At the 21 October Calderdale and Kirklees Joint Health Scrutiny Committee (JHSC) meeting, Councillors asked questions about a proposal for Calderdale A&E to close temporarily at short notice if there was:
“an urgent need on the grounds of safety to temporarily close one of the A&E sites”.
Members of the public are unimpressed by this proposal. A comment on the Save Calderdale Royal Infirmary facebook group asked:
“How is it SAFER for Calderdale people to have to travel to Huddersfield in an emergency? Might be ‘safer’ for the Trust, so they don’t fall foul of target numbers of staff they are supposed to have on site, but I don’t think it’s safer for the patients! What’s the point of cutting waiting times if journey times are twice as long? From Todmorden it will not be possible to get to an A&E (either Blackburn or Huddersfield) in under 40 mins. That is UNSAFE!”
Shooting the messenger
Councillors seemed to think the reason for public alarm is not that this proposal is alarming – but that the press is unnecessarily alarming people.
Calderdale Cllr Adam Wilkinson said:
“The lack of clarity in press reports about the possible temporary A&E closure underlines the importance of good communication to avoid alarmism.”
Kirklees Cllr Molly Walton said:
“We need to be careful about the language we use. I don’t like picking out terms that can alarm the public, so Councillors need to be careful in asking questions. We need to ask questions, but not in a way to alarm the public.”
“Real challenge to make sure of emergency care”
But the hospitals Trust Chief Executive Owen Williams confirmed that the hospitals and other NHS providers are facing ” a real challenge to make sure of emergency care”.
Cllr Malcolm James asked how the possible temporary closure of Calderdale A&E at short notice would be announced to the public. He said,
“You would obviously tell the ambulance people very quickly, but what if an A&E patient turned up in a car? How would CHFT reroute them to an appropriate A&E?”
David Birkinhead, the Trust’s Executive Medical Director, said:
“This will just be for very short periods of time when staff shortages dictate. We would always keep staff on site to stabilise any A&E patients before transferring them to A&E.
It would be a very unusual circumstance to close A&E – but if so, the plan is to introduce rigour into safe transfer arrangements.”
Dr Steve Ollerton, Chair of Greater Huddersfield CCG Governing Body, said,
“How many patients are we talking about? Most A&Es are well staffed up to midnight. Any closures would be midnight to 8am. You often only get 8-10 patients and half would turn up by ambulance.
The Trust would tell NHS 111 and Local Care Direct of any short term closure, and also ambulances, but it couldn’t do wider announcements. We’re talking about a very small number of patients.
The plan is only in the drawer and we hope we never have to get it out.”
Cllr Adam Wilkinson asked about the ability of the ambulances to transfer patients if the A&E is temporarily closed at short notice, given that a recent report found that Yorkshire Ambulance Service is overloaded and has inadequate response times.
Owen Williams said,
“This is a real challenge that we face, not just the Trust, but YAS and 111 – how to make sure of emergency care. This needs to be coordinated through different services. It’s very difficult. We’re trying hard through the Systems Resilience Group and also through conversations in the West Yorkshire footprint to make sure we can coordinate.”
The Monitor representative said:
“There is no silver bullet. It requires multiple agencies to come together and do stress tests on emergency plans. But I’m not going to sit here and say it’s straightforward.”
Wider problem of staff shortages
The JHSC heard that A&E staff shortage exists because, although the Trust has approved four more A&E consultants, it hasn’t been able to recruit 2 of them.
The Trust’s Executive Medical Director David Birkinhead told the JHSC:
“We have problems of staff retention, not just recruitment. Clinicians are deciding to move. There is a trend to increased specialisation and delivering services across two sites is inefficient. But a bigger issue is delivering out of hours services that are split across two sites. This means clinicians work 1 in 5 or 6 weekends, as opposed to 1 in 12 weekends, so this deters staff.”
Owen Williams, the Calderdale and Huddersfield NHS Foundation Trust (CHFT) Chief Executive, said that while exit interviews with clinicians leaving CHFT show that this is a material factor:
“Other Trusts in West Yorkshire would report a similar picture. Trusts are competing for finite resources. Compared to 3-4 years ago, there is a problem with the training and supply of nurses and doctors in the right areas and we are now seeing the cumulative effect. It’s not just a local problem, but a wider problem.”
You can also read about other issues Councillors raised at the 21st October JHSC by following these links (coming shortly):