Calderdale and Huddersfield NHS commissioners are to ask their Governing Bodies for permission to shelve the scheduled public consultation on the so-called “Right Care Right Time Right Place” NHS shakeup.

This shakeup includes the likely closure of Calderdale Royal Hospital A&E and at least 360 of its 450 beds.

Overall, at least 200 acute hospital beds across both CRH and Huddersfield Royal Infirmary would be cut and replaced with a new system of care in the community that is based on the model used by the American private health care company Kaiser Permanente.

Since NHS chiefs announced the shakeup in February, there has been widespread public opposition to these proposals.

This is why the NHS Commissioners want to avoid the public consultation that they were due to carry out this summer, according to their new Report, “Delivery of the Five Year Plan – Right Care, Right Time, Right Place”, p 10)

Instead, the Clinical Commissioning Groups (CCGs) are asking their Governing Bodies to approve a plan to:

• immediately introduce the “Right Care” community health and social care service transformation in two phases, without any public consultation
• delay the public consultation on the proposed acute and emergency hospital services cuts until after the “Right Care” community services are in place.

The Report doesn’t say so, but once the new community health and social care system is in place, the hospital cuts would be a foregone conclusion, since the commissioners’ budget won’t cover both the “Right Care” community health and social care services and existing hospital services.

Calder Valley MP Craig Whittaker said,

“If you read my last Courier article  you may get a clue. I would suspect the outline business plan from the NHS Trust does not include worked up costs on all other bits of the strategy and they are trying to ‘put  the cart before the horse’. Good that CCG’s recognise this to be the case. This is a good indication not a cynical one. People might just get what they want!”

Mr Whittaker’s comment overlooks the fact that the CCGs’ Report explicitly states that they have not yet looked at the hospitals Trust’s Outline Business Case.

This is because the CCGs are following rules about their “approach to market” – in other words rules that govern how they commission services, either by competitive tender which invites bids from private companies, or by sticking with the NHS hospital and mental health trusts as their preferred providers.

The NHS “market” regulator Monitor has advised them not to look at the hospitals Trust’s Outline Business Case until the CCGs have clarified their commissioning requirements.

Privatisation of community health services is on the cards

New information in the NHS Commissioners’ Report about how they will decide whether or not to commission services “competitively” – ie by inviting bids from private health care companies as well as existing NHS providers – indicates that both phases of introducing the Right Care community health and social care system seem geared to privatising community health services.

(85% of Calderdale Council’s social care services are already privatised.)

Phase 1 of the new plan to transform community health and social care services without consulting the public is to recommission existing services.

Phase 2 is to shift hospital-based services into the community.

Plain Speaker is asking Calderdale Council Adults Health and Social Care Scrutiny Panel  members if they will call in Calderdale Clinical Commissioning Group to explain these new proposals. Members of the public can also ask their ward Councillors to pass on this request to the Scrutiny Panel.

Ever-moving goalposts

The Scrutiny Panel has the statutory power to hold the Council’s external partners to account, as well as to call in decisions made by the Council.

Save Calderdale and Huddersfield Hospitals campaigners are writing to their MPs and Councillors, asking them to take action to stop these moves to make major NHS changes without any public consultation.

Ken Roe, Chair of Band Together For Our NHS, said,

“The ever-moving goal posts and increasing secrecy surrounding this project raises serious questions about the motivations behind the recommended timeline change and the competency of the team tasked to deliver the process. It appears that public opinions, needs and wants mean little or nothing to an organisation hell bent on implementing their preferred changes at all costs.”

Legal obligation to consult the public on significant changes to the NHS

The CCGs have a legal obligation to consult the public on significant changes to the NHS, and their document clearly states that the proposed changes to community health and social care are significant.

The CCGs hope they can get around this problem by showing that:

“we have conducted sufficient engagement in relation to our proposed changes to community services.”

Earlier this summer, public engagement events about the “Right Care” proposals were very poorly attended. Members of the public who did attend reported that CCGs staff seemed unable to answer their questions and were often unprepared to note their comments and questions.

Nor did they “engage” with the public about  plans to privatise community health services, which are strongly indicated in the document the CCGs Governing Bodies are to consider at their next meetings.

Band Together For Our NHS Chair Ken Roe said,

“For many months both Calderdale and Greater Huddersfield CCGs have made much of the critical importance of the engagement process and public consultation in the proposed Right Care, Right Time, Right Place Programme, however at the same time detailed questions regarding the robustness of the engagement process have been repeatedly fobbed off and instead of detailed results all that has been made available to the public is a list of anecdotal statements that are neither quantified nor evidenced.”

If the CCGs get their way, once the community health and social care services transformation has happened, the proposed acute and emergency hospital services cuts will be inevitable.

This is because the NHS commissioners don’t have enough money to continue to run existing hospital services alongside the new community health and social care services.

This all looks very much like “predetermination” – which is when public bodies make service changes that only make sense in relation to bigger service changes, before they’ve consulted the public on the bigger service changes.

Predetermination is illegal and can be challenged in a court of law.

Ken Roe said,

“The business case documents have been deemed confidential due to ‘commercial sensitivity’ and now we have a recommendation to delay the legally required formal public consultation until a major part of the changes have in fact been introduced.”

The CCGs acknowledge that this approach brings many risks. As well as risks associated with sidestepping their legal obligation to consult on significant health service changes, the document  says that the new plan could:

• increase the risk of a deterioration in hospital services, through delaying the proposed cuts
• make it impossible to “address current workforce issues”
• fund and resource double running of both new community care services and existing hospital services
• damage the motivation and morale of hospital clinical staff

Compared to these risks, the Report says that if the CCGs stuck to the original plan to hold a public consultation this summer, the only risk – apart from the public rejection of the Right Care proposals – would be that this could delay the proposed changes to community health and social care services, so that they would not be in place before acute and emergency hospital services were cut.

Plain Speaker is unable to see the logic in this statement. Surely public consultation would delay both elements of the Right Care proposals equally?

Calderdale CCG’s August 14th Governing Body meeting will be asked to approve proposals in the Report, “Delivery of the Five Year Plan – Right Care, Right Time, Right Place”.

The document rebrands the community care proposals as “Care Closer to Home”.

Care Closer to Home – phase one: NHS and Council commissioners to privatise existing community services; phase 2: shift hospital-based services into the “community”

The rebranded “Care Closer to Home” community health and social care system the CCGs want to introduce without public consultation is basically the same as the community care proposals in the Strategic Outline Case, fleshed out a little with new information about the Commissioners’ privatisation agenda.

For example, the “Delivery of the Five Year Plan – Right Care, Right Time, Right Place” Report outlines how the CCGs will decide whether or not to commission services “competitively” – ie by allowing bids from private health care companies as well as existing NHS providers. (p 7)

It also says that the first phase of commissioning care in the community services will be to re-commission existing services.

This strongly suggests that both the NHS and the Council commissioners plan to open up existing community services to competitive tender by private companies. Otherwise why would they re-commission them?

How to destroy NHS community care providers

In Calderdale, community health care services are currently provided by the hospitals trust or by the mental health trust, with a few exceptions where they are provided by private health care companies.

Calderdale Council has recently put the existing the Drugs, Alcohol and Tobacco Prevention and Treatment Service out to competitive tender.  This service is currently provided by the NHS mental health Trust.

(Update: Calderdale Council awarded the contract to the charity Lifeline, which went bust in 2017. The Charity Commission said  that Lifeline’s collapse highlighted the need for tight financial controls and oversight by charity trustees. Lifeline is just one of a number of charities that have collapsed, casting doubt on the running of essential public services by charities.

Calderdale’s Drugs, Alcohol and Smoking Cessation service was then taken over by DISC (Developing initiatives for support in the community). According to the Care Quality Commission report, DISC is one of three providers that run Calderdale Recovery Steps as a partnership that delivers accessible adult drug and alcohol services across Calderdale. Clients may use local ‘Recovery Hubs’ in Halifax or rural Todmorden, or go to their own GP surgeries for treatment, support and reviews known as primary care extended services. End of update)

The mental health Trust is apparently not bidding for the new contract for this service.

As a result of government underfunding, the mental health Trust is under massive financial pressure, like NHS providers across the country.

Losing the Drugs, Alcohol and Tobacco Services contract will not help the mental health Trust.

Calderdale and Huddersfield NHS Foundation Trust is currently struggling to make government-imposed £20m efficiency savings this year, but so far has only been able to identify £7.7m possible spending cuts. The Trust is now holding meetings to ask staff to identify more ways of cutting spending.

Caught between the pincers of underfunding and competition from private health care companies, NHS providers are likely to be scuppered.

This is playing out the stealth-privatisation aims of the 2012 Health and Social Care Act

Since the Health and Social Care Act came into effect in April 2013, the biggest proportion of the £bns of NHS privatisation has been in community health services.
Calderdale and Huddersfield NHS and Council commissioners are clearly following this trend. It’s becoming clear that the Right Care-type proposals that are being set in motion across the country are a Trojan Horse for NHS privatisation.

Phase 2 of commissioning community health and social care services without any public consultation is to shift hospital-based services into the community

In areas where the dismantling of the NHS is further advanced than here, this shift of hospital-based services into the community has led to the biggest privatisation contracts in the NHS so far.  For example, the East Midlands contracts for cancer care in the community and integrated care for the elderly together total £1.2bn.

Why do the NHS Commissioners and Calderdale Council think this is a good idea? Please consider asking them.

You can read Calderdale CCG’s Report “Delivery of the Five Year Plan – Right Care, Right Time, Right Place” here.

Information about the commercial confidentiality of the hospitals Trust’s Outline Business Case is here.

Information about Calderdale 38 Degrees NHS Campaign Group’s views on the Right Care proposals and the future of Calderdale NHS and social care services is here.