Plain Speaker is pleased to publish the Submission from the Calderdale 38 degrees NHS Campaign Group to the Calderdale Commission on health and social care.
Over the last 9 months, Calderdale 38 Degrees NHS has held honest discussions with over 1500 Calderdale residents about the proposals for local NHS cuts and service changes.
This submission summarises their considered views.
Submission from the Calderdale 38 degrees NHS Campaign Group
Calderdale 38 degrees NHS Campaign Group is a non party-political group of like-minded Calderdale citizens who wish to keep a full range of NHS services available, free at the point of demand, to the public, in our own community. It has been working for the last 18 months to protect the NHS from denigration and creeping privatisation, and has acquired information from attending Calderdale Clinical Commissioning Group (CCCG) meetings, and provided information to the public about proposed changes through regular market and information stalls.
1. The NHS has just been through the largest reorganisation in its history. We believe a period of consolidation and stabilisation is now needed and that our local services should not have to endure more changes. Every reorganisation costs huge amounts of money and we believe that money should stay in frontline services and not be frittered on further upheaval. We are not opposed to change in principle, and welcome evidence based ideas, but for the reasons above, out of the 5 options under consideration in the Strategic Outline Case, we support the first option of ‘no change’.
2. Furthermore, we believe that every town should have its own fully functioning, properly staffed hospital with an A&E department, acute services for children, adults, the elderly, maternity, and Mental Health services. We think it is the right of every citizen to have a full range of health services in their own town. We do however, accept there may be some call for multi-district specialist centres in a small number of specialisms. Calderdale and Huddersfield NHS Foundation Trust (CHFT) consistently comes out very high in the rankings of national hospital services. There is nothing wrong with it. It is doing an excellent job and should not be penalised by the screw-turning of central government. NHS services should be properly and adequately funded from central taxation. The health of its citizens should be absolutely the highest priority of any government.
3. We believe that the primary motivation behind the Trusts’s Strategic Outline Case ‘preferred option’ is to cut costs and generate income by using the beds that are proposed to become redundant at Calderdale Royal Hospital, for private medical care. This means that meeting the needs of the people of Calderdale is not the primary priority of our Trust. In our view this is a betrayal of the local population. We have a beautiful, modern, state of the art hospital in our town which we do not wish to see sold out to private enterprise, and find our needs for hospital care become secondary to those of the people who are paying. That is unfair and undemocratic, and we object to it. Furthermore, we do not think it is reasonable to require residents of Calderdale, particularly those dependent on public transport, to have to travel to Huddersfield Royal Infirmary, which is an antiquated, run down, cramped hospital with inadequate car parking, for their ‘unplanned care’.
4. We have good reason to believe that the majority of the Calderdale public agree with this. In our experience, the recent public consultation on the Strategic Outline Case (SOC) has been a sham, using coded language and disingenuous presentation of unpalatable facts, in order to fool the public. When the language is translated – for example when people are told that ‘unplanned care’ covers accident and emergency – they are appalled to discover what this means. Over the last 9 months Calderdale 38 degrees NHS Campaign Group has engaged with over 1500 members of the Calderdale public in the course of raising petitions and disseminating honest information about the local health chief’s plans. 99.9% of these people have told us categorically they do not want Calderdale A&E services to move to Huddersfield, and when the other elements of the plans are explained to them they are shocked and outraged about the proposed changes. Furthermore, these same people express pessimism about the chances of commissioners and providers listening to them or taking notice of what they think and want – ‘it’s already decided – they don’t care what we think’ has been regularly stated to us. This is a sad indictment of the lack of democracy in our public services.
5. We do not believe that the risks of the proposed changes have been properly thought through, nor honestly presented to the public. With respect to the threats to A&E, there is good research evidence showing although stroke cases may benefit from travelling further to a specialist centre, overall mortality rates increase with longer ambulance journeys. Dr Jon Nicholl, Professor of Health Services Research at Sheffield University has published a number of papers showing how mortality rates rise with an increase in the distance travelled to A&E. This is particularly evident for respiratory emergencies. He has found that 5.8% of patients who travel less that 6 miles to A&E died before being discharged whereas 9% of those who travelled more than 13 miles died before being discharged. This means that Calderdale residents will die as a consequence of having to travel further to a neighbouring A&E. In Newark, an increase of 37% in death rates has been noticed since the local A&E closed 2 years ago. This equates to 72 extra deaths. Furthermore, we have reason to believe that the ambulance services, which are under huge pressure from the government’s arbitrary deadlines and standards, are planning to reduce the competency levels of ambulance staff. If our A&E closes to emergencies this will mean travelling further with less qualified staff on board, doubling the risk of a bad outcome.
6. With respect to Integrated Community Care and the NHS England plan for ‘Better Care’ we have very serious reservations, and again do not believe the Trust has been open about the potential risks. We know that very recently the Government Cabinet Office held back the launch of the Better Care Programme because ‘ there is no evidence the policy will deliver the planned savings or introduce the proposed new system of care’. The policy was pushed through regardless of these concerns. Whilst we would very much agree that community care needs to be improved, and would support extra investment in it, we do not believe this should be done at the cost of hospital services, until and unless the new policies have clearly and consistently demonstrated superiority. We would strongly support closer, integrated working between health and social care staff. However, such working requires enormous co-operation and collaboration and goodwill, whereas privatisation of community services (the likely scenario of the future) will create fragmentation and competition, and is the antithesis of joined up working. Denmark has been attempting to introduce integrated community care for 3 decades, but the Danish system still suffers from a lack of co-ordination of care. Barriers to integration are described as including organisational fragmentation, perverse financial incentives and the absence of a single electonic medical record. (Rudkjobing et al 2013) The UK has exactly these problems and more. We do not foresee the integrated community care programme being successful in the context of the market culture, and therefore believe that the existing hospital services will need to remain available to cope with the fallout.
7. Other proposals by the Trust are of uncertain benefit. Telecare and Telehealth systems are advocated for helping reduce care costs. However, claims for the efficacy of these systems are unsupported by evidence. A paper published in the BMJ in 2013 found that ‘…telecare did not lead to significant reductions in service use over 12 months, and could have led to increases’. (Stevenson et al 2013). Henderson et al (BMJ 2013) found ‘….telehealth does not seem to be a cost-effective addition to standard support and treatment’. The Trust is accepting the advice of NHS England to pursue new approaches which have not been demonstrated as either effective or cheaper. Yet cuts are being planned on the basis of saving money from these schemes. The medical journals are full of papers criticising the government’s ‘back of an envelope’ approach to bringing in changes that have not been properly evaluated. These are the kinds of risks we believe the Trust and CCCG should be talking to us about.
8. The Trust and CCG officers tell us that no decisions have been made yet, and that these changes may never come about, and that they are waiting for the results of consultation/engagement processes. But the plans and figures are out in the public domain, whether it will happen to Huddersfield Royal or Calderdale Royal, and we believe some of the supporting changes have already started, under a different title. Over the next year we expect to see the kind of ‘mission creep’ that inevitably ends in full scale and dramatic change, despite earlier protestations to the contrary.
9. We believe that the proposed changes and cuts described in the SOC and the Balanced Plan are primarily driven by financial motivations rather than by patient need. There is clearly a severe shortage of cash available to the local NHS commissioners and providers, for which we largely blame the coalition government and its unmandated interference in the running of the NHS. We believe that the market system, the purchaser/provider split and the procurement process waste scandalous amounts of money and that our local commissioners should devote themselves to attempting to limit the amount of money lost in these areas. We also believe that both CCCG and CHFT should end the disgracefully extravagent use of external consultancy agencies to prepare documents that they themselves are very well paid to produce. We know that a company called PA Consulting was paid nearly £1 million by the two local CCGs to help prepare the Trust’s recent Strategic Review. An external consultant is currently advising the CHFT on the Balanced Plan. We believe this is an unacceptable use of public money and should stop.
10. Furthermore, we believe that the PFI contract on Calderdale Royal Hospital was badly negotiated and is proving to be extraordinarily poor value for money. We believe investment should be made into efforts to renegotiate this contract and free up the breathtaking amounts it is costing every year. If the CHFT were to carry out a genuinely transparent consultation involving staff at all levels in identifying savings, they may find there are alternative options to the drastic ones proposed. These are some of the areas where we believe savings could legitimately be made, rather than by penalising the citizens of Calderdale by cutting services and investing in uncertain/unproven practices.
11. In conclusion, we have grave doubts about the validity of the Preferred Option of the SOC and the proposed bed cuts/service configuration changes as described in that document and the Balanced Plan. We are not persuaded that the supporting clinical evidence is there for new service configurations and we fear greatly that health services for the Calderdale population will seriously deteriorate if these plans are implemented, and sadly for some people will end in a fatal outcome.