The Secretary of Calderdale NHS 38 Degrees Campaign Group reports on the first meeting of Calderdale Commission on health and social care on Tuesday 29th July, where she and two other members of the group handed over a paper copy of the 38 degrees submission.  This says that local hospital services are excellent and must stay in place.

There were three members of Calderdale NHS 38 Degrees and about 3 other members of the public at the meeting. It was a terrible turnout.

This was raised by a member of the public, and some suggested it was due to poor advertising, or to being held during the working day.  Councillor Lynn said many of her constituents were celebrating Eid on that day.

This is the ‘People’s Commission’ set up as a result of the unanimous Council vote in April to ask the Trust to withdraw the Strategic Outline Case which threatens to close A&E either in Calderdale or Huddersfield, as well as cut most of the beds in the hospital that loses its A&E, replacing some but not all of them in the other hospital and making up for the rest by care in the community.

We believe it will be Calderdale Royal to lose its A&E and have the beds cut to 87, because it carries a huge PFI debt and something has to pay it. Huddersfield Hospital does not have a PFI debt.

A Chair who’s advised local authorities how to privatise care services

The Council agreed to set up a commission to take evidence from the public, community groups, health and social care organisations and the Clinical Commissioning Group to determine what would be the best way for health and social care services to be provided in Calderdale.  They will look at research and practice-based evidence in various service delivery models.

There are 6 councillors on the commission, 2 from each party plus Leader Tim Swift.

[Editor’s note: As of the Full Council meeting on 30th July, Cllr Tim Swift is no longer council leader because the LibDems and Tories passed a motion of no confidence for reasons that no one seems to have clearly stated. The Council is now a Tory administration with Cllr Baines as leader. Cllr Swift has asked Cllr Baines whether this will affect his position on the Commission but hasn’t yet heard back].

The Chair is Prof Andrew Kerslake, Associate Director of Institute of Public Health from Oxford Brookes University. We have had some doubts about his impartiality because in 2011 he came to Yorkshire to tell Local Authorities how to privatise care services.

Calderdale Clinical Commissioning Group (CCG) and Healthwatch were invited but have declined to join the Commission.

Health and Social Care Director’s presentation on moves to integrated health and social care

Bev Maybury, Director of Adult Health and Social Care at Calderdale Council, gave a presentation about the relationship between health care and social care, and the move towards integrated care which is being driven by new Government policies – the Care Act, the Better Care Fund Programme and the Health and Social Care Act 2012.

She said that due to increasing numbers of people living to a later age and having multiple long term conditions, plus financial restraints, new models of care have to be considered.

[Editors note: The BMJ recently published an article  dismissing as a “myth” the idea that  integrating health care and social care requires a “heroic restructuring” of the NHS and social care systems. Instead it points to a short term problem that needs solving. Aging baby boomers want to keep and pass on their wealth, while having someone else pay for their care. At the same time, drastic cuts to social care funding mean that social care cannot keep up with hospital discharge so patients stay in hospital longer than they need to. The solution to this problem, say the article’s authors, is more funding, especially for social care.]

Bev Maybury spoke enthusiastically about a model of multi-agency locality care teams, clustered around the GP, where prevention was the priority.  She felt it would be possible to integrate organisations and mentioned the Re-enablement Service as a good example of post-discharge integrated health and social care.  She said it was all about changing culture and organising pathways, and identified the role of the ‘generic’ Worker/Team as being crucial.

Bev Maybury said she foresaw the challenges in the new models of care as being around equalising eligibility criteria: at the moment everyone is entitled to healthcare but only certain people are entitled to social care (those assessed as in moderate or severe need in Calderdale). Plus the fact that social care is not free at the point of need as health care is (currently).

One question from the public was about how ready are GP’s and services to make these changes. This has been tried many times before but never worked.  Bev replied ‘this is a work in progress’, but said that this time the Better Care Fund is demanding that the NHS transfer money to social services to form joint budgets, so it’s more likely to work.

(But a downside is that this takes vital money away from the NHS, at a time when it is increasingly short of funding and having to find ways of making serious spending cuts, as our hospitals Trust Chief Executive told the Council’s Adults Health and Scrutiny Panel earlier this week.)

Another question was about how will the formal and informal (friends, family, volunteers) systems work together.  Bev replied co-location is crucial to taking the personalisation agenda forward, (whatever that means).

She foresaw family and friends as being part of the spectrum of services/care that would routinely be available.

When asked about the many pressures on GP’s at the moment she said they are becoming ‘increasingly engaged with the agenda’.

Marketisation and fragmentation: “My, that’s a big question”

I asked about the tension between the integrated care philosophy of co-operation and goodwill, and the pressures of the market model which cause competition and fragmentation,  and which are the enemy of joined-up working.

Bev said,

‘My that’s a big question’.

She couldn’t really answer it and I think had probably never really considered the issue, as it is unlikely to have have come up in the planning systems as a matter to be considered.

The Chair asked how much of social care is contracted out (to private companies) and she said nearly 85%.  She did say they were trying to narrow it down to three main providers.

I also asked about the potential problems created by a lack of an integrated electronic record, even within health services.  She replied that Calderdale LA is planning to use an electronic system being piloted in Leeds which will create an integrated record within social care.  I asked why she thought this would succeed where the billions spent on attempts to introduce integrated NHS systems had failed.  Councillor Bob Metcalfe backed her up and said the Trust was trying a new electronic system to link in to all providers and social care services (a data protection nightmare no doubt) and they were optimistic about this development. (Not sure if he was talking about the same system as Bev.)

She was asked about bed blocking due to lack of social care for people at home.  She said this was a minor problem with the highest number of recent cases in a month being six.  She said some months eg June, there have been no patients waiting for discharge because of social care delays.  She said there are other reasons for bed blocking such as waiting for diagnostics, or transfer to another ward/hospital.

She was asked about continuity of care and how care providers will communicate what they are doing and keep the service consistent for clients.  She said again the local authority (LA) is trying to reduce the number of providers, and to draw up contracts to improve working conditions by banning zero hours contracts, paying the living wage, and paying travel costs. She said paying a little more is essential to get a better service.  She spoke of the concept of Personal Assistants who will be allocated to clients.

Councillor Barry Collins  suggested that the LA is not in any position to make these kinds of decisions yet, but that the Trust seems to be pushing them through.

The Chair asked what impact the Trust’s Strategic Outline Case (SOC) will have on social care.  Bev replied that the integrated service model wasn’t developed sufficiently in the SOC to be able to answer that.

The Chair asked if reduced demand for health care is ever possible.  Bev said prevention and early interventions may stop increased demand.  She said some people are admitted to hospital when they don’t really need to be, and could be managed better at home if the right services, such as night time home care for example, were there.

A member of the public (retired nurse) asked what staff on the ground thought about all this.  Bev said all they want is to be able to give their clients enough time to carry out their work properly.

Paul Butcher, Calderdale Council’s Public Health Officer, then circulated some documents showing graphs of statistics about A&E attendances and emergency and elective admission to Calderdale Royal.  He said they would be put on the council website.  He said there were 70,000 emergency admissions to A&E every year (I thought it was more like 124,000) and 31,000 planned admissions of which 80% are day cases. He said he would provide more information on 3 points.
1.  Data regarding emergency services
2.  What does good health performance look like
3.  How healthy is Calderdale?

This was a positive meeting, well managed and the Chair kept it to time and made sure people had their chance to speak out.

No real challenge at meeting

There was no real challenge, as Bev Maybury is a Calderdale Council employee and there was no talk of where the money for these ideas may come from, but I think some of the councillors are very unhappy about the way the Trust and Clinical Commissioning Group seem to be steamrollering changes through, whilst denying they have made any final decisions.

Personally, I support the concept of integrated care as a model and I think these ideas are very commendable, but extremely idealistic, and probably impossible to achieve for many reasons.  I certainly do not agree that they should be subsidised by cuts in health services.

I do not think there has been any thought given to wider issues outside the instructions being sent down from central government, and there is a lemming like quality to the total system acceptance of unproven and untried ideas, heading over the cliff.

Future meetings

The meeting also carried out Commission ‘housekeeping’ business, confirming the terms of reference and timetable for meetings. The Terms of Reference broadly cover 5 areas –
1.  To speak to the people and try to understand their future needs for health and social care.
2  To explore different policy and service delivery models to identify ‘what works’ and produces best outcomes.
3.  To look at current policy and delivery models
4.  To understand the Trust Outline Business Case
5.  To develop recommendations for the future design of services.

Between now and October there will be 3 full meetings with a series of locality events arranged across Calderdale in between.

The next public meeting –  Wednesday 13th August 1.30-3.30 at the Town Hall.  (this may change in the light of comments about poor public attendance)

Locality Events – all 4.30-6.30pm

Monday 4th August – Halifax Library
Wednesday 6th August Todmorden Town Hall
Thursday 7th August Three ways Centre in Halifax
Friday 8th August Brighouse Civic hall
Wednesday 13th August – Elsie Whitely Innovation centre
Thursday 19th August – Clay House West Vale

A report with recommendations will be presented to Cabinet in October.

Representing 38 degrees, I shall try to attend more events. Please send in your own stories about services to the email address on the Council Website.  Tell them what you have found to be good and what you want to see continue.  Even if it’s only a few lines.  I fear apathy and poor public awareness may mean there is little response.