In a dramatic move, Calderdale’s NHS Commissioners have decided to shelve public consultation on the proposed NHS shake up.

At a meeting on 14th August, they batted aside a letter from Councillor Malcolm James, Chair of Calderdale Council’s Adults Health and Social Care Scrutiny Panel, that asked Calderdale’s NHS Commissioners not to make any decisions about community health services that have not been subject to sufficient consultation with the public, or that lead to significant service variations and changes.

Now both Huddersfield and Calderdale NHS Commissioners intend to go ahead with all the community care service changes proposed in the Calderdale and Huddersfield NHS  shake-up plans, without any public consultation.

The unpopular shake-up, called “Right Care Right Time Right Place”, aims to:

• close one of the hospital Trust’s A&E departments – in all likelihood the one at Calderdale Royal Hospital
• cut over 100 acute hospital beds
• turn the hospital without an A&E into an 80 bed planned care clinic with a Minor Injuries Unit, and the other hospital into a specialist unplanned/acute/emergency hospital
• replace the lost hospitals services by a new system of care in the community, based on a model used by the American private health care company Kaiser Permanente.

The Secretary of Calderdale 38 Degrees NHS Campaign Group said,

‘Once again the Clinical Commissioning Group has shown it is not prepared to listen to its public nor to the elected representatives of its public, instead ploughing ahead with unpopular and pre-agreed plans which will end in the dismantling of our local health services.  This is not what we want nor deserve.’

 

However, guidance on the NHS Networks website says that the Scrutiny Panel makes the decisions about what is a significant service change that has to go to public consultation.

So if the Scrutiny Panel do their job properly, Calderdale Clinical Commissioning Group should end up having to consult the public, even though they want to avoid doing this.

“Time for our elected representatives to step up and halt this process before it’s too late”

Gary Scott, who organised the Only Clowns Would Close Our A&E march in Halifax last February, said,

“From the very start, we’ve felt that the Clinical Commissioning Groups have considered public “consultation” as a mere formality on the way to their preferred option of closing our A&E, implementing huge, untried changes to care, and cutting budgets, beds and jobs. These “consultations” and engagements have included the cancelling of public questions at their own public meeting, and failing to take any notes of objections whatsoever at “roadshow” events. And in one case failing even to turn up!

The people have Halifax have said loud and clear that we do not accept these unnecessary cuts, and have organised well to put forward a clear and coherent case for a full review of these changes. As the CCGs are now dispensing with even the pretence of public consultation, it’s now time for our elected representatives to step up, and halt this process, before it’s too late. By a legal challenge if necessary.”

On Thursday 14th August, Calderdale Clinical Commissioning Group’s Governing Body meeting approved a Report that recommended postponing public consultation until after the new “Right Care” community care system – now re-branded as Care Closer to Home – is in place.

Urging the Governing Body to approve this recommendation, the Chief Officer, Dr Walsh, asked them to think about:

“which approach gives us the best opportunity to deliver significant service change.”

While the Chair Dr Brook said,

“I strongly advocate this as unprecedentedly assertive and courageous.”

If these proposals go ahead, the public consultation would only cover the proposals to cut the hospitals’ acute and emergency services.

And by then, the outcome of that consultation would be a foregone conclusion, since NHS chiefs are clear that there is not enough money to pay for both the new community care system – now rebranded as Care Closer to Home – and existing hospital services.

Walk for the NHS organiser Katherine Horner said,

“Neither Calderdale Commissioning Group nor Calderdale and Huddersfield NHS Foundation Trust seem to understand that the people of Calderdale and Huddersfield deserve a say on their local health services and what they would like to see.

We don’t want to be fobbed off with boring power point presentations at poorly attended and poorly advertised meetings, or have the plans forced upon us because the Trust and CCG believe in a practice of smoke and mirrors and misinformation.”

Scrutiny Panel Chair’s appeal to NHS Commissioners

At Calderdale Council’s Scrutiny Panel meeting on Tuesday 12th August, Councillors agreed that their Chair Cllr Malcolm James would write immediately to Calderdale Clinical Commissioning Group, asking them to come to the Scrutiny Panel to explain their new plan for carrying out the “Right Care…” shake up, and in the meantime not to make any decisions about community health services without sufficient public consultation, or that lead to significant service variations and changes.

In support of this Scrutiny Panel move, Ken Roe,  Chair of Band Together for the NHS, said:

“The ever-moving goal posts and increasing secrecy surrounding this project raise 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.”

It took a member of the public to tell the meeting about the Scrutiny Panel letter

At the Commissioners’ Governing Body meeting on 14th August, neither the Commissioners’ Chief Officer Dr Matt Walsh nor Ms Bev Maybury, Calderdale Council’s Director of Adults Health and Social Care, made any mention of the letter from the Scrutiny Panel Chair.

Information about the letter only came to light when a member of the public, Ken Cheslett, told the meeting that it needed to acknowledge and deal with the Scrutiny Panel’s letter, and went on to explain what it said.

Dr Walsh said he would talk about the letter later.

When he did get round to it, he brushed aside the Scrutiny Panel’s request to refrain from making a decision to carry out the community care service transformation without public consultation.

Dr Walsh said that the community care service transformation was about strengthening existing services and was based on findings from the engagement process.

He continued,

“I do not believe that if we accept the Report’s recommendations today, we act in any way in contravention of the letter from the Scrutiny Panel.”

He said the CCG would be happy to attend a Scrutiny Panel meeting.

In response to a question from a Lay Member, John Mallalieu, about when the Governing Body would know what the change to the timeline would be, as a result of delaying the consultation until after the “Right Care”/Care Closer to Hom Community health and social care system was in place, Dr Walsh said,

“We’ve been careful not to set a timeline. There are processes we need to go through. We clearly need to work with the Scrutiny Panel in Calderdale and if the Scrutiny Panel declares there is an absolute requirement to consult we’ll have to deal with that.”

NHS Commissioners’ spin

If the NHS commissioners can get away with introducing this major change to NHS services without holding a public consultation, the main effect will be to make the outcome of the delayed public consultation on the proposed hospital cuts a foregone conclusion.

As already mentioned there is not enough money to pay for both the new community care system – now re-branded as Care Closer to Home – and existing hospital services.

The Clinical Commissioning Group spin is that their proposal is a good idea, because it would mean that the new community care system would be in place before the cuts were made to the hospitals’ A&E and acute/unplanned care beds.

But the CCG’s Strategic five year plan, agreed earlier this year, makes provision for the new community care system to be introduced before the hospitals services are cut, so that both systems run in tandem for the next two years.

And recently the hospitals Trust Chief Executive told the Calderdale Council Scrutiny Panel that the acute/unplanned bed cuts would not be made until 2016/17 and 2017/18.

So the only significant change appears to be that the public will not be allowed to play a part in making the decision about the proposed shake up of NHS and social care services.

Scrutiny Panel must guarantee the public’s right to a say in the whole Right Care shake-up

Stella Clarkson, a member of Band Together For Our NHS said,

“The public can count it as a small victory that their opposition to the Right Care shake-up has made the NHS Commissioners move the goalposts. They have done this because they know the public consultation on Right Care, which should be taking place this summer, would say a big NO.

But it’s important to recognise the Commissioners’ proposal for what it is: an attempt to take away the public’s right to have a say in the proposed shake-up.

Calderdale Council’s Scrutiny Panel now has the task of making sure Calderdale CCG does not do this.

But I was extremely disappointed with the Scrutiny  Panel’s performance (except one councillor) at the meeting attended by the Chief Executive of Calderdale and Huddersfield hospitals Trust and his advisors.  The Panel appeared out of touch with the issues,  were easily distracted by the Trust and they did not focus adequately on local issues, or question the Trust about their proposals to increase income from private patients and overseas visitors.

Following pressure from  Save our NHS campaigners the Scrutiny Panel are to employ an external advisor to help them perform much better. Hopefully they will have an appropriate adviser on Sept 8th when the CCG are to attend for scrutiny of their plans.

Locally our councillors have stated they are in full support of keeping Calderdale A&E open. In April, they voted unanimously to ask the hospitals trust to withdraw their Right Care Strategic Outline Case shake up plans.

The Council’s Adults health and social care Scrutiny Panel need to remember this, and stop the Commissioners from pushing through the Right Care community care service transformation without public consultation. The Commissioners have re-branded the Right Care community care proposals as Care Closer to Home, but they are still the same proposals.”

Asked by  Plain Speaker to explain the difference between the Right Care community care proposals and the Care Closer to Home proposals, the Calderdale Clincical Commissioning Group Governing Body Chair Dr Brooks refused. He said the question would be answered later in the meeting, but it wasn’t.

Stella Clarkson said,

“We are relying on the Scrutiny Panel to make sure that the whole Right Care shake-up proposals go to full, formal public consultation before the Clinical Commissioning Group and its co-commissioners Calderdale Council even think of setting up the new Right Care community care system, which commissioners for some reason have rebranded as Care Closer to Home.”

Campaigners will fight on to save hospital services and make sure public has a say

Apart from this, Save our NHS campaigners say the issues are still the same:

• funding cuts dressed up as efficiency savings are running down the NHS
• this opens the door to NHS privatisation, which is galloping ahead across the whole country
• the public and NHS staff will suffer unless these undesirable changes are stopped

Campaigners say they are not about to get distracted by smoke and mirrors and spin, about how this new proposal from the Commissioners is better than the previous version of the Right Care proposals that the NHS providers produced in the “Strategic Outline Case.”

The Strategic Outline Case was produced by the hospitals Trust together with the mental health Trust and the community health service company Locala.

Ken Cheslett said,

“My view is that Calderdale CCG were going to do this right from the start because, as I told the Chair of the CCG Dr Alan Brook yesterday, in my opinion they are pawns in the governments game of ‘Privatisation’. A government, again in my opinion, that is morally bankrupt.”

Save Our NHS campaigners will continue to focus on saving our hospitals, making sure the public is properly consulted about the planned shake up, and making sure that any new community care system upholds the core principles of the NHS.

Paul Cooney, an NHS worker and member of Huddersfield Keep Our NHS Public, said,

Although I dislike the term “servants”, the officers of the Trusts and Locala, and the commissioners of the vital services they provide, have an absolute responsibility as public servants to meet the health needs of the communities they serve. They also have the responsibility to fully and 
meaningfully consult us about any significant change proposals to these services.
By their decision both the Huddersfield and Calderdale commissioners are failing to carry out this role and they should be held accountable for this refusal to carry out this key responsibility. Although we should expect these officers to defend our services and inform us of the attacks on their budgets by central government, they are not. So we cannot rely on them to be honest actors in these radical changes to some of the most important services that we need and rely upon.”

Stella Clarkson, a member of  Band Together for our NHS, said,

“Once again the NHS Commissioners have moved the goal posts, and when I say commissioners  I mean executives employed by the Government, they are there to implement Government policy.

The clinical members of the CCG do not appear to understand the legislation or the financial implications and seem out of touch with their patients and community.  This has led to them relying on the CCG’s officers and they are gullible to their spin.  The premise that local CCG’s role is to commission local services as they know local needs is also spin.

The NHS commissioners (paid by central government) are the real power behind the throne.”

Serious erosion of NHS core principles

These principles were established when the NHS started in 1948, but are now being significantly eroded and under serious threat:

• The NHS will meet the needs of everyone
• It will be free at the point of delivery
• Health care will be delivered according to clinical need, not the ability to pay

But the recent Health and Social Care Act has removed the requirements to provide NHS services free of charge,  to everyone who needs them.

Unless these requirements are reinstated, increasingly people’s ability to pay for treatment – and not the patient’s clinical need – will determine who can access health care.

Stella Clarkson from Band Together For Our NHS said,

“I believe that the next 9 months leading up to the General Election are crucial. We need clear proposals about our NHS from each party.  The NHS and its core founding principles are strongly supported by the general public. The parties that will get the votes will be the ones that pledge a return to these core principles: universal, equitable health care for everyone, that is free at the point of need, and provided on the basis of the patient’s clinical need not their ability to pay ideal. Restoring these core NHS principles means reversing the unmandated changes in the 2012 Health and Social Care  Act and related legislation. The parties that pledge to do this will get the votes.”

Privatisation of community care services on the cards

At the NHS Commissioners’ Governing Body meeting, there was a lot of talk about commissioning so-called 3rd sector and voluntary organisations to provide the new community care services.

And Calderdale Council, having been forced by central government policies to privatise 85% of its social care services, now wants to mutualise community care services, according to a conversation Plain Speaker took part in after the meeting.

Mutuals are organisations run in the same way that John Lewis shops are run, and the Coalition government is pushing this policy nationally.

But Save Our NHS campaigners point out that the public – including NHS staff- already own the NHS, so what is to be gained by mutualising it?

Sounding out the community care “market”

At a Market Sounding Event last week, Huddersfield Clinical Commissioning Group gave potential community care service providers a presentation about the Care Closer to Home commissioning model. This shows that the plan is to commission one main provider who will then subcontract out different services to various other providers.

This is called the Prime Contractor model, and is like an American commissioning model called Accountable Care. Simon Stevens, the NHS England boss who was formerly head of an American private health care company, was going on about it in the media a few months ago.

The Market Sounding Event presentation, by Calderdale and Huddersfield CCGs’ Procurement Officer Martin Pursey, also shows potential community care providers that the Care Closer to Home reconfiguration has a “footprint” that covers not only Calderdale and Huddersfield but also North Kirklees and Wakefield.

Stella Clarkson of Band Together for Our NHS, said,

“We must not allow the privatisation of existing community health services, or of the new Right Care health and social care services that the CCG and Council are to co-commission.

On the whole, when services are privatised they go to companies who reduce actual contact with service users and staff work largely unsupervised, with very poor working conditions.

There are countless examples of this all over the UK. [link to Doncaster Care UK] I have worked in Social Care for many years and been witness to the erosion of social care due to privatisation and the reduction of money from central Government.

The myth of ring fencing the NHS funding etc on the one hand, and demanding increasing NHS savings on the other,  has already damaged services. When talking to staff in the public sector the one unifying comment has been about the lack of staff, due to ‘cut backs’. They want their services to remain local, such as A/E, if they are staffed properly and safely.”

For people who are interested in wonkery, a more detailed report on the Commissioners’ meeting and decisions will follow shortly.

Here is the Report  that the NHS Commissioners Governing Body approved at the 14th August Meeting.

Here is an Open Democracy article about plans to mutualise the NHS.

Here is the webpage where you can download the guide: Working with local authority scrutiny

Updated 16th August with comments from Paul Cooney, NHS worker and member of Huddersfield Keep Our NHS Public, Stella Clarkson from Calderdale and Huddersfield Band Together For Our NHS and Rosemary Hedges, Calderdale 38 Degrees NHS Campaign Group.