Yesterday a number of Save Calderdale Royal Hospital campaigners attended Calderdale Council’s Adults Health and Social Care Scrutiny Panel, to find out what Calderdale NHS commissioners are planning for Phase 1 of the Right Care Right Place Right Time NHS shake up (which they’ve re-branded as Care Closer to Home.)

After the meeting, those of us who attended were clear that the Scrutiny Panel must use its powers now to stop the the implementation of Phase 1 Care Closer to Home and tell the Clinical Commissioning Group (CCG) to formally consult the public on the Care Closer to Home proposals.

This is what happened

Ms Graham, the Clinical Commissioning Group’s Head of Service Improvement (lol) tells Councillors that on 1st April 2015 the CCG’s community health services contract with our hospitals Trust will include new specifications, which they’re calling Phase 1 Care Closer to Home.

In answer to a question about whether the “provider” is happy with this, Ms Graham strongly implies that the CCG has the Trust over a barrel. She says that the Trust know that if they don’t go along with this new contract, the CCG will “go to market”.

Such an innocent phrase, imagine them all tripping off with baskets over their arms.

The Trust’s minds are concentrated, Ms Graham says, by the example of the CCG in Greater Huddersfield, which has put a £284m 5-7 year community health services contract out to competitive tender. Locala and a consortium based around the hospitals Trust are now fighting over the contract.

Then Ms Graham says that come July 2015, the CCG will measure whether the Trust has reduced “inappropriate” hospital admissions as a result of following the new community health care service specifications in the new contract.

Since existing evidence is that care closer to home schemes don’t reduce hospital admissions, this looks like setting up the hospitals Trust to fail.

However, Councillors seemed oblivious to this.

If at the July check, it turns out that the Trust’s newly-specified Care Closer To Home community health services haven’t reduced hospital admissions, in August the CCG Governing Body will decide whether to sell off our NHS community health services.

Councillors didn’t seem to register this shocking fact as important either.

This would clearly be a major service change. It would put the hospitals Trust further at risk of financial failure, when it’s already got Monitor in investigating its deficit – which is the result of an impossible efficiency savings requirement on the Trust.

Since a formal public consultation is legally required when a major service change is proposed, the Scrutiny Panel should have called a halt to the implementation of this Phase 1 care closer to home scheme, since it could lead to a major service change.

They should have also told the CCG to go off and prepare a formal public consultation on the proposals. Did they? Did they heck.

They meekly asked Ms Graham (who couldn’t quite remember when the CCG was planning to consult the public but thought it might be April 2016) to go away and kindly ask the CCG Chief Officer Matt Walsh when he’s decided to consult the public.

But it’s the Scrutiny Panel’s job to decide when the public consultation has to take place – as Matt Walsh himself mockingly reminded them at a Scrutiny Panel last year.

And then they meekly asked the CCG to communicate more clearly and in future not send them a 61 page document, which none of them had been able to make sense of, so late in the day that the legal requirement had been broken for when documents have to be circulated before meetings in order to allow Councillors time to read them.

Still and all, an election’s coming up, with the chance to vote off at least some of these  Councillors who don’t seem willing or able to do their job of protecting our NHS from damage. But that will be too late to stop the imposition of the Care Closer To Home contract on our NHS hospitals Trust. What are we going to do?

Time to call the lawyers?

This is the email I have since sent to Scrutiny Panel members

It suggests that in the light of what they learned at their meeting yesterday, the Scrutiny Panel must now use their powers to stop any further implementation of  Phase 1 Care Closer to Home and tell the Clinical Commissioning Group to formally consult the public on their proposals.

Dear AHSC SP members & substitutes

At yesterday’s Scrutiny Panel it became clear that, if implemented, Phase 1 of the Care Closer to Home shake up of Calderdale NHS and social care may lead to a Calderdale Clinical Commissioning Group decision in August 2015 to sell off our NHS community health services.

This would amount to a major service change as it risks further destabilising the already precarious CHFT, with potentially serious consequences.

At the worst, this could mean that all we are left with is a package of core essential services – which the CCG said last November it was identifying, in case the Calderdale and Huddersfield NHS Foundation Trust (CHFT) becomes unable to meet its debts, and is writing into the 2015-16 contract with CHFT.

For this reason, it seems evident that the Scrutiny Panel must now use its powers to prevent damage to Calderdale NHS, by telling the CCG to stop implementation of Phase 1 Care Closer to Home (CC2H) now and formally consult the public on their proposals.

New information from CCG

Yesterday Ms Graham, the Clinical Commissioning Group’s Head of Service Improvement, provided information that shows that Phase 1 CC2H has the potential to seriously destablise our NHS hospitals Trust – and so is potentially a major service change:

1) Ms Graham told the Scrutiny Panel that on 1st April 2015, the CCG’s community health services contract with our hospitals Trust will include new specifications, which they’re calling Phase 1 Care Closer to Home. The CCG’s plan is that Phase 1 CC2H will run until 31/3/2016

2) Replying to a later question from Cllr James:  (“What happens on 1st April 2015? … The big changes on 1st April are?”), Ms Graham said,

“The CCG will have a dashboard to see if there is a reduction in inappropriate hospital admissions. There will be a formal measurement in July of that dashboard. If the providers have not met the new Phase 1 specification based on that dashboard measurement, the August governing body meeting will decide on what to do about the providers.”

3) In answer to Cllr Bob Metcalfe’s question about CCG’s current discussions with providers about Phase 1 CC2H – “what if the provider says no?” to the new community health services contract specifications, Ms Graham said:

“The provider’s going along with this because they know their future’s tied up with this because the CCG could go to market as has happened in Greater Huddersfield.”

(In Greater Huddersfield, a £284m 5-7 year community health services contract is currently being fought over by Locala and a consortium based around CHFT that includes our mental health Trust and apparently some other providers too.)

According to info provided yesterday by Ms Graham, the Phase 1 Care Closer to Home specification basically boils down to:

• providers working together to share patient data so patients don’t have to repeat info to different providers – this raises big questions about how the providers will gain informed patient consent to sharing their confidential GP medical records with other providers, and whether/how providers will follow Caldecott standards of information governance
• use of risk stratification to identify patients at risk of hospital admission and to make early interventions designed to reduce the risk of them being admitted to hospital (this wasn’t mentioned in the SP but is indicated in the documents)
• reducing inappropriate hospital admissions, by an amount the CCG hasn’t revealed as far as I know

Piecing together this info, we know that:

• CHFT is going along with Phase 1 CC2H because they know that if they don’t, CCG will sell off the NHS community health services to another provider
• CHFT will have 3 months from 1 April 2015 to show that they can deliver the key Phase 1 CC2H specification, which is a reduction in “inappropriate” hospital admissions – although we don’t know how big a reduction the CCG requires
• If by July 2015 CHFT has not met this Phase 1 CC2H specification, this failure will be reported to the August 2015 CCG Governing Body meeting for a decision on whether/when to “go to market” for community health services ie sell them off to another provider.

Implications of this information

We also know that the evidence from schemes that have set up care closer to home systems, is that care closer to home schemes don’t reduce hospital admissions.

So this looks like the CCG setting up the hospitals Trust to fail.

Once CHFT has failed to meet the Phase 1 CC2H specification of reducing inappropriate hospital admissions, the CCG can sell off our NHS community health services – while still claiming that they tried to “work with their strategic partners” – in the words of Matt Walsh, and that they have treated “providers equally” in the words of Martin Pursey. While also bearing out Dr Brook’s claim to have “no loyalty to existing providers”.*

This would be the perfect stealth privatisation – this being the agenda of the 2012 Health & Social Care Act (HSCA).

Section 3 of the HSCA2102 contains all the provisions that are driving the Right Care transformation.

And despite what the CCG likes to say about local clinicians making the decisions, Right Care Right Place Right Time is an NHS England scheme that is being rolled out across the country. It is the source of most of the big NHS sell offs that have taken place since HSCA 2012 kicked in in April 2013.

That NHS privatisation is the clear intention behind Right Care is shown by what’s happening in Stafford, where the sell off to private providers of £1.2bn integrated end of life and cancer care services has been driven by the Government’s ‘Major Projects’ department, and is promoted by the Government as a new model for privatised cancer delivery across country.

Selling off Calderdale NHS community health services would clearly be a major change. It would put the hospitals Trust further at risk of financial failure – when it’s already got Monitor in, investigating its deficit – which is the result of an impossible efficiency savings requirement on the Trust.

Since a formal public consultation is legally required when a major service change is proposed, the Scrutiny Panel should now call a halt to the CCG’s implementation of Phase 1 care closer to home and tell the CCG to go off and prepare a formal public consultation on their proposals.

CHFT is already in a precarious position

CHFT is so short of beds and staff that on 6th Jan it declared an internal major incident, when it found itself with 27 more patients than beds and was forced to open 45 more beds in each hospital, but was then worried that it didn’t have enough staff to cover the extra beds.

After Monitor increased the CHFT’s risk rating regarding its future as a going concern, last November  I asked CCCG what essential core services they would require to be maintained if CHFT is unable to meet its debts at the end of this financial year. Here is their answer fyi.

On 29th October, Monitor held a meeting to deliberate in secret about re-commissioning NHS community services. Agenda item 7 asked the Monitor Board to note, in secret, “significant developments with regard to the work of the Co-operation and Competition directorate.”
They say if the public knew what the directorate had found, this would “inhibit the free frank disclosure of information.”

The CCG is no doubt under considerable pressure from NHS England and Monitor to sell off the reconfigured NHS community health services created by CC2H/Right Care.

*(These statements were all made in response to a question I asked the CCG Governing Body last spring, at the meeting where it nodded through the Strategic Outline Case.  My question was whether they intended to sell off the reconfigured integrated/community health services that would be set up under the Right Care/Care Closer to Home proposals.  Monitor lays down the rules about how the CCG procures NHS services, and is pushing for more sell offs, But clearly the CCG is aware that if they came out and said they intend to sell off the reconfigured Care Closer to Home services, there would be political uproar. Hence the stealth.)