At the Kafka-esque Scrutiny meeting on 29th January, the Clinical Commissioning Groups’ monkey business meant that there was no consultation document on the hospital cuts for Calderdale and Kirklees Joint Health Scrutiny Committee (JHSC) members to scrutinise.

Today (4th February), the CCGs have sent JHSC members the full consultation documents, with a message that the documents are going to be signed off tomorrow and Councillors need to send any comments today!

“This is impossible for those of us who work in the day time. I am sure there will be some members who will not even check their emails until this evening, by which time it will be too late. I am fuming.

“Members of the Joint Health Scrutiny Committee have only been sent the CCGs consultation documents the day before they are set to be signed off. In effect we’ve been given a matter of hours to read them and feed in comments, which shows a disregard for the proper Scrutiny process. If the CCGs want the public to have faith in their consultation process it is vital that Scrutiny is able to do its job”.

From everything Plain Speaker has observed over the past two years since the hospital cuts plans came to public view, the CCGs couldn’t give a toss about the public.

The Kirklees Scrutiny Officer has just emailed the CCGs on the Joint Health Scrutiny Committee’s behalf asking for more time to feed in comments, and that Healthwatch are given time to test the questions.

This is all well and good, but Plain Speaker thinks that the JHSC needs to tell the CCGs that the JHSC will refuse to allow the CCGs to sign off these documents until they’ve thoroughly scrutinised them, in public and are satisfied they’re fit for purpose.

#HandsoffHRI campaigner Nicola Jowett said

“This is shocking. My constitutional & administrative law tutor was so wrong telling us not to be cynical

“The JHSC is supposed to be there for our Councillors to check i.e scrutinise the CCG plans but they are allowing the CCG to provide documents at the last second, therefore are unable to scrutinise them properly. This is pushing things behind closed doors where those most affected cannot see. It’s just plain wrong! Why are the JHSC doing this?”

Chair of Calderdale 38 Degrees NHS Campaign Group, Jane Rendle, said:

“The people of Calderdale and Greater Huddersfield are understandably anxious about the plans for their hospitals and have a right to be meaningfully consulted. It was clear at the Joint Scrutiny Committee meeting that consultation proposals were not yet ready. It’s outrageous that such an important consultation should have little or no scrutiny which further undermines the legitimacy of the process.

How can Councillors let this pass when they know the level of disquiet in their wards?”

The Calderdale and Kirklees Joint Health Scrutiny Committee meeting on 29th January was to scrutinise:

• Calderdale and Greater Huddersfield Clinical Commissioning Groups’ (CCGs’) decision to consult the public on the hospital cuts plan
• The CCGs’ Pre Consultation Business Case
• The CCGs’ 12 week consultation pla
• The CCGs draft consultation document – which the CCGs presented to JHSC members only 30 minutes before the meeting started, so it’s not on the JHSC website, and which turned out to not be a consultation document at all. This only emerged late in the meeting when, faced with Councillors’ questions about the consultation document’s lack of information about planned hospital services, the responsible CCG officer thought to clarify that it’s only some draft consultation questions.

The following report of the JHSC meeting is only about the Councillors’ attempts to scrutinise the consultation plan and the draft consultation document (that wasn’t).

(There will shortly be another report on their attempt to scrutinise the hospital cuts proposals, that are the subject of the public consultation.)

Public consultation to start week of Feb 8th – despite the fact that Councillors were unable to scrutinise the CCGs’ Consultation Document because it didn’t  exist

A key outcome of the meeting is that the CCGs are planning to begin the public consultation in the week starting 8th February – despite the fact that they only handed over the draft consultation document 30 minutes before the start of the meeting, so Councillors had no time to read it.

This only came to public light through a comment by Calderdale Cllr Wilkinson in the meeting.

This draft consultation document lays out the CCGs’ “key messages” on their hospital cuts plans, and the questions that the CCGs aim to consult the the public on.

Later in the meeting, it turned out that it wasn’t even a draft consultation document at all, only some draft consultation questions.

This transpired after the JHSC Chair, Cllr Elizabeth Smaje, complained that the consultation document doesn’t  explain what an urgent care centre is, what an emergency centre is, and doesn’t give any of the detail of other services.

Only then did the CCGs Head of Quality and Safety Penny Woodhead think to explain that:

“What you’ve got is outline questions, not a consultation document. The consultation document will include all that information. It’s only got consultation questions.”

This led Calderdale Cllr Adam Wilkinson to observe that:

“The JHSC would like to see the full consultation document before the consultation starts.”

Too right.

Penny Woodhead replied:

“We’re hoping mid week [ie around 3rd February] to be able to share the whole suite of information – revised consultation plans and the consultation document – with the JHSC.”

Cllr Smaje said she was concerned that a small leaflet may be given out by the CCGs without enough detail. There is a need for clarification of what an urgent care centre is, what an emergency care centre and other services are, which services would go in the acute hospital and which in the planned hospital, as well as clarification of what CCGs mean by community services.

Dr Brook, the Calderdale CCG Chair, said that the most important part of the consultation would be to attract people who currently attend A&E because they have serious problems and need help, to have confidence in attending the urgent care centre at the planned care site instead.

( ie in Huddersfield, where the plan is to knock down Huddersfield Royal Infirmary and its A&E, sell the land, and build a 119-bed planned care clinic with outpatients, therapies and an urgent care centre across the road on the Acre Mill site.)

How could the JHSC let the CCGs get away with this?

It is obviously vital that the public can see that our elected representatives have been able to properly scrutinise the consultation document’s key message, to make sure that it is accurate, truthful and clear, and that its questions are appropriate – not designed “to give us the right answers”,  as the CCGs’ Head of Quality and Safety Penny Woodhead unbelievably said at the JHSC that they should be,

But there will be no opportunity for the public to witness the Councillors’ scrutiny of these key consultation materials.

No such scrutiny could happen at the JHSC meeting, given the CCGs’ slackness in handing over a key document too late for Councillors to read it before the meeting, and their duplicity in trying to pass it off as something it’s not.

Despite this, the Chair simply waved the (not the) consultation document through, with the JHSC’s deciding to ask the NHS Commissioners to:

1. Consider extending the 12 week consultation period;
2. Provide the Committee with final drafts of the consultation material for comment;
3. Test the consultation questions before staring the consultation;
4. Confirm the consultation timescale to include the date when the response from the Committee is required and the date a decision will be made as to whether to proceed with the proposals.

Those are the JHSC decisions recorded on the Kirklees Council webpage for the meeting.

They omit Cllr Smaje’s statement towards the end of the JHSC discussion of Agenda Item 6, Consultation Plans, that the JHSC would collate all their comments by Monday [1st February], and send them to the CCGs.

Chair brushes off public objection that – with the amount of work and scrutiny still to be done – 8th Feb is too soon to start consultation

Paul Cooney, Chair of Huddersfield Keep Our NHS Public objected to Cllr Smaje’s statement. He protested that the target of starting the consultation in week of 8th February is too soon for the work that needs to be done.

Cllr Smaje brushed this objection away by saying that the consultation materials need to be right which is why JHSC wants sight of them before they’re published.

The effect of all this is that the Scrutiny of the consultation documents is essentially being done in private. This is not good, so Plain Speaker has asked the JHSC for:

• a copy of their collated comments on the consultation plan and documents that they were due to send to the CCGs on Monday 1st February
• a copy of the CCGs final draft of the consultation materials, before they are published
• a copy of the JHSC members’ collated comments on this final draft

Glossing over Cllr Wilkinson’s revelation that the JHSC had only received the Draft Consultation Document 30 minutes before the start of the meeting, Cllr Smaje opined:

“We will go through this and agree a timescale for the JHSC to get back to the CCGs. We haven’t had time to read it properly.”

Matt Walsh soothingly replied that the CCGs had a reinforced commitment to working with the JHSC and will have a conversation about how this JHSC meeting might shape their thinking.

As if.

If the CCGs had a reinforced commitment to working with the JHSC, they’d show them the basic respect of delivering complete documents, in good time.

Why didn’t the Joint Health Scrutiny Committee (JHSC) postpone the meeting until they’d received the complete document for scrutiny, and had time to read it?

The public may be furious about the CCGs’ decision to ride roughshod over public objections to their hospital cuts plans – but the Councillors are not representing this justifiable fury to the CCGs.

Vague

Penny Woodhead, the CCG’s Head of Quality and Safety, said she was happy to take comments at the meeting on the Draft consultation questions that the CCG had handed out at the start of the meeting.

She said the Consultation Plan included some detail of the  “proposed mechanisms” but it was not exhaustive and she was happy to explain how they work.

She said the timetable was for illustration – “ not, that is the timetable”.

For a consultation that is due to start one week after this meeting, this all seems a bit vague.

Testing the consultation questions

Rory Deighton, Director of Kirklees Healthwatch, asked if the CCGs were willing to test the questions and consultation before taking them out, to make sure that the questions are asking what they think they’re asking –  are what people understand them to be asking

It was at this point that Penny Woodhead unbelievably said:

“We’re happy to test the questions to make sure we’re getting the right responses.”

Calderdale Cllr Martin Burton asked what “develop” means, in the draft question that says they’re proposing to develop the hospital.

Matt Walsh replied,

“Development will be required on both hospital sites. In terms of detail, we need to consult on the hospital services model and be prepared to flex and change in response to the consultation and then reflect on what that means for the estate and discuss this with the Treasury. We won’t have that information until we’re out the other side of consultation.”

Cllr Molly Walton asked how realistic the prospect of a new planned care hospital was, given the current government and its finances.

Dr Steve Ollerton, Chair of Greater Huddersfield CCG, said that Huddersfield will have a new planned care hospital & urgent care centre and that will be great.

This sounds to me like pre-determining the outcome of the public consultation. Which would render the consultation unlawful. Interesting.

Carol McKenna, GHCCG’s Chief Officer, said:

“We can’t give a definitive answer on the time frame for hospital development because we haven’t had a definitive answer from the Department of Health, although the Department of Health said we have made a stong case.”

Owen Williams, Chief Executive of the hospitals Trust (CHFT) said that regarding how realistic a new hospital is:

“A lot of national policy narrative in the 5 Year Forward View is that there is a need to transform how health & social care is provided in future. That can’t be done on a cost neutral basis. This model that we’ve contributed  to – the development of a planned care site & urgent care centre – is absolutely business-critical to CHFT and the broader Calderdale & Huddersfield system. Those elective services are critical not just to patient care but to CHFT financial survivability. It can’t physically go on the CRH site, so without it CHFT and the wider system sustainability is in doubt. So this is the acid test of whether the government is going to invest.”

No one asked him to explain why putting the elective services in a 119-bed new planned care clinic is so financially critical to CHFT.

CCG forced to admit the draft consultation document is not a consultation document

This admission came as a result of Councillors’ questions, kicked off by Kirklees Cllr Molly Walton who asked why the CCGs are now talking about urgent care, emergency care and specialist care – why those 3 designations?

Dr Brook said that the model for acute care is not something they’ve invented, it’s part of the national Keogh review which doesn’t use the term A&E, as it’s an outdated concept and a description that’s not consistent. It can cover a wide variety of services. What the CCGs are interested in is the hospital that sits behind the emergency care.

He said there will be changes to both A&E depts. An urgent care centre will be “front facing in both”. (By which presumably he meant that patients could turn up to one.)Then at CRH, behind that there will be an Emergency Centre. Dr Brook added:

“This is not a direct route for people presenting themselves at hospital.”

Meaning that patients will have to be triaged in order to get into the Emergency Centre.

He went on:

“In the Mid Yorkshire Trust, the Dewsbury District Hospital model is an UCC, consistent with the CCGs and Keogh’s  description of and urgent care centre.”

Cllr Smaje said that when the “Meeting the Challenge” proposals were referred to the Secretary of State for Health, the Independent Review Panel asked for clarification of what an urgent care centre is.

She continued

“We need to be very clear about what is an urgent care centre and what is an emergency centre. In the current consultation document they don’t explain urgent care centr and emergency centre and don’t describe any of the detail of other services.”

This was when the CCG’s Penny Woodhouse had to admit:

“What you’ve got is outline questions not a consultation document. The consultation document will include all that information. This has only got questions.”

Rory Deighton said that Kirklees Healthwatch had a commitment to test the questions and they needed a complete set of consultation materials over the next week so they could test them and feed back information to the JHSC.

JHSC asks for 16 week consultation

Cllr Molly Walton  kicked off a second line of enquiry by asking:

“On the length of the consultation – I don’t know that you could extend the consultation because there’s a timeline.

Dr Steve Ollerton, Chair of Greater Huddersfield CCG, said that the timescales were suggested by public but the CCGs will look at that.

Kirklees Cllr Andrew Marchington said that in their deputation statements,  Natalie Ratcliffe and Paul Cooney had raised questions about the length of the consultation, and asked:

“How far can we extend the length of the consultation?”

Cllr Smaje said:

“If you start in the middle of February you go over Easter. What impact would there be if you said 16 weeks not 12 weeks?”

Matt Walsh, Calderdale CCG’s Accountable Officer, said

“I don’t want to get into a bidding war. We have to keep in view that other systems are having these conversations, for example CHFT with the Treasury [about government funding for hospital buildings]. It’s about getting to a place where we believe the proposals are deliverable.

We want to follow statutory guidance on consultation and that includes guidance  on statutory holidays. Can we talk about that and come back with a response later?”

Cllr Smaje said that the JHSC would like the consultation extended from 12 weeks and would like theCCG to come back to them when they have discussed this.

No one said anything about the issue of purdah in the run up to the May elections.

Consultation venues, accessibility and methods

On these topics, points raised included:

• A request to reconsider the timings of the launch events or to add extra launch events. The timing of consultation events means they’re not that accessible to all people particularly people at work. The launch events on p 33 of the consultation plan show 1 session in Calderdale and 1 in Huddersfield. 1 is 2-4pm, the other 5-7pm. If the 2-4pm one is in Halifax, no working person in Halifax would be able to attend either event.
• Whether the venues are large enough – the CCGs are lookng at using the 2 theatres in both towns for the public meetings.
• An offer from the CCGs that if groups want a CCG person to come and talk, they will accommodate that if possible.
• The CCgs agreed they need to go to paces where there is good footfall and do leaflet drops  in busy places the week before consultation events in any locality.
• Healthwatch opposed the idea of phone calls from the CCGs as not an effective way of consulting and Cllr Smaje agreed that a lot of people get a lot of phone calls and don’t necessarily want that sort of call.
• Everything including the consultation form will be online
• The CCGs are pianning how to use social media including FAQs and consultation details. Plus print and broadcast media
• Page 5 of the consultation plan says that the CCgs have to follow a process that allows everyone to give their view .
• What about timing  metings for evening and weekend events and also with a geographical spread so people can get to events without travelling long distances
• At least 12 sessions planned. Locations are based on “stakeholder” suggestions. Timings suggested by stakeholders but can extend
• Plan to hold 2 public meetings on either side of the consultation but this isn’t in the draft plan
• The CCGs have trained over 100 community groups to have face to face conversations with their local groups to extend the consultation reach as far as possible
• Not included in the plan is going into workplaces of significant employers and schools and HE.