Patients and NHS staff in North Kirklees and Wakefield are feeling the pressure of hospital cuts and changes that are about to be replicated in Kirklees and Calderdale, if NHS Commissioners have their way.

This is against the wishes of both Calderdale and Kirklees Councils, who have both unanimously passed motions rejecting the plans, and of scores of thousands of members of the public, who have joined various “2 Towns 1 Fight – keep both A&Es open” campaign groups.

This report looks at some the of the effects already apparent in North Kirklees and Wakefield, on patients, their families and friends, and NHS staff.

Same old: bankers’ PFI profits before people

What’s happening in N Kirklees and Wakefield is the result of the recent imposition of the so-called “Meeting the Challenge” scheme – which is almost identical to proposals in the so-called Right Care Right Place Right Time Pre Consultation Business Case that NHS Commissioners have announced they plan to consult the public on, starting in early February.

Kirklees and Wakefield Clinical Commissioning Groups have turned their deficit-ridden PFI hospital – Pinderfields – into the unplanned/ A&E hospital, and they are downgrading the non-PFI Dewsbury District Hospital to a small planned care hospital with a minor injuries unit (which the N.Kirklees CCG Chief Officer continues to insist is an A&E department). At the same time they are moving services out of hospitals into the “community”.

This is what is also proposed for Huddersfield and Calderdale hospital cuts and changes – repeating a pattern that is happening in other parts of the country.

The publicly owned hospital – and patients – are being sacrificed to protect the bankers’ PFI equity and profits.

A local retired doctor said:

“Bed cuts are not being mirrored by an increase in community services. Each hospital needs massive expansionary programme of investment.

“Dewsbury A&E is an urgent care centre not a blue light A&E, but putting A&E above the door misleads the public into thinking there is still a blue light A&E.”

An A&E is dependent on a range of acute services also being available in the same hospital. At the moment DDH has still got its High Dependency Unit and people can be admitted, possibly until September 2016. It still has a fully functioning Consultant led Obstetric department with epidural if needed, until possibly April 2016.

So the planned downgrade of Dewsbury A&E to an urgent care centre is not yet quite complete, but it has been brought forward a year with the intention of completing the downgrade this year.

However, the community health provider Locala is not ’embedded yet’ so will not be keeping people out of hospital as they are contracted to, in plans more or less identical to the “Care Closer to Home” scheme for Calderdale and Kirklees.

When will they be embedded and how will anyone know? A question for N. Kirklees CCG Governing Body meeting in February.

Dewsbury’s A&E downgrade means 30K patients/year have to go to Pinderfields or whichever major A&E can take them

Downgrading Dewsbury A&E to an urgent care centre (aka Type 3 A&E department) means that it can only treat patients with minor to moderate problems like broken bones, sprains and strains, wound infections, minor burns and scalds, minor head injuries, insect and animal bites, minor eye injuries and injuries to the back, shoulder and chest.

This has meant that around 30,000 patients a year who used to attend Dewsbury A&E with major emergency health problems when it was a Type 1 or major A&E have had to go to Pinderfields or whichever other blue light/major A&E can take them.
Ambulance diverts from Pinderfields

As a result of overcrowding in Pinderfields, in 2014 there were 70 Yorkshire Ambulance Service diverts from the hospital.

What happened was that basically Pinderfields A&E closed to ambulances, and “diverts” were put in place – taking anything from 1 and 1/4 hours to 6 and 3/4 hours – for reasons that included:

• Minus  beds  at  Pinderfields  with  45  patients  in  ED
• Pinderfields  resus  bay  open  but  can  only  take   cardiac  arrests.  All  other  resus  and  trauma  to  go   to  nearest  A&E
• No  beds  at  Pinderfields
• 67  patients  in  A&E,  resus  full  and  no  bed  available
• Insufficient  Medical  &  Surgical  beds  to   accommodate  admissions  high  numbers in  ED

Without doing a FoI request, the 2015 figures are not publicly available – but at a Calderdale Council Adults Health and Social Care scrutiny panel meeting in 2015, a Yorkshire Ambulance Service guy said they sometimes have to divert from Pinderfields A and E  to Dewsbury A and E, where they find other diverted ambulances bringing people in from all over southern Yorkshire.

It sounds like musical chairs, all chasing the only A and E that is taking in.

Patient diverts from Pinderfields

Pinderfields is already finding it hard to cope with the numbers of women coming there to have their babies.

On Friday 11 December, Pinderfields sent more and more expectant women from Pinderfields to Dewsbury Maternity Unit – until, according to Jenifer Devlin of N Kirklees Support the NHS, “someone senior” stepped in and said enough was enough and no more referrals from Pinderfields were to be accepted.

Ms Devlin decided to make enquiries and this is the response from Jules Preston, the Chair of the Trust:

“It was an exceptionally busy day that resulted in a cross site (Whole Trust) closure – an event that is extremely rare and has only occurred the once in the last 12 months. However it would be wrong to suggest that the reason was purely as a result of Pinderfields being full.

“I think that there were several issues at play.”

Mr Preston went on to explain that:

• “at times of complex acuity and heavy workload”  women may be diverted to the unit best placed to give quality care
• although there was a Mid Yorks- wide bed shortage at the time, no women were recorded as being transferred outside the Trust
• The postnatal ward at Dewsbury District Hospital  was full, but the Delivery suite were able to accept women in Labour.
• At Pinderfields the postnatal ward had beds, but the delivery suite was full. So Dewsbury District Hospital triaged the labour calls and Pontefract General Hospital only admitted Antenatal and postnatal triage patients.
• Even with a full complement of staff at Pinderfields, the pressures were so great that community staff were brought in to assist during the evening.

Mr Preston concluded:

“So the fact is that there were pressures at both DDH and at PGH but because we have the ability to flex across the 3 sites we were able to retain patients within our services, not something that can be said for all hospitals that day. This is such a rare occurrence but we are currently looking at the events of that day to see if there are any lessons to be learnt.”

“Meeting the Challenge” by downgrading Dewsbury DDH maternity unit

Under very controversial “Meeting the Challenge” Consultation proposals, Dewsbury DDH is soon to be downgraded to a mid-wife-led unit catering for just 500 births a year, compared to the current 2,500/year.

This is not due to happen for another couple of months – there is still shuttering around the new build maternity centre.

So there was still consultant obstetric cover in Dewsbury on 11 Dec, when a large number of women about to give birth were diverted from Pinderfields to Dewsbury.  This consultant cover will remain at Dewsbury District Hospital until perhaps Apri 2016, although there’s a suggestion for for the downgrade to a midwife-led maternity unit to be brought forward.

When that happens, all but the most straightforward births will have to take place at Pinderfields.

So what will happen with even more extra women, among the additional 1089 patients who’ll go to Pinderfields if Huddersfield Royal Infirmary, which includes a consultant-led maternity service, is knocked down as planned for the Right Care Right Place Right Time scheme?

Jules Preston, the Chair of the Mid Yorks hospital Trust, has told N Kirklees Support the NHS that:

“Our plans to improve maternity services includes Pinderfields obstetric unit being configured to accommodate the high risk women from Dewsbury who wish to birth in the unit. High risk women will be booked to birth at the expanded obstetric unit at Pinderfields – the women will be cared for within the unit irrespective of their geographical home. Women with low risk pregnancies will be supported to birth in one of the Midwifery led units unless they also choose the obstetric unit, which is their personal preference and they will, of course, be accommodated.”

But if the proposal goes ahead to turn HRI into a planned care clinic with no A&E or acute services, Pinderfields may also have to take Dewsbury maternity patients who would have gone to HRI.

The Calderdale & Huddersfield Pre Consultation Business case says that if HRI were the unplanned site, there would be more maternity patients coming from Dewsbury because of “anticipated service changes at Dewsbury”, which I guess is the maternity downgrade/cuts stuff.

But since HRI is intended to be the planned site, where will these pregnant women from Dewsbury go, if they need complex/emergency obstetrics?

Christine Hyde of N Kirklees Support the NHS Hyde said,

“This is a tricky one. On one of our stall days in Dewsbury, a bloke was telling me that his daughter had been booked in to Halifax to have her baby, but had started in labour while in Barnsley so had gone to that hospital She was consistently berated for going there. It was the wrong hospital and she shouldn’t have turned up. She should have traveled from Barnsley to Halifax, what was she doing in Barnsley when she was booked in at Halifax. He said she has been very upset about it.”

Nowhere to put more people at Pinderfields

Ms Hyde continued,

“There is already a queue for Pinderfields operating theatre time for serious leg/bone fractures, as the consultant has only 2 days allotted. If you break your thigh on Thursday night, you have to wait in pain as an inpatient, until the following Thursday, if the bone has not broken the skin, which elevates the status to ‘serious’!

“Has Greater Huddersfield CCG been in negotiations with the Mid Yorks Hospital Trust to establish if there is capacity at Pinderfields for an extra 1,089 patients a year, and if not, why not?

“Pinderfields has already had to convert office space into ward space, so there is nowhere to put more people and Dewsbury will have only 4 wards and no fully functioning blue light A&E.”

So where are the Huddersfield people who are taken ill/have an accident, going to go?

The Mid Yorks Hospital spend in the private sector on outsourced patient care rose from £227K in 2013/14, to £1.445m in 2014/15. The person who passed on this information said,

“The rise seems to have come from increased pressure in numbers of patients and difficulty in meeting elective targets. I guess lack of day beds plus theatre time is part of this.

In terms of expenditure it amounts to  0.32% of treatment budget.”

Time for medical leaders to speak out to restore the NHS

Commenting on the proposed Calderdale and Huddersfield hospital cuts and changes, a retired consultant from the Wakefield and N Kirklees area said,

“Trust has been lost with a huge section of dedicated people who have followed, analysed and documented the cuts in Calderdale & Huddersfield which will surely inconvenience the people served  by that hospital, as well as putting additional pressure on Pinderfields. They have done this in the attempt to raise these changes to the attention of an unsuspecting public.

The NHS has always evolved including before the days of ‘Executive Management’ and the NHS will continue to need to evolve.

However, it has become increasingly clear over the last few decades that there is an agenda to use the continuing need for evolution of the NHS as a vehicle to introduce marketisation and privatisation.

This continues to be carried out largely under the radar of the general public and even of many or most of those working in the NHS. Politicians of all three main parties have been so clever at obscuring these radical changes that we are now on the threshold of what will effectively be the end of the NHS within this parliament. Indeed the passing of the 2012 Health and Social Care Act essentially spelled the end of the NHS

It is against this background, unfortunately, that any and all service reconfigurations must now be viewed.

There are many in the NHS who are aware of what is happening and are trying to fight it by bringing it to the attention of the public. I believe the time has come for the leaders in the medical profession including the BMA and the Academy of Royal Colleges to speak with one voice clearly in favour of a comprehensive publicly funded service, publicly accountable and free at the point of use. I believe it their duty to do this in view of the negative influence on medical practice that must ensue from the introduction of the profit motive into clinical practice.”

Calderdale and Huddersfield hospital cuts will put additional pressure on Pinderfields

These are the effects of the imposition of the new clinical model on Dewbsbury and Pinderfields, that NHS Commissioners now want to impose on Calderdale and Huddersfield

This will undoubtedly cause the same kind of overcrowding and mayhem that is already happening in North Kirklees and Wakefield.

And it will worsen what’s happening in those areas, as they have to take some of Calderdale and Huddersfield’s strain, although they are already groaning under too great a burden for the resources that are available to cope with comfortably..

The Pre Consultation Business Case states that the effects of closing HRI A&E and downgrading the DGH to an elective care clinic would mean an extra 1089 patients/year would go to Pinderfields.

Christine Hyde of North Kirklees Support the NHS in Dewsbury said:

“This is more than awful, this is playing with people’s lives in a cavalier and callous way. Pinderfields is already being stretched to more than breaking point, with diverts to Dewsbury Hospital, which doesn’t have a fully functioning A&E – and will shortly be downgraded from a consultant-led Maternity department.”

Knocking down hospital buildings and selling as much land as possible

Like the “Right Care Right Place Right Time proposal for Huddersfield Royal Infirmary  –  which plans to knock it down and build a new 119-bed planned care clinic plus outpatients, therapies and an urgent care centre –  fewer beds are now needed at Dewsbury District Hospital, which will provide mostly outpatient planned care and short stay surgery.

As a result, the Staincliffe Wing and Bronte Tower are due to be knocked down soon, and the land sold to developers,

Christine Hyde of North Kirklees Support the NHS said,

“They are selling as much land as they can, knowing that in the future they can build a multistory and extend on to the car park if they have to!”

It’s not clear where money from the sale of the land will go, according to Christine Hyde. She reports that a project development manager on the Mid Yorks Hospital Trust Board is apparently saying it will go to the Treasury, while Mid Yorks Hospital Trust Chief Executive Steven Eames is on record as saying:

“We would look to reinvest the revenue from any sale of land back into local health care.”

According to the Trust Development Authority’s guidance on Capital Regime and Investment Business Case Approvals, NHS Trusts are able to use the receipts from asset disposals (up to delegated limits) to fund investment.

The drive to knock down NHS hospitals that are deemed surplus to requirements and to sell off the land is part of the transformation of public services that goes under the term New Public Management . This is about handing over public services to the private sector

In its “Time to Think Differently” report on NHS buildings, the influential pro-privatisation Kings Fund advocates selling off NHS buildings as a way to resurrect the New Labour privatised Darzi clinics – named after the guy who dreamed them up – aka Independent Sector Treatment Centres. These were a disaster, and quickly fell apart.

But according to the Kings Fund,

“While the polyclinic model proposed in Lord Darzi’s NHS Next Stage Review (Darzi 2008) was not sold well and was poorly implemented, the idea is sound and needs to be developed. Creating campus developments that have mixed use and ownership offers opportunities for much more flexible space and the ability to ensure a high level of utilisation.”

They give as an example the Orford Jubilee Neighbourhood Hub in Warrington, which belongs to Warrington Borough Council’s privatised leisure, library, and lifestyle services, run a company called LiveWire, and where some NHS community services are also provided.

The sale of NHS land and the destruction of its buildings is all part of the march to privatise our NHS and all our other public services along with it.