At its meeting on Thursday 14th November, Calderdale Clinical Commissioning Group’s Governing Body faced questions from the public about A&E.

Presenting his Report, the Chief Officer, Dr Matt Walsh, said that the national crisis in Accident and Emergency (A&E) is being felt in the Calderdale and Huddersfield NHS Foundation Trust (CHFT).

Calderdale & Huddersfield A&E have one of the worst staffing levels in England

Dr Chris Day, a member of Calderdale NHS 38 Degrees, asked:

“Can the chief officer give an immediate assurance that safe staffing levels will be achieved and maintained in Calderdale A&E? Including, for example, a minimum ratio of one fully qualified nurse to eight patients in all hospitals and properly qualified paramedics and support staff on all emergency ambulances.”

BBC Freedom Of Information requests have shown that the CHFT Trust is not recruiting sufficient staff – more than one in ten posts are vacant. Calderdale A&E has one of the worst staffing levels in England.

A recent article by Jacky Davis in the Guardian reports that:

“NHS staff are trying to keep the service going while the infrastructure is cut away from under them. Since the coalition has come to power 20,000 nursing posts have been lost or left vacant, 8,000 beds cut and A&E performance is at an eight-year low.”

There would be a lot more money  to spend on staffing and essential NHS infrastructure if Calderdale CCG did not have to spend around 10% of its budget repaying the huge Private Finance Initiative debt for the construction of Calderdale Royal Hospital

Dr Walsh said that the CCG’s strategic planning programme is looking at Dr Day’s question, and that

“all appropriate contracting processes are operating in line with contracting obligations and money is flowing to contractors to enable them to deliver what commissioners ask them to deliver. It is the providers’ job to provide staffing levels needed to do what commissioners ask.”

‘System is running hot’  

In the second quarter of 2013, CHFT was ranked in the bottom quartile for the target of seeing 95% of A&E patients within 4 hours. Things had not improved by September, when the CCCG Finance and Performance Committee heard that A&E hadn’t met the 4 hour target for the past two months.

The Governing Body discussed the current Performance Report, which showed that overall Calderdale is achieving the 4 hour standard for access to A&E (95.1% during Q2), although performance has varied during 2013/14. Dr Matt Walsh said,

“The numbers look good but there’s a lot of pressure in the system to keep the figures right. The system is running hot at the moment in relation to the 95% target for patients to be seen within 4 hours in A &E. The figures reported here on A&E are different from the feeling on the ground in the Urgent Care Board. We’re not sure if this is about staff on the ground, or the severity of patients’ conditions.”

Debbie Graham, Head of Service Improvement, added that in October Calderdale CCG had asked for outside help from the Emergency Care Intensive Support Team, in figuring out why A&E feels so hot, and how much is to do with the flow out of patients and delayed transfer of care out of A&E.

Would it not make more sense to consider the obvious need to improve staffing levels in Calderdale A&E, so that A&E is fully staffed, instead of only 90% staffed? Dr Walsh told Dr Day that “it’s the provider’s job to provide staffing levels needed to do what commissioners ask” –  but is Calderdale CCG paying Calderdale and Huddersfield Foundation Trust enough for them to employ enough A&E staff? What about the £4m “efficiency savings” that Calderdale CCG has to make this year? How many A&E staff would that pay for?

Plans to centralise A&E in Huddersfield

Dr Day’s second question asked:

“Could we be assured that properly staffed and funded A&E services will be maintained in both Calderdale and Huddersfield hospitals and could we be given a start date for the public engagement process and full particulars of current proposals for future A&E provision in Calderdale?”

A recent letter in the Halifax Courier (Your Say, 8th Nov. 2013) claims that reliable information exists about plans to amalgamate Calderdale Royal Hospital and Huddersfield Infirmary A&E services onto one site in Huddersfield.

This claim is supported by an 18 June 2013 letter from Dr Chris Clough, Chair of the National Clinical Advisory Team (NCAT) to Martin Carter, Head of Communications and Engagement for the public consultation on proposals to change hospital and community services across North Kirklees and the Wakefield District.

In a section of the letter  that discusses rising A&E attendance, Dr Clough wrote,

“NCAT has also been privy to plans for Calderdale, with centralisation of services at Huddersfield Royal Infirmary…”

Dr Day is concerned that the proposed removal of A &E services from Calderdale would leave a vulnerable society with inadequate access to health services, introducing substantial inequalities in Calderdale that would undermine the duty set out in the NHS Act 2006 for the health service to reduce inequalities.  He is also concerned that increases in population over the next ten years will create capacity issues in A&E.

In relation to the future of Calderdale A&E, Dr Walsh told the meeting,

“There is a lot of noise nationally about urgent care services”, coming from the interim Keogh Report and the Royal College of Physicians’ Future Hospital Commission  report.

He confirmed that Calderdale CCG had asked Calderdale and Huddersfield Foundation Trust (CHFT) to commission the National Clinical Advisory Team to review urgent care and to report on recommendations for  the CHFT to consider. This review took place over the summer and autumn, within the CHFT.

CCCG expects CHFT’s recommendations to come through to its Strategy Review committee some time in December.

Dr Walsh said,

“Significant change needs to be made in ways services need to be delivered. So Calderdale CCG will listen to the provider’s [CHFT’s]  recommendations and then consult with the public on their decision on the provider’s recommendations.”

“Whatever happens, there is no doubt that both hospitals have a vital role to play in whatever future we map out.”

After the CCCG Governing Body meeting, Calderdale NHS 38 Degrees Chair Ken Cheslett said,

“In the light of Dr Robert Hey’s letter in the Halifax Courier, Calderdale branch of 38 degrees feel appalled with the idea that residents who need emergency treatment, may have an extra 30 minutes, (and sometimes more) added to their journey time on a very busy road that is notorious for traffic hold-ups.

If this does come to fruition, then the people of Calderdale are to be placed in a more vulnerable position, with risks to their lives, than the residents of Huddersfield; so who, by making such a decision, has the right to ‘Play God’?

Whilst we have no wish to make this a battle between the people of Halifax and our neighbours on the other side of the M62, – both communities each need their own A&E departments – is it not time that the people of Calderdale made their opposition to such an amalgamation quite clear to the ‘powers that be’?

The people of Lewisham fought two battles through the courts to save their General Hospital; should we not fight with the same vigour to retain our Accident and Emergency Department?”