Clinical Senate rubbishes Right Care Right Time Right Place clinical model

Anyone wanting to ask a question at Calderdale CCG governing body meeting  on 10th Dec has until 5pm Tuesday 8 Dec to email it in, to

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The agenda and all the papers for the Gov Body meeting are online here.

There are many questions to ask about Agenda item 8, Changing the hospital services.
The Report for the Governing Body meeting says:

“We have submitted our Clinical Model to the Clinical Senate”.

The Yorkshire and Humberside Clinical Senate is another organisation set up by the Health and Social Care Act 2012. Their review of the Clinical Model is downloadable here.

A couple of questions about this that come to mind for the Calderdale CCG Governing Body are:

  • Is the clinical model in the public domain. If not, why not and when will it be?
  • Now that the Clinical Senate has rubbished your clinical model, will you have to postpone the proposed public consultation yet again while you come up with something acceptable?

The Clinical Senate report is produced by people who have buy-in to the Clinical Model proposals, because they’re all in the same kind of positions as the people who produced the Clinical Model. As a result, their criticisms are about detail, not the overall direction of travel.

But despite the lack of critique of the overall direction – that the Clinical Senate probably aren’t allowed to come up with – they have pretty well taken everything else apart.

Little evidence of local clinicians’ input or whether the clinical model is “deliverable”

It’s hard to make any sense of whether the Yorkshire & Humberside Clinical Senate are right or wrong, because they didn’t include the clinical model or anything else such as the Case for Change as an appendix, so we can’t know what they’re talking about.

But they basically say the clinical model is a rehash of national standards and policies (which in my eyes makes it immediately suspect, given what is going on in NHS England with their cuts and sell offs agenda), with little evidence of local clinicians’ input, or of the deliverability of the model – in other words whether it will work.

So basically Calderdale CCG has dutifully done what the Commissioning Support Unit and NHS England have dictated to them. But the Clinical Senate has said this won’t wash.

The Clinical Senate review says:

  • They can’t tell if the proposed clinical model is “deliverable”, because there’s no clarity about key factors including staffing levels.
  • There’s no clarity about the current services including geography, population, patient access etc. or about how this current model will change.
  • There’s not enough information about what role primary care (and social services) have in the Right Care Right Place Right Time plan… “the links with the work on care closer to home do not come through here clearly enough.” Nor is there any clarity about the link to mental health services, or about End of Life care and palliative care services. In other words, the whole Care Closer to Home thing is a dark void.
  • There is no information about the strategy for the supporting data and intelligence systems (which are a big part of the Right Care Right Place Right Time scheme).
  • There’s no clarity about the non-elective service that will continue to be provided on the hospital site that isn’t the acute and emergency care site.

That’s not the half of it.

Clinical Senate rubbishes plan for Urgent Care Cantres with inexperienced staff skyping colleages for advice

In addition, the Clinical Senate review totally rubbishes the proposals for 3 Urgent Care Centres.

It starts out by saying:

“There is a lack of detail within the evidence supplied about the urgent care centre model.”

But it says that talking with the Commissioners produced the following info about the urgent care centre model:

There will be 3 centres,

“medically-led by a clinician with the knowledge and skills to undertake triage and autonomous decision making regarding the next steps in an individual’s care. We expect this is likely to be GP’s but have to recognise current and future workforce issues.”

So there might not even be a GP present to see patients who come to Urgent Care Centres.

The Clinical Senate review then says:

“patients in the remote UCC(s) who have serious illness will be triaged, stabilised often with technology assistance (Skype) from the specialists at the Emergency Care Centre, and then transferred.”

So someone who may not have the diagnostic and treatment skills of a GP will skype the Emergency Care Centre to ask what to do with a seriously ill patient while they’re waiting for an ambulance to come. Somehow this doesn’t inspire confidence.

The Clinical Senate didn’t think so either, they say:

“…an inexperienced staff member seeking advice from colleagues via Skype does not offer a rounded solution.”

And they have told the CCG to:

“consider the skills of the workforce. The triage skills and staff clinical portfolios need to be sufficient to enable them to make timely and informed decisions. There is always the possibility that a very ill patient will attend the Urgent Care Centre and commissioners need to ensure that staff have the medical and nursing skills, experience and capabilities to safely stabilise that patient. Currently, the Senate has no information on the staffing of these centres…We are also not clear on the paediatric expertise at each centre.”

So basically the Clinical Model is rubbish as far as I can make out from the Clinical Senate review.

We the public need to see it, and the sooner the better.

Independent report on the NW London version of Right Care Right Place Right Time says it’s “deeply flawed…and should be halted immediately”

As all this is going on, Michael Mansfield has recently produced the Report of the Independent Commission into the North West London version of Right Care Right Place Right Time.

The Independent Commission Report says:

“…the reforms, both proposed and implemented thus far, are deeply flawed…there is no realistic prospect of achieving good quality accessible healthcare for all. Therefore, any further implementation is likely to exacerbate a deteriorating situation and should be halted immediately.”

Since all these hospital cuts and closure schemes accompanied by a move of care into the community, are cut from the same McKinsey cloth, this raises big doubts about the Yorkshire & Humberside Clinical Senate’s endorsement of the basic direction of travel of Right Care Right Place Right Time Clinical Model for the hospitals.

The NW London report is intensely critical of the McKinsey-directed model and its cost-cutting motive. The Report is very damning.

The Michael Mansfield Report is here if you haven’t seen it.

We must make sure the same thing does not happen in Calderdale that has happened in North London, with the closure of A&Es and the run down of District General Hospitals to local hospitals having the worst impact on deprived areas and low income people.

But there is really very little sign of  community health services being prepared for Calderdale to significantly reduce hospital services. As the Clinical Senate review of the Calderdale and Huddersfield hospital cuts clinical model made plain.

CHFT Boss says there are now 3 options for hospital changes

Another piece of the jigsaw puzzle comes in a recent email from Owen Williams, the hospitals Trust Chief Executive, to all CHFT staff. He tells them that:

“due to constraints on funding and clinical requirements… the remaining options for the hospital changes are:
1 The Base Case – Minimum change in hospital configuration across CRH and HRI
2 * Emergency and Acute Care Centre and high risk planned care delivered at CRH
3* Emergency and Acute Care Centre and high risk planned care delivered at HRI
*These options include two alternatives relating to the use of the building on the planned site.
All of these options remain very much open. We are now completing some very detailed work on how many beds we are likely to need. This is based on the clinical model proposed by our doctors and the GP commissioners. We will also be working through what building work would be needed in either Calderdale or Huddersfield and how much this would cost. All of this work has to be completed by the end of December.”

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