One of the doctors behind controversial hospital plans for Huddersfield has admitted: “Neither Huddersfield or Halifax can sustain a hospital on their own.”
Dr Steve Ollerton says there needs to be a population of 500,000 to keep a hospital going.
It is one of the main points made by Dr Ollerton, who chairs the Greater Huddersfield Clinical Commissioning Group (CCG), one of two local NHS organisations behind the Right Care Right Time Right Place plan.
The five-year plan proposes to demolish Huddersfield Royal Infirmary (HRI) and replace it with a smaller hospital which will focus on planned care and crucially, will not have full emergency services.
Calderdale Royal Hospital (CRH), Halifax, will be expanded to concentrate on emergency care and will have, for many Huddersfield residents, the nearest emergency care centre.
A 14-week public consultation on Right Care Right Time Right Place begins tomorrow (March 15).
There is a seemingly endless list of questions about the biggest local NHS shake-up since World War Two.
I put some questions to Dr Ollerton.
What do you think of the #HandsOffHRI campaign?
“I’m very passionate about HRI. It’s our local hospital and it’s where I send a lot of my patients.
“The fact that it says ‘hands off HRI’ makes me think it’s just going to disappear...
“The new HRI is going to be quite an exciting place that’s not going to be 60 years old and in need of a lot of work.
“People think that HRI is their local hospital and its sacred, but it’s not providing the best services that it could and our plans are going to try to address that and make it a better facility.”
If from the public consultation you find there is overwhelming opposition to the plan what will happen?
“When we get into consultation our plan is to convince as many people as possible that we’re doing the right thing.
“I will be disappointed if, after 14 weeks, they’re still all against us.
“If we didn’t believe it was for the best then we wouldn’t be doing it...
“We can’t carry on as we are. Whatever we do, we are going to have to change things.”
How much of Right Care Right Time Right Place is about improving local healthcare and how much is it about cutting costs?
“At the top of this proposal is quality of care and safety.
“We recognised three years ago that things weren’t as good as they should have been.
Finances have become more tight.
“We have that PFI and we have to use it and we have to fully utilise it and that has been behind why Halifax has been chosen as the emergency centre.”
When the PFI was signed in 1998 Calderdale and Huddersfield hospital trusts were separate and they fused in 2001. Some people believe that Huddersfield is paying for the debts incurred by another trust.
“Towns of 250,000 people, which is what we’ve got, are not big enough to sustain a modern hospital. Both Halifax and Huddersfield actually only need one major hospital. Regardless of what happened in 1998 or 2001, we need a hospital serving a population of about 500,000 people.
“We would have ended up doing this anyway.
“What should have happened around the turn of the millennium is they should have built a nice, big hospital at Ainley Top, and we wouldn’t be in the situation we are now.”
What proportion of emergency patients will go to CRH if A&Es at HRI and DDH close?
“Approximately 30% of the current attendances at A&E – and these are the more poorly 30% – need to be seen by emergency care consultants. 70% of those will be able to be dealt with in the urgent care centre which we will have at HRI.
“About 10,000 or 15,000 of our emergency patients will be making the journey over to CRH per year.”
There are times when ambulances will be travelling from CRH or even Bradford Royal Infirmary to Huddersfield and South Huddersfield. You’re not going to getting those people to CRH within 22 minutes – or the recommended 45 minutes.
“We have been working with Yorkshire Ambulance Service on our proposals. They have helped us with travel times and we have taken all those journey into consideration for those extra patients and we’ve worked out how many thousands more of hours those ambulances need.
“We are going to buy those extra hours or ambulances within the proposals.”
You don’t have blue light journey times by postcode and area. There were 4,700 of the blue light journeys from HD7, HD8 and HD9 last year. Why don’t you have these figure or feel the urgency to obtain them?
“As a GP, who works in HD8 and a resident of HD8 with a family, my family has only used A&E twice and both times we went to Pinderfields Hospital in Wakefield so it highlights that patients can travel to different areas.
“If the public want see it (figures) we can look at it.”
How is increasing 999 journey times improving care?
“A longer journey to a more specialised unit is a journey that’s worth making because your chances of survival are better.
“It is difficult for more rural areas but there are plenty of people who live in rural areas who are a long, long way from hospital.
“Here this is not a ridiculous distance. It might be an extra nine minutes but we’ll get them there and treatment starts in the back of the ambulance.
“Rarely there will be a time where distance matters, but we will save lives by people being in a more specialised hospital that has the right equipment, the right staff and the right senior staff.”
People are worried about traffic on the Calderdale Way slowing down ambulances?
“We know there are road improvements planned later this year for that particular bypass.
"Ambulances can get through but that isn’t the only route.
“We would all like a better road system but we don’t feel it’s putting life in danger.”
CRH and HRI have been declaring ‘black alerts’ meaning they can take no more patients. How is one emergency care centre going to manage better than two?
“One of the biggest problems that caused the black alerts was readmissions of patients.
"One of the reasons we are doing this reconfiguration is that too many people are being readmitted.
“With senior decision-makers at every point in a patient’s care (and) because they get can they tests quicker, we think the length of stay will be reduced by at least one-and-a-half days for each patient because they will be seen and treated quicker and better and they will get home quicker.”
Do you think patients could die as a direct result of these changes?
“On average more people will live.
“We were in the bottom 10 hospitals in the country last year for mortality rates.
"There were 2,700 deaths last year, either in the hospital or very soon after discharge. I think 230 of those were preventable if we were average, rather than being in the bottom 10.
“I’m hoping for good; I’m hoping for better than (average).”
Have neighbouring health authorities been consulted?
“Yes. We’ve had a lot of conversations with Mid Yorkshire Hospitals Trust, especially.
"We will need to increase the number of our beds at Royal Oldham Hospital. We’re going to increase our contract with them.
“We are looking at increasing capacity at Wakefield Pinderfields and Barnsley Hospital.”
Would you like the Government to bail the hospital trust out of the PFI?
“Yes. Hospitals are better owned by the NHS. The debt is eye-watering and it’s making everyone’s life difficult. But we’ve got to deal with it.”
How much is the PFI dictating Right Care Right Time Right Place?
“It is dictating the site of the emergency centre because we have to fully utilise the asset.”
Huddersfield was originally the site for emergency care: why has that changed?
“It was two years ago when the model first came out.
“At the time, the hospital wasn’t in any financial difficulties. They hadn’t fully costed everything. They hadn’t fully explored what the possibilities were.”
Right Care Right Time Right Place needs about £490m; is there any guarantee the Government is going to give you that?
“I would be extremely disappointed because we have made the case for change and if we don’t change, our hospitals and the services will be come unsafe.
Have you got a ‘plan B’?
How will centralising services address recruitment problems?
“Many of the services at the moment are split across two sites. Not all services are 50:50 split but quite a lot of them are. That means your teams are split, they don’t get to meet up and discuss cases. It means there’s less flexibility and less capacity. That makes the jobs less attractive.
“It won’t cure recruitment problems but it will certainly make it better for our patch and make it a place where people want to come and work.”
When can we see what the new HRI and the expanded CRH looks like?
“We have to make our decision (on whether to go ahead with Right Care Right Time Right Place) before we do that.”
What will there be at the new HRI?
“There will be an urgent care centre that will see about 70% of the people who currently go through A&E.
“It will have x-rays and blood tests 24 hours a day and we will be able to deal with the vast majority of patients.
“There will outpatients, day cases and primarily, the 10 operating theatres doing the planned surgery which means that a lot of Calderdale patients with have to travel to Huddersfield to have their hip or knee done, because that’s where the majority of planned procedures will be.”
You’re moving more services out of hospitals and into the ‘community’. GPs surgeries are having their funding cut and there are cuts going on here, there and everywhere. What makes you think the community has the capacity to pick all this up?
“I have every confidence that the community will. There’s good evidence, mainly from America, where investing in primary and community care can be up to a quarter of the price of an inpatient. That’s not for everyone because some people do need to be in hospital.
“But we will spend less in the hospital and invest that money in the community and more people will get their care in the community at better value.
“As far as we know, our money is not being cut.
“We’re not expecting GPs to do a lot more for nothing; the investment will follow.”