(Non) answers to public questions to #Calderdale NHS commissioners Governing Body meeting 14th August

These are Plain Speaker’s and Calderdale 38 Degrees NHS Campaign Group’s questions to the Calderdale Clinical Commissioning Group Governing Body meeting on 14th August – updated with the answers.

1) Please will you explain the key points of difference between the community health and social care model in the Care Closer to Home Commissioning Intentions document (Appendix C to the Report: Delivery of the Five Year Plan- Right Care Right Time Right Place, Item 6 on the Agenda), and the community health and social care model outlined in both the Strategic Outline Case and the Better Care Fund submission prepared jointly with Calderdale Council?

(At first reading, the Commissioning Intentions document seems to reproduce the same  proposals for the community health and social care reconfiguration that the two earlier documents contain.)

A: The proposals have been actively developed over time as a result of the engagement journey.

2) Has Calderdale CCG held, or is it planning to hold, a Care Closer to Home market testing event for potential providers, like the one held by Greater Huddersfield and North Kirklees CCGs on 7th August?

If so, on what date and with how many potential providers in attendance?

And are the local NHS hospital and mental health trusts among the potential providers?

A: The approach to procuring the Care Closer to Homes services will be discussed in the Report under Agenda Item 6 Delivery of the Five Year Plan – Right Care, Right Time, Right Place. (It wasn’t)

3) Do Dr Matt Walsh and Julie Lawreniuk agree with this statement by the self-described “curmudgeonly NHS bean counter” Jonathan Allsopp, in his blogpost “Patients not profits”:

“Sadly the NHS, an internationally renowned health service that cares for the sick and some of the most vulnerable people in our society, continues to pay a high price for the banking crisis of 2008. Whilst it was considered unthinkable not to bail out the banks who caused the financial crash, six years on it appears perfectly thinkable to make NHS patients, staff and other public sector workers pay for the greed of the bankers. Morally this is indefensible. In the meantime, the NHS’s finance function unquestioningly busies itself with finding more and more ways to save money. Cut, cut, cut and then keep on cutting. Surely patients, not profits, should be the primary concern of any health service?

… Sadly, I’ve never felt so disillusioned with my own profession as I have over the last twelve months.

…Since the Health and Social Care Act of 2012 the NHS is steadily being chopped up and packaged off to private health companies. Between April and December 2013 over £5 billion worth of NHS services were put out to tender with 70% of the four hundred contracts awarded to a private sector provider; from cancer services in the East Midlands (yes, it seems that it is possible to make money out of cancer services) to psychological therapies in Barnet. The health service as we know it, with its strong public service ethos, is being demolished piece by piece. Soon it will simply be a brand under which a multitude of providers will ply their trade. In short, we are witnessing the privatisation of the health service, something which goes completely against my main reasons for joining the NHS in the first place.

…Yet finance managers appear reluctant to speak out about the changes. There is a fightback by doctors, nurses and other healthcare professionals that is gathering momentum. The National Health Action Party, led by consultant oncologist Clive Peedell, will field candidates in hundreds of constituencies in next year’s general election. The party is aiming to oust those Members of Parliament who supported the Health and Social Care Act. In August, a national March for the NHS will commence from Jarrow to London organised by a group called 999 Call for the NHS. The wonderful Keep Our NHS Public group campaigns to protect the NHS as a public service that is free at the point of use. The superb book NHS SOS written by Dr Jacky Davis and Raymond Tallis demolishes the propaganda behind the Tory NHS reforms. Meanwhile across the country public campaigns to save Accident & Emergency departments, maternity services and other services from closure are in full swing. The NHS is “unaffordable” is the oft-repeated justification for these cuts. It’s not though. Nowhere do I hear one of the NHS’s highly paid Finance Directors speaking out about the damage done by these financially-driven reforms.”?

Are you ready to speak out with your fellow NHS bean counter Jonathan Allsopp?

If so, please join us on Friday and/or Saturday 22nd and 23rd August on the Walk for the NHS from CRH, to HRI, to Dewsbury Hospital and on to Pinderfields where we will meet up with the People’s March for the NHS on its way from Jarrow to London.

A: The Chair declined to take this question as not relevant. He also opened the meeting with a major rant about the fact that the public should only ask appropriate questions, not inappropriate ones such as this.

These are questions that Calderdale 38 Degrees NHS Campaign Group have sent to the meeting:

1.    CHFT is planning unprecedented bed cuts of over 100 beds starting from this autumn to 2016,  some of which have already been earmarked.  Owen Williams CEO of the trust admitted to Calderdale Adult Health and Social Care Scrutiny Panel that 110 beds will go, 66 this October, and 44 in 2015/16.   Given that the consultation period on the SOC is still underway does this not constitute illegal activity on the part of the Trust, for which a referral to the Secretary of State is indicated.  If not, please explain why not?  Mr Williams further admitted that over the last 10 years 200 beds have been cut, an average of only 20 a year. This current rate of cuts is therefore unusual and highly significant.

A: This question will be addressed in the Report under Agenda Item 6 (it wasn’t)

2.  Following the headlines of the Halifax Courier last Friday is it not now apparent that Calderdale GPs are suffering extraordinary pressures?  Would the CCG agree that this is a direct result of underfunding for Calderdale A&E, and that the proposed closure of A&E at CRI will only magnify this problem to dangerous levels.  Would the CCG not agree that this is the point at which they should finally take notice of local NHS staff and residents and put an end to the plans to shrink Calderdale Royal to a minor injuries unit with some planned care beds (which are reducing all the time).  If not, why not?

A: This question will be addressed in the Report under Agenda Item 6 (it wasn’t)

3.  At a Calderdale and Huddersfield Trades Council meeting on 22nd July the ambulance service union Unite disclosed that there are plans by YAS to reduce the qualification levels of staff on ambulances, thus reducing the level of expertise available to patients in the ambulance.  Can you explain how this may affect the survival chances and quality of care given to severely ill medical emergencies?  What percentage of excess deaths is predicted with these new arrangements, using as a baseline the last year for which figures of emergency ambulance journeys in Calderdale are available, and taking account of both extra distance to A&E and the lower technical expertise of some ambulance staff?

A: This question will be addressed in the Report under Agenda Item 6 (it wasn’t)

4.  Item no. 6 on your Agenda for the Governing Body Meeting on 14th August 2014, entitled ‘CC2H Governing Body Report August 2014‘ is actually called ‘Delivery of the 5 year Plan – Right Care, Right Time, Right Place’ when the document is opened up.   The matters reported in that document indicate that you are being asked, among other things,  to ‘…approve the approach to the further development of our proposals for community services’….  and to ‘…delay consultation and adopt a phased approach to implementation in line with Option 2 above‘.  (Recommendations P10).    Are we right to understand from this that the Governing Body is being asked to approve the significant service change of commissioning Care Closer To Home services, without public consultation? And that you will only carry out the public consultation on the proposed acute and emergency hospital service cuts once the Care Closer to Home System is in place?”

4. 1  Do you not think this title is confusing and misleading for the public, at a time when transparency and openness is so important?  Why does the wording conceal the content of this Report and make it hard for the Public to identify what is really on the Agenda?

A: When you open the document the title is very explicit so “we feel it’s not misleading”.

4.2  Do you not have a legal duty to engage and consult before  making significant changes? Are you not running the risk of opening the CCG up to the charges of a) failing to allow the public a proper chance to be involved in making decisions about a significant service change? and b) predetermining the outcome of a consultation, given that once the community care services are in place, the hospital cuts will be a foregone conclusion since there is not enough money in the CCG’s budget to pay for both the new community care system and existing hospital services?

A:  This question will be addressed in the Report under Agenda Item 6 (it wasn’t)

4.3  If it is to be funded through the Trust’s proposals in the ‘Balanced Plan’ (which describes swingeing bed cuts over the next 2 years) can you explain how the 8 outcomes that you say are based on the needs and opinions of patients and public translate into them saying that they agree with closure of the local A&E department and most of the acute medical wards?

A: This question will be addressed in the Report under Agenda Item 6 (it wasn’t)

4.4  What is an ‘asset based approach’ as referred to in Appendix B and how did it generate 1263 contacts in Calderdale and 1244 responses?  How many responders in the engagement process stated they did not want this new model of care if it meant closing down their local hospital?  (we have 1500 + signatures objecting to closures and other local organisations have thousands more)  Is this an option that responders were made aware of?  If not, do you think it should have been put into the equation?

A: The CCG’s “asset based approach” to engagement is that the CCG trains and uses local groups to speak to the public on the CCG’s behalf, in order to get people’s views in the groups’ communities. The engagement analysis report will be on Calderdale CCG’s wesbite at the end of the week.

Updated with the CCG Governing Body’s answers on 28 August 2014.

Posted from here.