On 22nd September 2014, Calderdale and Kirklees Councils’ Joint Health Scrutiny Committee (JHSC) started scrutinising the local NHS commissioners’ proposals for chopping and changing hospital and community based health services. These proposals are known as Right Care Right Place Right Time.

The JHSC has decided that, should the options outlined in the Right Care Right Place Right Time Strategic Outline Case be developed into formal proposals, they would constitute a substantial development and variation to the health service.

The JHSC has a duty to scrutinise such substantial proposals and their impact on the people of Calderdale and Huddersfield, by requiring local NHS bodies to consult with them.

It also has the power, and the responsibility to use this power, to ask the Secretary of State to stop any proposals if they think that the Clinical Commissioning Groups’ (CCGs’) consultation with the JHSC on the proposals has  been inadequate, and/or if the JHSC considers that the proposals are not in the interests of the health service in Calderdale and Kirklees.

Campaigners worried that JHSC has no timeline for producing scrutiny report

Although the JHSC persistently questioned the CCGs about the timeline for their proposed transformation of Calderdale and Huddersfield health services, they didn’t come up with a timeline for their own scrutiny report.

And at the time of writing, the JHSC has no plans for a follow up meeting.

This is a matter of concern for campaigners from Save Calderdale Royal Hospital, Calderdale 38 Degrees NHS and Huddersfield KONP – particularly since the Health Scrutiny Committee that scrutinised similar plans for cuts and changes to N. Kirklees NHS left it too late for their critical report to the Secretary of State to have any effect in stopping the changes – despite the JHSC’s conclusion that they were not fit for the people of North Kirklees.

According to a member of the public who witnessed the process, the JHSC that considered the N. Kirklees and Dewsbury Hospital reconfiguration plans were plagued by lack of attendance of councillors at meetings and poor quality questions to the Mid Yorkshire Hospital Trust, Wakefield CCG and North Kirklees CCG.

What about the legal requirement for formal public consultation for major health service changes?

Another worry for Campaigners from Save Calderdale Royal Hospital, Calderdale 38 Degrees and Huddersfield KONP, who attended the JHSC meeting, is that Calderdale and Greater Huddersfield NHS commissioners are not proposing to formally consult the public on the Right Care proposals until 2017. By this time, the NHS commissioners they will have already set up Phase 1 and Phase 2 of the community health care system.

Since Right Care proposals amount to a substantial development and variation to the NHS, there is a legal requirement for the NHS Commissioners to carry out a formal public consultation on the proposals.

This has to happen at a formative stage, when all options are open. Otherwise it is not a meaningful consultation – the outcome has been predetermined.

In an adjournment debate in the House of Commons on 20th November 2014, Halifax MP LInda Riordan called for proper public consultation on the NHS shake up plans.

The JHSC meeting was to find out about the NHS commissioners’ formal proposals for commissioning community care services as outlined in the Right Care Right Time Right Place Strategic Outline Case.

But the JHSC failed to scrutinise the Clinical Commissioning Groups’ decision early in August to abandon their scheduled public consultation about the Right Care proposals,  that was planned for July-September.

Faced with widespread public opposition, both CCGs ducked the public consultation.

Instead, they produced a commissioning intentions document that split the Right Care proposals into two – the new community care system (Care Closer to Home) and cuts and changes to Calderdale & Huddersfield Hospitals.

They said they would only consult the public on the hospital cuts and changes, and delay that consultation until they’d set up Phase 1 and Phase 2 of community care system, which is scheduled to take until 2017.

The hospital cuts and changes would see at least one hundred beds go, Calderdale Royal Hospital operating as a small, 87 bed planned care clinic with a minor injuries unit and Huddersfield as the acute care hospital with the A&E department, hospitals cuts.

In her presentation to the JHSC, the GHCCG Chief Officer Carol McKenna said that the CCGs would:

“produce a consultation document in the fullness of time, when we’re ready to do so.”

The CCCG Chief Officer Matt Walsh said that the CCG has a timeline for working to get ready for consultation and will let the JHSC have it.

The JHSC Chair, Cllr Elizabeth Smaje, replied,

“We need that timeframe, clarity on Care Closer to Home services and how it impacts on hospital services.”

Lack of money to run both community care system and existing hospital services will make delayed hospital changes consultation meaningless

By holding off on the public consultation until Phase 1 and Phase 2 of  the community care system are in place, the proposals will no longer be at a formative stage. Many options will have been closed off.

And cuts to acute and emergency hospital care will be inevitable, since there’s not enough money to run both the new community care system and existing hospital services.

Matt Walsh, the Calderdale Clinical Commissioning Group Chief Officer, said that Phase 1, which is currently underway and will be complete early in 2015, is about introducing a Single Point of Access for existing community health services and increasing integration and coordination of existing community services.

Phase 2 will expand the level of services in the community setting and will have an impact on the hosptal trust and the way it works. Matt Walsh said,

“A key issue is double running – having a contract with CHFT [Calderdale and Huddersfield NHS Foundation Trust] and contracts with community services means double funding.

We need to think about the Impact and consequences of that on hospital services – which are currently operated by CHFT & SWYPFT [South West Yorkshire Partnership Foundation Trust].”

Cllr Ann Collins said,

“CHFT is required to make efficiency savings this year and next. For Phase 1 CC2H [Care Closer To Home], will the efficiency savings make up the balance to cover the costs of community care?

And how can you reconcile the fact that CHFT has to make spending cuts now, with the need to double fund Phase 2?

Really as a group we need to look at phasing these services. I’m still very concerned about this.

Are we putting the cart before the horse – cutting hospital services before putting community services in place?”

CCG worried about hospitals’ “efficiency” cuts

Matt Walsh said,

“I’m  worried about it too. It’s part of the way the tariff works – providers have to deliver efficiencies year on year.

It’s slightly different in Calderdale – community services are delivered by CHFT – we have to have a conversation about how existing services can be delivered differently under the existing contact.

GHCCG is different because community services are contracted out to Locala, and the contract ends Sept 2015.”

Carol McKenna, Chief Officer of Greater HUddersfield CCG, said that  CHFT has to deliver efficiencies like every other public sector organisation, and the CCGs have to make sure that efficiency cuts don’t reduce the quality of services. She added,

“The trick is to increase efficiency in community care which will increase the ability of the hospital to cuts costs. For example, the end of life community care should cut patients’ hospital admissions from 10 a year to 4 a year. This will help hospital to make efficiency savings.”

The JHSC Chair Cllr Elizabeth Smaje asked about the remit of the Joint Assurance Hospital Services Programme Quality Group.

Carol McKenna said that it is focussed mainly on hospital services. But it will also have to take into account the effects on the hospitals of CC2H. She said that the CCGs can share the Terms of Ref for that Quality Assurance Group with the JHSC

Cllr Malcolm James asked,

“How much clarity can you give us that CHFT can make 4% efficiency savings 14/15, 15/6? What about figures for following years? How much clarity can you offer us about financial stability of CHFT over the next 2,3,4,5 years?”

Matt Walsh replied,

“The situation is full of uncertainties. We know there’s going to be a major financial challenge – a £30bn funding gap over next 5 years. I wish one of the political parties would fix this – but there’s no sign of this, so the dilemma is how to fix services to meet the public sector challenge.”

Cllr James said,

“The information’s cloudy beyond the first year and a half. The path forward is not that clear.”

Carol McKenna said,

“That’s no different from any other health and social care economy in the land, given the challenge we’re facing.”

Cllr Malcolm James said,

“In the context of the CHFT Balanced Plan presentation– there’s a substantial likelihood of failure to meet their efficiency cuts targets. This is going to compound the problem that the CCG faces.”

What are the specifications for community health care?

Cllr Barraclough asked,

“Will the new model deliver cost savings across the board? Will hospital savings be cancelled out through community care and this this affect LA budgets?”

Matt Walsh replied,

“The Better Care Fund is the way to have a better conversation between the NHS and Local Authority commissioners. There’s anxiety on both sides about cost-shifting. Risk exists on both sides of the relationship.”

Cllr A Collins asked:

“Regarding the JHSC, what we have no view of yet is about specifications for community services. This will be more difficult to consult on, engage on. The JHSC needs to know about what services people are going to get.”

Carol McKenna said that Greater Huddersfield Clinical Commissioning Group documents presented to the JHSC include the community care service specification, that shows how engagement work has been transferred into the commissioning intentions and services specification.

Kirklees Councillor Phil Scott said,

“I’ve not been engaged with once with you, despite claims that CCGs have engaged with MPs, Councillors and so on. Your statements about, for example, engaging councillors could be misleading to the public.”

The JHSC Chair, Cllr Elizabeth Smaje, said,

“It’s disappointing because we’ve been here before with other reconfiguration processes, so it’s concerning that you haven’t learnt from these previous experiences.”