickness pay, cutting spending by £590K/ year

The secret Plan notes that this risks a deterioration in staff/employer relationships, loss of staff morale and making it harder for the Trust to recruit staff.

£2.25m will be cut from “housekeeping”

£200,000 will be cut from Estates, through a mix of:

• savings on utility bills through removing the laundry, plus other energy saving measures
• closing the nurses home, closure and sale of Acre House, closure and sale of Princess Royal Community Health Centre, while relocating services to another base
• developing agile working within the community so community services can vacate offce properties (does this mean community staff working in random places with laptops?)

£1.98m will be cut from spending on patient stays in hospital, through cutting 100 acute hospital beds

• Cutting adult (surgical, medical and gynaecology) inpatient beds across both CRH and HRI, with a plan for winter fluctuation. The plan is to cut 66 beds starting in October 2014, and to cut a further 44 beds in 2015/16. This tallies with the Strategic Outline Case proposal to cut 100 acute adult beds.
• 90% occupancy of adult beds, so patients can access “the right bed at the right time” -ie meet targets for treatment within 4 hours in A&E
• Increasing rates of daycare
• Improved access to social care

£90,000 cut as a result of reviewing unprofitable Level 3 services (the secret Plan says they are services which are not essential to the survival of the organisation).

£4.8m cut by the Efficiency Board Programme – details of these cuts seem to be absent from the secret plan.

£1m from cutting approximately 33 posts that are not critical to direct care or to “keeping the base safe”. This will be delivered through a “vacancy control process” which will cover recruitment and non-recruitment to vacancies and was put in place by 3rd June. The secret plan notes that there is a risk that staff in posts identified for cuts can’t be redeployed to other posts.

It also identifies a risk associated with outsourcing services, eg TUPE risk. So presumably the hospitals Trust is considering outsourcing services delivered by the 33 people whose jobs are for the chop.

Do the £6.55m  income -generating schemes have owt to do with the proposal to turn Calderdale Hospital into an 87 bed planned care hospital – leaving 363 beds with no assigned use?

The Trust’s Strategic Outline Case does not  say what CRH’s 363 remaining beds would be used for, if the hospital became an 87 bed planned care hospital with a Minor Injuries Unit.

Save Our A&Es campaigners have voiced their suspicion that they would be used for private patients’ planned operations.

The Trust has told Plain Speaker that it’s too soon for the Trust to have thought about what it might do with these 363 beds, since no decision has been made about whether to go ahead with the option of turning CRH into a small planned care hospital with a Minor Injuries Unit. The Trust also said that decision will be made by the Clinical Commissioning Groups, when they decide what services it wants the Trust to design.

Plain Speaker has put in a Freedom of Information request to the Trust, asking for emails, memos and notes/minutes of meetings where the issue has been discussed of what to do with the 363 CRH beds that are not required for the 87 bed planned care hospital.

The Trust’s Communications person said the FOI request may well turn up nothing, since as far as she knows there have been no Trust discussions about what to do with the 300+ CRH beds.

We shall see.

Patients and their families have told Plain Speaker that several wards in Calderdale Royal Hospital have already been closed since the start of this year and they have been unable to have emergency operations at Calderdale Royal Hospital. They have had to wait for a bed to become free at Huddersfield Royal Infirmary before they can be sent there for their emergency operations.

A week ago, Plain Speaker asked the Trust for information about these ward closures and lack of emergency operations at Calderdale Royal Hospital, and is still waiting for answers.