A top hospital doctor and architect of A&E shake-up plans in Huddersfield and Calderdale has said she truly believes the proposals will lead to better care for patients.
And Barbara Crosse, medical director at Calderdale and Huddersfield NHS Foundation Trust (CHFT), says she thinks a plan to downgrade both Huddersfield and Halifax hospitals’ casualty departments is likely.
Mrs Crosse revealed for the first time that she “suspected” Option 4 of the controversial shake-up plan would eventually happen.
It would see seriously-ill patients in Kirklees and Calderdale sent to a major emergency centre somewhere else, possibly Leeds.
Her comments come as hospital chiefs pass their Outline Business Case – a more detailed document about the re-structure plan – to colleagues at Greater Huddersfield and Calderdale clinical commissioning groups (CCGs).
GPs and NHS managers at the CCGs will make a decision on what to consult with the public and get the final say on which option to recommend.
Mrs Crosse said after months of hard work there were no major surprises in the document.
But she did confess that NHS policy may lead to Kirklees and Calderdale not having any major A&E unit, in line with recommendations by Sir Bruce Keogh.
Last year Sir Bruce said there should be a fundamental shift in emergency medicine with larger specialised A&Es called Major Emergency Centres.
The move would mean the downgrading or closure of smaller A&Es, as is planned at Dewsbury District Hospital.
Mrs Crosse said NHS talks were already taking place about the implementation of Sir Bruce’s plan across Yorkshire, which were likely to affect their proposals.
At the end of February hospital chiefs revealed their vision for the future after months of speculation that a casualty ward was under threat of closure.
Managers at CHFT said “doing nothing” was unsafe and presented options to split emergency and planned care between Huddersfield Royal Infirmary (HRI) and Calderdale Royal Hospital (CRH) in a bid to save £50m.
They said this meant only one full A&E department across the two patches and that they preferred HRI as the location for emergency care.
The preference would lead to CRH being used for non-emergency departments, although it would have a minor injuries unit.
Hospital chiefs want to offer more care in people’s homes and at community locations, including GP surgeries, health centres and pharmacies.
And they say they will boost facilities at under-used sites such as Holme Valley Memorial Hospital and Todmorden health centre.
But the proposals have sparked outrage in Calderdale and a series of protests to try and keep an A&E in Halifax have taken place.
The Examiner asked the Calderdale and Huddersfield NHS Foundation Trust’s medical director Barbara Crosse to respond to a number of concerns and questions about the controversial re-structure of health services.
What evidence is there that Huddersfield and Calderdale can cope with just one A&E?
There’s good evidence elsewhere that this model is good practice.
Whatever we put in place, it will be a bigger A&E to cater for the population, not just the existing one with double the patients.
Are you serious about option 4 - downgrading both HRI and CRH A&Es and relying on a major centre elsewhere?
I imagine that would be even less popular than the current preferred proposal.
But we think it’s a possibility and we will work very hard to offer people in Calderdale and Huddersfield a really good A&E service.
We need to look at the best spread of A&Es around West Yorkshire – the decision makers will need to bear in mind that they are best placed around a big population.
Why do you want to split emergency and planned care between HRI and CRH?
There’s a surprising difference between the two sites already, they’re quite different, more so than people might think.
Equally, if you come to Huddersfield and you’d had a stroke you’d be moved to Calderdale.
There’s a lot of data to support having specialised services with consultants at the front door and having senior decision makers available 24/7, that makes a big difference to patients outcomes.
The other important thing to understand is that while A&E is the emergency front door, behind that you need to have all those specialist acute services in place to give people the best care and have the best outcomes.
If we don’t make some changes we won’t be able to meet the standards that are being set, which are increasingly significantly.
We might struggle to provide local services.
Are you not worried about longer journey times to A&E?
We recognise people are concerned about their access.
We’re looking very carefully at any particular groups that would be disadvantaged by the arrangements.
But we are going to try and put a better provision into the community so that a lot of people that might have come to A&E can go somewhere else, somewhere more convenient to them.
We recognise the travel issue but the fundamental of the proposal is to provide as much care as we can closer to people’s homes.
We acknowledge it’s a congested and busy area but we have to reduce our demand on hospitals and specialise.
Given how our age profile is changing (more older people) then it’s really important that we address the community aspect of care.
Why have you stated a preference for closing A&E in Halifax?
I acknowledge making that statement has caused a lot of concern. This was an offer from us to the CCG who will review it and consider the options.
It’s not for us to decide but we offered a view as the public might say, ‘Have you thought about this sufficiently yourselves and what’s the reasoning behind it?’
Some of it’s about the site and opportunities for development, that’s a key thing.
The other thing is a lot of our acute services are already here at HRI.
Which ever site is chosen both sites will be used well and will function well.
Is the Yorkshire Ambulance Service comfortable with this proposal?
They were in favour of moving towards a single A&E site for the two hospitals but they haven’t stated a preference for which hospital.
That’s something that’s under review and will be considered when the Outline Business Case is published.
They’ve done a lot of modelling of the two options but we’re still getting that information through.
