Report of “a fixed mindset whereby no other options are open to consideration” at drop-in on NHS plans

This report on the Mytholmroyd public drop-in session about the future of Calderdale and Huddersfield NHS is by Rosemary Hedges, Secretary of Calderdale 38 Degrees NHS. (For readers who don’t know about the proposed NHS “right care” shake up, there is some background info about the drop in here.)

I went to the event at the Community Centre in Mytholmrod at 4pm and stayed till 6pm when I went outside to stand with Chris on the Calderdale 38 Degrees NHS stall until nearly 7pm.

Minimally advertised, low public attendance

There was no signage for the event on the road, there was a banner outside the door and a small ‘drop in’ sign on the door.  The door is at the far end of a huge car park so a sign there is not visible from the road.  I rang my GP (Hebden Bridge Practice) to ask about posters and information.  They did not know anything about the events and had no posters up.  They suggested I try the local papers.  So – minimal advertising.

Unsurprisingly there were only about 20-22 people who attended the event at any time over the 5 hours.  I was told there had been 16 attendees when I arrived and there were still 10 in the room then.  Another 5-6 (including me) then came in over the next 2 hours.
No-one came in in the last hour. Of that 20 I saw, 6 were members of 38 Degrees.

There were two young women welcoming us, offering leaflets and drinks.  There were 6
representatives sitting near big signs, some from the Clinical Commissioning Group (CCG) (Martin Pursey was one, and later Judith Salter came in), from the two Trusts and from Locala.  I spoke to a manager from Locala, a Consultant in Anaesthesia and Intensive Care from the Calderdale and Huddersfield NHS Foundation Trust, and  a Senior Manager for Continuing Care and Special Care from the Clinical Commissioning Group.

No one was recording public comments

None of them was recording my comments.  Towards the end I asked each if they were going to record what I said.  2 said they would afterwards (though there were others waiting to see them) and one started writing there and then.  I told them I wanted them to record my comments and told them what I wanted to see – ie no A&E closure at either hospital, no bed losses at either hospital, increased investment in community care, and the
ending of the obscene wastage of public money on consultancy and other such costs.

Proposals to close one or both A&E departments and centralise acute and emergency care in Huddersfield

I asked each – isn’t this about saving money not better care?  The CCG manager said,

‘If we are being honest we know budgets are very limited.  We have an ageing population and we have to make sure we use what we’ve got to best effect.’

The Consultant supported the model of specialist centres where outcomes are usually better.

I asked how she would feel if her elderly mother in Todmorden had a heart attack and had
to go to Huddersfield A&E (I have no reason to think she has an elderly mother in
Todmorden!) and she said the quality of care in the ambulance is what can make the
difference.  I said did she know the Yorkshire Ambulance Service (YAS) was reducing the qualification levels of ambulance staff.  She said no. I asked if the YAS and Unite had been involved in the Strategic Outline Case plans, and she said they were already partners and it would be discussed with them.  So – obviously not!

None of the 3 committed to the preferred option as being definite – ‘it’s not been decided
yet’. I said I thought it had been, and carried on talking as if it was.  The consultant
denied that building plans were under way for new wards at Huddersfield Royal Infirmary (HRI) and said the building there was for a new OutPatients Department.  She went on to tell me she knew new building work on the Calderdale Royal Hospital (CRH) would be prohibitive because it’s tied into the PFI agreement so would make the costs worse, so they couldn’t really do it the other way round.

I asked her about job cuts and she said many staff already work over the 2 sites.  I said
that may be true for medics but I doubted it was for nurses, care assistants and porters
etc.  She seemed to think people could travel to HRI for work.

I asked what she thought would happen to Calderdale hospital after the changes.  She said she didn’t know and didn’t respond when I said it would be ripe for takeover by private healthcare companies.

She said they were having difficulty recruiting A&E consultants.  I said Virgin didn’t
have any trouble getting a Dermatology Consultant when they took over the service at CRH (one of the reasons why it was put out to tender was that they couldn’t recruit a
consultant). I wondered how they did that – maybe headhunted and offered extra money?  I asked her why shouldn’t the trust follow the example of the private sector.  She didn’t

Making up for cuts to acute and emergency hospital care, with integrated care in the community – where’s the evidence that it works better and costs less?

All three of them were promoting the concept of improved integrated health and social
care in the community as the big headline, but the costs/risks of this were not
highlighted at all.  I said this is a wonderful idea that no-one could disagree with in
the abstract.  I asked where the evidence is that it works better and costs less?  They
couldn’t answer that.  The Locala Manager spoke of the Expert Patient Programme which has been trialled successfully in Calderdale.  This is to help patients to manage long
term conditions better.  I said hasn’t this been happening for years? People attending
specialist clinics with specialist staff, to help them manage diabetes, asthma, Chronic Obstructive Pulmonary Disease etc.

In Mental Health (where I worked) we had the Care Programme Approach for years, where
a Care Plan Co-ordinator would make sure everyone involved with a patients (including
social services staff ) were all working to the plan.  We would all meet at a patient’s house and draw up the plan with them.  The Locala Manager told me that this is the integrated care model, and that medical consultants would be visiting patients at home to draw up care plans with their families.  I said are you joking? What would that cost?  It’s not a new model and it’s certainly not cheap.  When I think of all the travelling time and costs the teams I worked with ran up, driving round Huddersfield all day, it is not a cheap option. I suggested all this was happening too fast and that shutting beds without establishing solid community services wasn’t wise.  He told me that the Outline Business Case has not yet been drawn up so there is plenty of time.  I thought there were rumours that it had, with the help of PA Consultants.

The CCG Manager did not think the Calderdale Councillors’ recent vote against the Strategic Outline Case would slow it down, as the Council itself is signed up already to the plans.  She thought a People’s Commission would be a good thing.

Only one of the 3 knew about the payment of £1 million to PA Consulting for ‘support’
with the Strategic Review.  The Locala Manager said that the 2 CCGs commissioned PA
Consulting to do this after the NHS Providers had presented the Strategic Review Document to the CCGs.  Not sure I understand that.  I thought the Calderdale and Huddersfield NHS Foundation Trust had commissioned the consultancy before the document was presented.[* See editor’s note, below]

All about direction from central government and an inexorable conveyor belt travelling towards a fixed destination

All 3 of them seemed very earnest decent people who were working very hard to do their
jobs properly and probably under difficult circumstances.   I just think there is a fixed
mindset now, whereby no other options are open to consideration, its all about direction
from central government
to their agenda, and the conveyor belt is taking them all
inexorably in one direction.  Two of them hinted that they were not unsympathetic to
some of my concerns but could not speak about it.

I have come away with an evaluation form (meet and greet, stand and information etc good/poor etc) a request for my views on ‘what works well, what could be improved, what else would you like to tell us’ to post on.  Also a form on Calderdale CCG -Commissioning
Strategy – ‘Your views – do you understand, do you agree, is there anything else you
would like to tell us’.  Also an equality form.    I suppose if all of us who went fill
all these forms in it will look like there were three times as many attenders!

* Editor’s note: Information about the two Clinical Commissioning Groups’ contract with PA Consulting, for support with the Strategic Review, is in item 28/13 of the 19 September 2013 Minutes of Calderdale CCG’s Audit and Governance Committee. They show that the contract dates from 6 November 2012.

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