Despite Calderdale Clinical Commissioning Group’s public statements that it has not yet made any decision about the closure of either Calderdale or Huddersfield A&E department, and won’t do so until after a public consultation in the summer of 2014, this claim appears downright shaky. Think about these facts:

• Most of the proposed division between the two hospitals into an unplanned/routine care hospital and an acute care hospital has already happened, with unplanned care in Calderdale Royal Hospital and acute care in Huddersfield Royal Infirmary.
• The hospitals Trust has set up a joint venture property development company with Henry Boot Development and this company is already expanding Huddersfield Royal Infirmary.
• Calderdale Council and Calderdale Clinical Commissioning Group are ready to set up the low-cost community care system that’s designed to reduce A&E visits and hospital admissions. They will do this through implementing their Better Care Fund plan this year.
• Calderdale Clinical Commissioning Group’s 5 Year Strategic Plan states that it is the CCG’s contribution to delivering the Strategic Review. This is the document that outlines the preferred option for closing Calderdale A&E, moving acute care and A&E to Huddersfield Royal Infirmary and cutting 100 hospital beds.

Calderdale CCG says it hasn’t decided and will hold a public consultation.

The Clinical Commissioning Group is the organisation with the power to decide whether the proposed changes to Calderdale NHS and social care will go ahead, and it says it hasn’t decided yet.

The preferred option for the proposed changes is to close Calderdale A&E, centralise all A&E and acute services in Huddersfield Royal Infirmary and turn Calderdale Royal Hospital into an 86 bed routine/unplanned care hospital with a Minor Injuries Unit.  Huddersfield Royal Infirmary would have 649 beds.

Overall, there would be 100 fewer beds than there are now.

Of the 736 beds, 50 would be allocated for patients from Mid Yorkshire Hospitals NHS Trust, which has recently been through a similar upheaval to the one proposed for Calderdale and Greater Huddersfield.

So there would be 150 fewer beds than at present for Calderdale and Greater Huddersfield folk.

To keep patients out of hospital beds and out of A&E  (which would be necessary if hospital services were cut like this), the plan is to introduce a low-cost system of integrated NHS and social care in the community, copying a system used by Kaiser Permanente, an American private health insurance/private health care company.

Calderdale Clinical Commissioning Group has a legal duty to involve the public in its decisions, so it will hold a public consultation over the summer months about the wide ranging “Right Care Right Time Right Place” proposals for changes to Calderdale’s NHS and social care system.

But some people, including me, think it looks as if they’ve already made up their mind and the consultation will be a sham.

Most of the proposed split into two specialist hospitals has already happened

Dr Martin De Bono, a doctor and senior manager at the hospitals’ NHS Foundation Trust, strongly advocated the “Right Care Right Time Right Place” proposals at the 14 March meeting of the Calderdale Clinical Commissioning Group Governing Body.

One of the reasons he gave was that the existing set-up of the two hospitals is already similar to the Trust’s preferred option, since Huddersfield Royal Infirmary already has most acute services.

A Calderdale healthcare worker said on social media:

“Its been like that for a long time. The trauma team is at HRI and has been for a few years, as well as emergency surgery, planned complex surgery and emergency paediatric surgery. Vascular goes to Bradford, bad trauma to Leeds, heads to Leeds as well as cardiac stenting – paramedics do that automatically. CRH was downgraded and no one said a thing.”

Huddersfield Royal Infirmary is already building new facilities

Dr Martin De Bono said that creating two specialist hospitals would involve “an enormous amount of building” and that there is room for this building work at HRI.

The Calderdale and Huddersfield hospitals NHS Foundation Trust has set up a joint venture property development company with developers Henry Boot Developments and is already expanding HRI.

This joint venture, Pennine Property Partnership, is redeveloping the Acre Mill site in Huddersfield to house HRI non-clinical services (things like  bereavement services, chaplain, fundraising), freeing up space on the main HRI site for more clinical facilities.

The Better Care Fund plan will kick in in 2014 and is key to the proposed changes

The Better Care Fund plan, which starts in 2014, describes how Calderdale Council and Calderdale Clinical Commissioning Group (CCG) are going set up a low-cost integrated health and social care system in the community, that is supposed to keep patients out of hospital so the hospital cuts can go ahead and save the CCG a lot of money.

Calderdale Council and Calderdale CCG are switching to the Better Care Fund low-cost system of care in the community this year.

In 2015, Calderdale CCG plans to invest £8m into this system.

That amount of investment is not achievable unless cuts are being made elsewhere in the Calderdale CCG budget, which is tightly stretched already and will be even more tightly stretched next year.

To put it in the language of the Strategic Outline Case for making the Right Care Right Time Right Place proposals:

“There is opportunity to reduce hospitalisation and improve efficiency in the use of hospital services by delivering community based integrated support for people with long term conditions and by applying efficient working in the hospital. Analysis of this has identified the opportunity to reduce the value of hospital services required by £31m…we have estimated that 70% of the cost saving from hospital utilisation (£33m) will be cash releasing and be reinvested in alternative community provision ie £24m”

These figures are included in the Strategic Outline Case Table 3:

Calderdale CCG are effectively committed to hospital cuts including A&E closure, because where else is the money going to come from to fund the Better Care Fund plan? (Aka “invest to enable changes”.)

The Strategic Outline Case also confirms the interrelation with the Better Care Fund plan (p54):

“Proposals in this Strategic Outline Case are developed in line with the objectives of the Better Care Fund”

The Minutes of Calderdale Clinical Commissioning Group’s Finance and Performance Committee Meeting 30th Jan 2014 (section 6/14) say:

“The Better Care Fund is the vehicle to support the aspirations of the Strategic Review”

(The Strategic Outline Case, already mentioned, is about how to carry out the proposals in the Strategic Review. I hope, dear reader, you are keeping up with this dog’s dinner of strategic reviews and outline cases.)

Sneakily, the Minutes of that 30th Jan meeting also say that after 14th February there is a legal requirement for the Better Care Fund plan to be published, but that:

“It was AGREED that only the narrative will be released for publication, not the financial and performance information and the documentation needs to be marked as draft and subject to amendments.”

As Hebden Bridge resident Dave Boardman commented:

“We need to save the NHS from management geeks on management and marketing courses.”

Calderdale Council and Calderdale CCG are starting to implement the Better Care Fund plan in 2014, and the Better Care Fund is “the vehicle to support the aspirations of the Strategic Review”, so how can Calderdale CCG logically claim that they have not yet decided whether to close an A&E and cut hospital beds, since this is the only way they can release funds to carry out the Better Care Fund plan?

And the Better Care Fund is only necessary if they have made up their mind to make these hospital cuts and closures.

By claiming it’s not decided on an option for A&E closure, Calderdale CCG is splitting hairs

Whether the A&E closure, the split between an unplanned care and an acute care hospital, and cuts to hospital beds are achieved through option 2, 3 or 4 really is beside the point.

Whether Calderdale CCG decide to go for 2, 3,or 4, they all involve hospital cuts and A&E closures.

And by claiming that they’re the ones who decide, Calderdale CCG are glossing over the fact that Greater Huddersfield CCG also has the power to decide on what happens.

Dr Steve Ollerton, Clinical Lead at Greater Huddersfield CCG, said at a public meeting in Kirklees last week that he was determined that Option 4 wouldn’t happen.  (That is, to close both A&Es and send everyone to Leeds).

So that leaves Option 2 or 3  (with Option 3 being to close HRI A&E, make it the unplanned care hospital and move all acute services to CRH).

Either way, option 2 and 3 both mean losing one A&E and closing 100 hospital beds. And on the evidence of A&E closures elsewhere, they will both damage people across Calderdale and Greater Huddersfield.

Calderdale Clinical Commissioning Group’s Strategic 5 year plan aims to carry out the proposed changes

Calderdale Clinical Commissioning Group Governing Body met on 14 March 2014 and accepted the CCG’s draft Strategic 5 Year Plan 2014-19. After a bit more work the final version will go to its April meeting.

Right at the start the Strategic 5 Year Plan says in big bold letters “Vision for large scale transformational change”, and the first paragraph says the Strategic 5 year plan is based on the CCG’s contribution to delivering the Strategic Review.

The Strategic Review (dear reader, you may remember) is the document that includes the “preferred option” for:

• closing Calderdale A&E
• centralising all A&E and acute services in Huddersfield Royal Infirmary and turning Calderdale Royal Hospital into an 86 bed routine/unplanned care hospital with a Minor Injuries Unit, while Huddersfield Royal Infirmary would have 649 beds

While setting up a low-cost care in the community system based on the American Kaiser Permanente company’s  private health insurance/private healthcare model.

Confirming its “alignment” with the Strategic Review and Strategic Outline Case, the CCG Strategic 5 Year Plan even reproduces the model of the “Future Care System” from the Strategic Outline Plan, with the Right Care Right Time Right Place logo on.

 

 

 

 

 

 

 

This diagram is particularly impenetrable, in my opinion.

But it shows a poorly patient at the centre, with money from a personal budget going directly to them. And with this spending power control is also supposed to pass directly to the poorly patient.

With this control over their personal health budget, which is designed to cover the costs of an agreed continuing healthcare plan for patients with continuing care needs, patients will be able to buy the care from any available provider. The personal budget also covers the personal social care budget.

Backing up this care in the “locality” – a term which means an area of Calderdale that covers a group of GP practices – is a ring of specialist care which at the moment is mostly available in hospital but in the Better Care Fund plan, is supposed to be untethered from the hospitals and float around the locality. The meaning of total care and safety net are unclear to me but presumably could mean hospitalisation.

However badly designed and incomprehensible this diagram is, it’s the same as the diagram in the Strategic Outline Case. Which is my main point. That the Clinical Commissioning Group’s Strategic 5 year plan describes how they’re going to put their bit of the Strategic Outline Case into action.

As already suggested, whether than means option 2, 3 or 4 really doesn’t matter, because they all involve A&E closure, hospital cuts and an entirely dubious system for replacing existing NHS and social care services with what is basically an American private health care system.

I could go on with more quotes and references from the draft 5 year strategic plan, but I’ve had enough already.

If you want to figure it out for yourself, you can read the documents and see what you think.

The Better Care Fund Plan, Strategic Review and Strategic Outline Case are available here on Storify.

The Calderdale CCG Draft 5 year Strategic Plan is downloadable here.