Final Consultation Document Analysis: please post here!

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Final Consultation Document Analysis: please post here!

Postby Ian Bagshaw » Wed Mar 16, 2016 10:16 am

Margaret Ann Newsome Georgiadou:

QUESTIONS DERIVING FROM A READING OF THE MARCH 15TH CCG CONSULTATION DOCUMENT

Foreword page 5
You speak of ‘big financial challenges’ (col 2 para 2). I would suggest that most of these challenges derive from incompetent agreement to a disastrous PFI deal by Calderdale CCG, and the equally incompetent and highly questionable move to a merger with Calderdale CCG by a then very solvent Huddersfield CCG in 2001. Why should Huddersfield ratepayers have to contribute towards rescuing Calderdale from its own financial incompetence, by losing so much local health care? This is altruism gone mad. I believe there should be a ‘demerger’ of these presently combined CCG’s.

You omit a deal of necessary detail in your statements viz: (col 2 para. 3) What evidence is there regarding your ‘early discussions’: how many of different groups (i.e. patients, general public, clinicians, nurses, doctors, which ‘partner organisations’) How many and of which group claimed they wanted as much care as possible provided closer to home? What type of care was specified, how close to home was ‘close’, which services if any did they want more than others?

To what extent have you done this ‘exactly’? What evidence is there that ‘These are making great progress’? and what ‘progress’? (col 2 para 4)

Page 6
You appear to contradict yourselves here, having previously said ‘This is exactly what we have done’ you now say (col 1 para 2) that you are ‘laying the foundations.’

More evidence is required for the ‘many more discussions’ (col 1 para 2) with again details of the groups’ make-up. Also same paragraph: ‘two independent reviews’ by whom for what?

In the following paragraph (col 1 para 3) you mention ‘investments’ without saying what the cost of these will be, nor what they actually will be. You also in this paragraph say you will make ‘efficiencies’ to generate £291m+. What efficiencies exactly, and how?

You mention using NHS 111 – often this number takes quite a while to respond, and is often unsuitable for use in an emergency. (col 1 para 5)

How exactly will you fund the ‘big development’ at Acre Mills? (col 2 para 1)
What would happen if you do not obtain this funding?
120 beds at Acre Mills is not a ‘big development’. It is a reduction in beds available in Huddersfield. (col 2 para 1)

How many of the clinical staff have been involved in this new model? How many of them ‘support’ the proposed change? (col 2 para 3)

Your ref to a comprehensive review of alternatives (col 2 para 4) needs a link to later in your document. Many will at this point ask what they are.

You were looking only for the ‘most affordable’ model? So money was your priority guide, rather than health needs? Why is Calderdale the ‘most affordable’? (col 2 para 4)

You state that HRI is more than 50 years old. Parts of Calderdale Hospital are more than 100 years old. (col 2 para 4)

You also state that HRI has a need for significantly expensive rebuilding, yet also state you will need a very large amount of money to extend Calderdale Hospital! (col 2 para 4)

In the next paragraph (col 2 para 6) you say you are ‘not consulting on more than one alternative’ and that the reason for this is that you want to be clear that…..doing nothing would not achieve the improvements…needed.’ This is a non sequitur. Consulting on more than one alternative does not equate with ‘doing nothing.’

Page 8
You estimate you will need £270m by 2020. To what extent will removing most healthcare from Huddersfield meet your estimated need? ( col 2 para 9)

Page 9
Where does the CCG’s ‘financial gap’ of £60m come from? Also the gap of £193m from the merged trusts? Who are the ‘other providers’ @ £17m? (col 1 para 1)

Where does the ‘underlying (Trust) deficit’ of £27.5m come from? (col 1 para 2)

(col 1 para 3) If, as is most likely, you do not gain funding from the government of the £291m you say you will ask for, what would happen to these proposals in this document? No redevelopment of CRH, no new hospital on the Acre Mills site? And would you, by the time you receive a governmental ‘No funding’ response, have already have demolished HRI and sold its site? What are your plans, exactly, in the no government funding scenario?
You say if this happens ‘our proposed changes cannot go ahead.’ Is this a promise that the situation regarding healthcare provision, in the case of no funding, would remain EXACTLY AS IT IS NOW?

Why has it taken you 3 years to act on Keogh’s 2013 recommendations? (col 1 para 5)

Why are you ignoring the last quoted of Keogh’s guidelines: ‘To connect all urgent and emergency care services together………’ You are splitting these between 2 separate towns with very difficult transport connections. (col 2 para 1)

More details are needed of the groups you consulted among the 4000 you claim. (col 1 para 6). Your link to these engagement reports (col 2 para 5) does not work.

There is no evidence given for your statement that the public wanted you to address community services before looking at hospital services. (col 2 para 6).

Page 10
How many of which members of the public mentioned the key themes you list? (col 1 para 2)
FOUR of these key themes you are NOT addressing at all are:
1. ‘Services that everyone can access, including the buildings….’
2. ‘Any barriers to travel and transport addressed with a clear plan…..’
3. ‘A reduction in delays in getting the treatment required…..’

It took me 97 mins to travel door to door Huddersfield-Calderdale Hospital by bus. I do not consider this reasonable access, nor a reduction in delays for treatment. In effect, it was an INCREASE in delays. You appear to have no clear or sensible plan to address this problem.

4. ‘Technology that people can use to reduce travel times….’
This amused me. I had visions of a rocket launcher attached to my feet! I shall need it.

(Col 1 para 5-col 2 para 4) How many medical staff were involved and from what level? How many supported having emergency and acute services in one hospital?

Page 11
(col 1 para 1) To what extent was there a ‘clinical consensus’? What was the number of clinicians, out of how many from each hospital, who supported your plans?

(col 2 para 4) The Clinical Senate report I have to hand. Their report says your proposals were ‘visionary’ which can be regarded as a two-edged sword, since they had grave doubts about the deliverability of your plans. I would say these criticisms still stand. Your plan was heavily criticised by them for lacking sufficient detail, not least as to how you could recruit the necessary workforce, how you could merge primary care with care in the community and many other issues. What you quote from their report here is highly selective, and to some degree manipulative.

(Col 2 para 6) You need a link here to your later details of your alternatives.
I fail to see why your challenges mean you MUST have only ONE emergency centre site and only ONE planned care site.

Page 12

(col 1 para 1) Fine. Sell of Acre Mills and KEEP HRI. I notice you make no mention here of an A&E either at CRH or at HRI – Why?
It would be best to sell off Acre Mills and move the departments in there back to HRI, and HRI to retain its A&E. Both Calderdale and HRI need an A&E EACH.
You wouldn’t need to develop an Emergency Centre in either if both kept their A&E’s. You could run an ‘Emergency Centre’ in parallel with the A&E’s.
Please explain to me why this cannot be done.

Page 13

Para 2: ‘There are no protected groups who are likely to be highly impacted by the proposed changes’. My husband and I are in no particular need of protection, but nonetheless will be highly impacted by these proposed changes.
‘There is no material difference in average travel time’ This is palpable nonsense. My travel time by bus to HRI is 30 mins door to door. My travel time by bus to CRH was 97 mins. Averages do not reflect reality

Page 20

(para 3) Patients from Huddersfield will not be able to access anything, never mind ’the best expertise’ at CRH ‘in a timely manner’. And this would not give the ‘best possible chance’ of survival.
You are neither eliminating nor reducing transfers of medical patients. You are asking Huddersfield people to transfer THEMSELVES to CRH.

(para 4) ‘within the 4 hour A&E target’? I thought the ‘golden hour’ was the target?

Impact of travelling further
More unrealistic averages! The following points need to be made:
1. How long does it take, even on average (!), for an ambulance to reach the patient, never mind how long it takes to get to CRH?
2. Your comparison of average times taken by ambulances to reach HRI/CRH is faulty. In your comparison there would be people travelling from BOTH areas to EITHER hospital. This is why the figures appear similar. However, since there is a far larger population in Huddersfield, there would be a larger number of people (from Huddersfield) travelling to CRH, which would make the average times to CRH higher. Thus the ambulance journey, on average, from Hudds to CRH would be a great deal longer, which would endanger these patients’ chances of survival.
You seem not to have discussed the overall ambulance situation with the ambulance service. This worries me.
3. There are many traffic jams on the route to CRH from Huddersfield.
4. Weather conditions in winter (Nov-March) badly affect travel times, and indeed prevent any travel at all at times along that route,

You also say: The report also showed that the impact may be greater on some vulnerable and disadvantaged groups. I regard my husband and myself as neither vulnerable nor disadvantaged yet my bus journey to CRH was totally exhausting as well as very lengthy. I would say ‘will be greater’ not ‘MAY be greater’.

It seems you are well-prepared to ignore the plight of the carless in attempting to cope with your plans. I find this appalling. How can you talk about their receiving the best possible care, when they arrive frazzled and exhausted, and with the prospect of a nightmare journey back home in their minds? Such stress is very bad for one’s health.

I have also attempted to reach CRH by car. I can reach HRI in 5-10 mins. My journey to CRH took me 45 mins, on a pretty decent run – only two hold-ups. However, I did not manage to reach the door of CRH as there was no parking available when I arrived either at the hospital or in the surrounding area.

Page 23

(col 1 para 3) How will you suitably staff the Urgent Care Centres to cater for a wide range of injuries/illnesses, in a wide range of age groups 24/7?

(col 1 para 4) How would you staff the out of hours GP service in an Urgent Care centre? Do you have the full co-operation of local GP’s and if so where is your evidence for this?

Page 26

I definitely would not want a consultation by video or phone.

Page 27

You mention Calderdale people travelling from distant parts to CRH. You make no mention of Huddersfield people from distant parts of Huddersfield travelling to CRH. Why?

I need more information on how patients using public transport will be helped, otherwise your proposed changes will be of little use to them, and I therefore would not endorse them. Have you any idea of the numbers of such patients. For instance, I always travel to HRI by bus (30 mins max) as I can never find parking there or the surrounding area, and I object to the high parking charges anyway.

I need more information on the community services you envisage, and how they will be staffed and funded. These services appear to be of major import in your plans yet you provide very little detail as to how you will fund and staff them. If your plans fail in this area, then the whole of your plan will become a disaster. Again, I feel I cannot endorse your plan, whilst such details are not available.

Page 35

Locala is a private company. Why are we giving public NHS money to a private organisation? I object. How much does the NHS pay Locala p.a. for their services (a) currently? (b) if your plans are passed? Is Locala providing ALL the community services you list in Phase 1?

You state your intention to procure additional community based services for Phase 2 – are these also being provided by Locala? If not, by whom? And at what cost? Looks like a lot of NHS money is being siphoned off by privateers! It would be better spent reducing your debts.

Page 36

You list some community services for Calderdale (a lot) and some for Huddersfield ( very few). Are these for both areas or not? If they are then a large number are NOT closer to home for Huddersfudlians.

Page 39

Any (planned) changes to the A629 would disrupt traffic considerably on that route for quite some time. Also it would be hugely expensive. You need to provide some estimates on what/how long it would take/the cost, before anyone will take this suggestion seriously.

You also needed to have sought provisional approval for multi-storey car parks with the relevant planning authorities, again for anyone to take this proposal seriously.

Voluntary transport schemes would work only for those intending to drive, and involving those with similarly timed appointments, which latter I would think highly unlikely.

You mention the difficulty of those travelling from distant parts of either area, especially by bus. I think you should realise that even though one may live not very far away, one may still need two bus journeys. So someone living in Fartown, Huddersfield, if they were crows, could get to CRH in a possibly reasonable time. But, travelling by bus, would necessitate their taking one bus into Huddersfield bus station, and then another bus from there to CRH.e. 16/3/16
Ian Bagshaw
 
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