Several members of Calderdale 38 Degrees NHS attended the Health and Wellbeing Board meeting at Halifax Town Hall on Thursday 2nd July.

This Board is a statutory body set up by the Health and Social Care Act 2012, with the intention that the local authority should plan strategically to integrate health and social care services. It has little statutory power.

Rosemary Hedges, Secretary of Calderdale 38 Degrees, reports on Councillors’ challenges to the NHS bosses’ cost-cutting plans for Calderdale hospital and community health care services.

But do these challenges have much substance, given the Board’s lack of statutory powers? These lie with the Adults Health and Social Care Scrutiny Panel.

There was a bit of tension when Cllr Barry Collins chided Calderdale Clinical Commissioning Group (CCG) bosses for ignoring a key Council recommendation not to go ahead with “Care Closer to Home” plans to move hospital services into the community, in the absence of evidence that this scheme is likely to reduce acute and emergency hospital admissions.

This recommendation came in the report from the People’s Commission last year, that the full Council unanimously adopted.

Cllr Collins told Dr Matt Walsh, the Accountable Officer of Calderdale CCG,  that if the CCG doesn’t act on this People’s Commission recommendation, it would be presenting exactly the same plan that last year was unanimously rejected by the entire Council.

Matt Walsh rejected this, saying:

“We have taken on board the recommendations of the People’s Commission and will work with them”.

(There is no evidence that they have).

Councillor Swift and Metcalfe also rebuked the CCG representatives for racing ahead with the substantial and contentious NHS shakeup without properly evaluating Phases 1 and 2 before Phase 3 is implemented.

Cllr Swift told the HWB Board meeting:

“We didn’t expect it to be so fast.”

Coun Metcalfe said:

“There is no time there to get a proper evaluation, how could you think you would be in a position to make the decision?”

Matt Walsh reiterated his “narrative” about the “journey” of these plans,  with all the “conversations” the CCG has had with other groups.  He seemed irritated and said:

“Our timeline is our timeline…. there is a credibility issue here for the CCG… ..we will stick to our timeline”.

It seems the CCG credibility is more important than what happens to our hospital.

CCG keeps moving goalposts and changing its version of events

This NHS shake up, called Right Care Right Time Right Place, was first publicly announced early in 2014, and was met with massive public protests. The CCG then ducked the scheduled public consultation and went ahead with plans to take services out of the hospital and put them into the community, calling this Care Closer to Home.

In January 2015, the CCG told the AHSC Scrutiny Panel that Care Closer to Home Phase 1 would take effect from 1 April 2015, with new specifications for the community health services that the hospitals Trust provides. And that in August 2015, the CCG is to review whether Phase 1 Care Closer to Home has reduced acute and emergency hospital admissions.

But the Update on Care Closer to Home that the CCG presented to the HWB Board, says that Phase 1 took place in 2014/15 and:

“strengthened community services in line with a strategically developed specification. Significant engagement with service users and patient groups was undertaken to shape the specification and the desired outcomes.”

Why is the CCG rewriting  history?

Phase 2 of Care Closer to Home – to take community health services out of the hospital and provide them in the community – is supposed to be carried out this year. But since the CCG and the hospitals Trust have been unable to agree the 2015-16 contract and are now in arbitration over this dispute, who knows if or when this will happen? For some reason, Councillors didn’t ask this question at the Health & Well Being Board.

Rosemary Hedges reports that the CCG told the HWB Board that in September, the CCG aims to consult the public on hospital changes – Phase 3 of the Right Care Right Time Right Place programme.

The Hospital Changes will probably close all Calderdale Royal acute & emergency services and move them to Huddersfield, although the CCG keep saying a decision has not yet been made. (But Barry Sheerman, MP for Huddersfield, says he’s been told that neither hospital will have an A&E. A new Major Emergency Centre for West Yorkshire is being planned).

The timeline is very short and has to include some ‘public consultation’, which is scheduled for September.  This means the plans for hospital reconfiguration will be nice and ready by the autumn for implementation by the end of the year, (despite the fact that legally they are required to consult the public about whether they even want these plans before they start them off).

Many people believe that the decisions have in fact already been made and that the ‘consultations’ and ‘engagement’ are just a paper ticking exercise.  I am one of those people, and from all the meetings I attend I have come to the view that the (covert) plan is to move as many hospital services as possible into the community, with no evidence to suggest this will reduce the need for hospital beds, and then send the rest of the vital hospital functions to a nearby hospital.  This is an ideologically and financially driven plan which has no regard for the needs and wishes of the local population (with no evidence to suggest this will reduce the need for hospital beds).

Multi-speciality Community Provider Vanguard Scheme

In March this year, Calderdale CCG announced that NHS England had awarded “Vanguard” status to a consortium of Calderdale NHS organisations, Calderdale Council, health care companies and voluntary organisations.

This provides some extra money to fast track setting up one of the new “models of care” that NHS England’s Five Year Forward View says is needed in order to make NHS spending cuts (although they call the cuts “wide ranging and sometimes controversial system efficiencies”).

The Calderdale Vanguard new model of care is the “multi-speciality community provider” (MCP).

Although the CCG presentation to the HWB Board said nothing about this, the Calderdale MCP Vanguard scheme is almost certain to commission Wainhouse Healthcare Ltd – a new, private limited shareholder company representing 23 of the 25 GP practices in Calderdale – as the MCP.

This company is also known as Pennine GP Alliance.

Calderdale’s MCP Vanguard scheme is due to be operating by June 2016.  

Rosemary Hedges reports that the HWB Board heard that the Calderdale Vanguard scheme will fast track the implementation of the the Care Closer to Home scheme in the Upper Calder Valley, around a “hub” based in Todmorden Health Centre.

The CCG reported that that the Upper Calder Valley Vanguard scheme is being delivered by the multi-agency Upper Valley Steering Group.

But a question at at last week’s Calder Ward Forum found that none of the Councillors had heard of this Steering Group.

When asked by Coun Swift about the arrangements for public input, Debbie Graham, Calderdale CCG Head of Service Improvement, said:

‘We have already had lots of input from our sources’.

These sources later emerged as being “Community Based Assets” – these are apparently “community champions” embedded in a variety of voluntary organisations who spread the message and tell other people (mainly patients)  how good the new system will be.  They call this engaging with the community but from outside it looks suspiciously like engineering a good response.

Matt Walsh said:

“Vanguard is regarded with suspicion by some but it’s all about better together”.

He said the Upper Valley had been chosen:

“because of the energy of the community in wanting to engage”.

(Not because it is the community furthest from the controversial proposed re-siting of acute hospital facilities such as A&E, in Huddersfield?)

Better Care Fund

A senior officer of the Council Adults Health and Social Care Department reported on the Better Care Fund. This involves the transfer of just over £14 m of NHS money from the CCG to the Council’s Adults Health and Social Care department. This is not new money, but money that the CCG would otherwise have spent on the hospital services. Both the CCG and the Council use the Better Care Fund money to commission health and social care services aimed at keeping frail elderly patients and patients with long term illnesses out of hospital – which is also the aim of the Care Closer to Home and Vanguard schemes.

The AHSC officer told the meeting that they are “looking to approve the joint governance [between the Council and the CCG] by April 2016, ahead of schedule” and that:

“The general direction of travel is good, and this is playing out in our headline indicators”.

She gave out a document listing the 34 schemes planned, which fall into 6 categories with these titles:

• Early Intervention Services : promoting independence
• Holistic Locality Assessment and Case Management
• Reablement, Recovery and Rehabilitation
• Support at End of Life
• Information and Advice: supported Self Managed Care and Primary Prevention
• Admission Avoidance and Supported Discharge

All the schemes are costed and come to a total of just over £14 million. Most of it seems to be going towards supporting the elderly in a variety of out-of-hospital settings (a role which used to be provided by the Council from its own budget in the old days – before central government slashed local authority funding).

The written Update on Care Closer to Home (CC2H) that the Clinical Commissioning Group presented to the HWB Board says that:

“The work done jointly with CMBC to align the 32 BCF schemes with CC2H plans has been critical to the early success of the CC2H programme.”

Mental Health Crisis Care Concordat

The meeting also discussed the Mental Health Crisis Care Concordat  – a new national initiative to improve outcomes for people experiencing mental health crisis, by specifying what needs to happen when people in mental health crisis need help.

The local document has 50+ action points which Councillor Tim Swift felt was far too much for any committee to ‘own’  and needed streamlining. Debbie Graham, CCG Head of Service Improvement, said – with no mention of money:

“it’s all about integrating services and involving voluntary services and carers”

Paul Butcher Public Health Officer said the board is using an”Outcome Based Accountability Approach”, which is a way of assessing the effectiveness of measures by identifying whether patients experience the intended outcomes.