Huddersfield Keep Our NHS Public and Save Calderdale Royal Hospital campaigners want NHS chiefs and Calderdale Councillors to come clean about the damage that funding cuts and privatisation are inflicting on our NHS.

Paul Cooney, a member of Huddersfield KONP, said,

“The Trust’s September newsletter really obscures the truth about the Trust’s worsening financial situation. I have previously called for candour and transparency in their public statements. It is time for the Trust bosses to stop pretending everything’s going to be ok and admit that things can’t go on as they are.”

The newsletter reports on the Trust’s Balanced Plan, that aims to increase income and cut costs in order to save £20m this financial year and £19m next financial year. The newsletter states,

“We have to find savings to show our commissioners we have a sound financial management track record.”

This is rather economical with the truth.

Cuts and sell offs risk putting the Trust in breach of its licence to operate

The Trust’s finances are deteriorating because the government requires the Trust to make £39m efficiency savings  – ie cuts – this financial year and next.

Last financial year, the Trust had to save £12.5m, compared to £20m this financial year and £19m next financial year.

To date – despite employing an outside consultant, Mags Barnaby, to identify how the Trust can make these “savings” – the Trust has only found ways of saving less than half the £20m that’s required this year.

It was in the red in the first quarter of this financial year and faces a deficit at the end of the financial year.

Because of the Trust’s deteriorating finances, Monitor (the NHS market regulator and enforcer of competition requirements) sees an increased risk that the Trust will fail to to carry on as a going concern.

Monitor has asked the Trust for further information, before deciding next steps.

In the worst case scenario, these steps could include removing the leadership of the Trust and putting the Trust under the control of a Special Administrator, from one of ten management consultancy companies employed by Monitor for the purpose.

The Special Administrator would recommend to the Secretary of State which core services should continue to be available, and how and where these services should be provided. If the Secretary of State approved the recommendations, the management consultancy firm would implement them.

NHS Foundation Trusts are legally required to balance their books. But by their own  admission, the government’s attempt to run the NHS on the cheap means the Trusts are now in a position where they can’t do this without cutting patient care.

Ms Lawreniuk, Calderdale Clinical Commissioning Group’s Finance Officer, told Calderdale Council Adults Health & Social Care Scrutiny Panel that the hospitals Trust intend to make a number of cuts in order to save the required £20m this financial year, but if the proposed service cuts threatened patient safety, the Commissioners would not allow the Trust to make them.

But this would then put the Trust further in the red – breaking its legal requirement to operate within a balanced budget.

Freda Davis, Chair of Calderdale Green Party, said

“The Trust puts out bland reports pretending all is well but our NHS services are being threatened by a pincer attack. One arm of Government insists the Hospital Trust cuts so much from its budget that the service cannot safely be delivered, and another arm of Government waits to declare the services as below acceptable quality, leaving the Trust vulnerable to being taken over and broken up, and its ‘profitable’ elements shared out between the profit hungry providers. I dread to think what minimum level of service will be left available to most residents in Calderdale. Community services will not take away the need for hospital beds and emergency treatment. Calderdale Green Party wants to help local people wake up to what is being done.”

Trusts have to provide “mandatory” services, but only until April 2016

Since the Health & Social Care Act (HSCA) 2012, Trusts have operated under a licence from Monitor that lists certain services as “mandatory” – they have to provide them, but only up until April 2016.

In September 2013, Monitor entered into a £210m, four year contract with ten consulting firms to develop “continuity of service” plans for providers that have been assessed as at high risk of failure.

Monitor has also told NHS commissioners that between now and then, they have to identify services that would need maintaining if a foundation trust was unable to pay its debts.

But under Monitor’s contract with the management consultancy firms, the management consultants would make contingency plans that recommend how these essential services should be provided – either at the existing site, by other healthcare providers or through other means, which include “possible closure”.

Care Closer to Home community care scheme risks destablising hospitals Trust

Calderdale Clinical Commissioning Group and Calderdale Council’s Care Closer to Home and Better Care Fund plans are making the hospital Trust’s financial situation worse.

These plans aim to cut acute and emergency hospital services and replace them with care in the community, based on a private American health care system.

Rolled out all over the country, this new care in the community system is fast being privatised.

This will also happen in Calderdale – where public and community health services are at the moment mostly provided by the hospitals Trust, but the NHS commissioning group and the Council are now putting them out to competitive tender.

Care Closer to Home schemes to move healthcare out of hospital into “cost-efficient” settings are the other side of the coin of “efficiency savings”.

Both measures come from the American consultancy company McKinsey, who in 2009 advised the New Labour government on how to run the NHS more cheaply.

But there have been overwhelmingly negative results from schemes to reduce emergency hospital admissions by providing community-based health care, like the Care Closer to Home system.  (Bardsley and others, 2013 – link at end of this article)

The Hospitals Trust Chief, the NHS Commissioners’ Chiefs and both Calderdale and Kirklees Councils need to come clean about the damage that both the government, and they, are inflicting on our NHS.

They say they want to integrate services, but they are fragmenting, cutting and destabilising them.

The Councils’ Scrutiny Panels and/or the Joint Health Overview Scrutiny Committee must use their power to tell the Clinical Commissioning Groups to hold a public consultation now, before they carry on with setting up the Care Closer to Home scheme.

Calderdale AHSC SP also needs to call in the Council’s AHSC and Public Health officers in order to investigate their decisions to re-procure community and public health services through competitive tender.

This is all the more urgent since:

• the evidence is overwhelming that Care Closer to Home & Better Care Fund schemes are most unlikely to cut emergency hospital admissions and so save money for the hospital
• Monitor has upped its risk rating for the hospital Trust’s continuity of service and governance
• Monitor’s continuity of service contracts with management consultancy firms remove  the requirement for mandatory services

You can read more information about Monitor’s Special Administrator /“continuity of service” contracts with management consultants here.

Bardsley and others, 2013