Hot topics at NHS chiefs’ 11th June public meeting: ongoing NHS shake-up saga, A&E woes & risks to Child & Adolescent Mental Health Service

Calderdale Clinical Commissioning Group Governing Body is meeting tomorrow, June 11 at 2pm, Function Room 2, Shay Stadium, Shaw Hill, Halifax. It’s open to the public, so if you’re free why not come along.

They put the agenda and papers online late, so this report is also late.

Key issues for this Governing Body meeting include:

The ongoing Calderdale and Huddersfield NHS shake-up saga

    • What is to happen to Calderdale Royal Hospital and Huddersfield Royal Infirmary?
    • What is happening to the new care in the community scheme, aka Care Closer to Home?
    • What is happening with the new “Vanguard” scheme?

See separate report here

Calderdale CCG has been rapped over the knuckles by NHS England for failures to discharge patients promptly from hospital

Compared to other parts of the country, elderly or frail Calderdale patients who are medically fit to leave hospital are more likely to be kept in because there’s nowhere for them to be discharged to.

This has an impact on CRH’s ability to see A&E patients within 4 hours. (Item 12c, 3.1)

NHS England has told Calderdale NHS organisations to halve the number of delayed hospital discharges (aka Delayed Transfers of Care – DToC) by 31st June, but this doesn’t look likely on the basis of this info:

The risk log lists as a black (critical) risk that Calderdale Royal Hospital will not meet the 4 hour A&E waiting time target & the CCG will not be able to guarantee the stability and resilience of the system.

As a result of the failure to meet the 4 hour A&E waiting time targets in 2014/15, the CCG will lose £250K. This is  25% of the Quality Premium.

The 26th Feb Quality Committee heard that in Calderdale A&E, only 3 out of 10 doctor posts were filled at senior registrar level. Which could have something to do with long waiting times, you’d think?

The Risk log shows a serious risk (level 16) that the Continuing Health Care /Specialist Care team  (which includes the hospital complex discharge team) may not be able to “deliver the performance that is expected by the CCG due to the increasing workload demands upon the team from all areas of activity” and the “unpredictable nature of demands and pressures associated with Adult Health and Social Care”, among other things.

The problems with the Continuing Health Care/Specialist Care team include insufficient capacity to:

  • cope with increasing workload
  • manage the increasing number of very complex cases
  • cope with crisis situations that require immediate attention such as nursing homes.

High risk of poor quality care and lack of availability of care in care homes

The CCG Governing Body papers don’t say this, but it seems likely that the failure to discharge patients promptly from hospital relates to the high risk, identified in the risk log, of poor quality of care and lack of availability of care in care homes, due to shortage of nurses available for recruitment.

In unannounced inspections, Lands House and Park View Nursing Homes were both found to be inadequate. As a result, at Park View, the CCG and Local Authority have suspended admissions to permanent beds, stopped admissions to intermediate care beds and jointly commissioned external support to work with the Home on an improvement plan. At Lands House, external support will be commissioned. Carr Green care home has closed and all residents have been relocated.

Another care home-related high risk in the risk log is that outstanding Information Technology /Commissioning Support Unit issues in the Quest for Quality in Care Homes project are not resolved, meaning that staff will be unable to access clinical records. A serious incident (near miss) was reported in November 2014.

The Quest for Quality in Care Homes project provides telehealth and telecare gadgets for patients in care homes and a MultiDisciplinary Team to manage end of life care with the use of the digital healthcare technology, calling in GPs as necessary. More info here.

Child and Adolescent Mental Health Services (CAMHS)

Plain Speaker reported some time ago on Calderdale Council’s privatisation of Tier 2 (community) CAMHS and on problems with Tier 3 (clinics) which are provided by the mental health trust, South West Yorkshire Partnership Foundation Trust (SWYPFT).

It seems the privatisation hasn’t solved the problems of waiting times and patient experience, which remain as a red, level 16 risk in the risk log for this meeting.

The risk log says that these problems are the result of “slippage in the recovery plan” including a failure to clear the backlog as scheduled.

There is also the problem of care being fragmented between the different CAMHS providers, with “a lack of clear pathways and systems…within the wider CAMHS service” so the CAMHS Executive Steering Group is working on “fully operational single criteria for Tiers 2 and 3 to support access and referral to both services”.

There has been a CAMHS “Summit” meeting between commissioners and providers to try and sort out problems with:

  • agency staff not entering info correctly into the Rio electronic patient record system
  • double counting from continued use of paper system
  • continued reliance on agency staff although recruitment is improving
  • if staff are called into A&E overnight they are unable to cover morning shifts
  • there is no system for recording the concerns of those referring to CAMHS

The Local Authority and CCG commissioners are appointing a CAMHS commissioning manager for 12 months. And CAMHS is now under observation from clinicians from Calderdale and Greater Huddersfield CCGs.

The 26th March Finance and Performance Committee heard that “the depth of the challenge to SWYPFT is larger than expected.” (Meaning what?) And that commissioners are talking to SWYPFT about introducing a Calderdale crisis response team for CAMHS, as already operates in Wakefield, and that this should be discussed in public at the next Governing Body meeting.

Finance teams are working on the potential for a tariff-based approach to paying for CAMHS. This is about moving away from a “block contract” to paying for specific outcomes.

By 26th May, Martin Pursey, the head of procurement and contracting, was supposed to produce a clear report about the approach to procurement of CAMHS.

Yorkshire Ambulance Services (YAS) – Response Times

YAS did not meet the required standard for Red 1 and Red 2 response times in Calderdale or the wider area. Red 1 and Red 2 are the most urgent calls and ambulances should be with the patient within 8 minutes.  YAS’s November 2014 action plan was expected to solve the problem, but didn’t. However in May 2015 it achieved the Red 1 standard, but not Red 2.

A confidential Report on YAS was supposed to be made public by 26th May.

Commissioning Support Unit privatisation

Yorkshire & Humberside Commissioning Support Unit has not made it onto the list of approved contractors for when the CSUs are privatised next year, so the CCG has been figuring out where its commissioning support is going to come from.  See Item 8

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