Greater Huddersfield Clinical Commissioning Group chief officer Carol McKenna and Holmfirth GP and CCG board member David Hughes spoke to the Examiner’s Martin Shaw midway through public consultation into health shake-up plans which could signal the end for Huddersfield Royal Infirmary.
1) Why is change needed?
DH: The services we provide are not sustainable. We have less than average outcomes as far as preventing deaths, patient satisfaction and a number of other clinical indicators. That’s, in part, because we are trying to run acute services over two sites which is splitting the consultant staff. We know if we can have more consultant-led care at an early stage in A&E that’s likely to produce better outcomes.
If we want to move to consultant care from 8am to 10pm seven days a week over two sites we will need to double the number of consultants and when we recently went to advert we had only one applicant who is currently working abroad.
It’s not about the money. It’s improbable we will be able, with the consultants we have, to operate safely from two sites.
While the plan has a disadvantage (in terms of distance) for some parts of the population the outcomes will be better and the lengths of stay in hospital will be reduced.
2) Why is there only one option and no Plan B?
CMc: When we started off there were 11 options, some far more radical. They were narrowed down to five options. When you look at meeting standards around quality and safety they were all pretty equal, apart from doing nothing. But when we did the value for money analysis we came up with the one which was less costly. That’s the one we are willing to take to the Department to ask for money. We have been honest with people. This is the one that stands the best chance of success. We want to improve the lives of patients rather than service a debt.
3) The perception is that this consultation is just a box-ticking exercise. Are you really listening?
CMc: We are listening. Even if a decision is taken to go ahead with the proposal there will be things that people tell us that we need to take account of. We need to hear from people what impact they think this will have. There may be issues we need to look at – like transport.
DH: Transport is an issue and something we are going to have to listen to. If you have your mum in an acute medical bed in Calderdale you are going to want to go and see her. We have to look at the buses. How does someone from Holmfirth or Denby Dale get to Calderdale? We have to listen to that. As I have said to a number of people, you may have to travel further but you may have to go visit them for less time.
4) What happens if the money needed for the reconfiguration is not forthcoming from the Government?
CMc: The people who go asking for the money are the trust. If that’s not forthcoming we have to ask if there are other sources of funding. If we don’t get all of it or only some of it we will have to look at other options.
5) What have you learned from the consultation?
DH: That one of the big issues is transport. We have also learned that quite of a lot people don’t yet understand what we’re actually proposing. There have been lots of questions about the process.
CMc: There’s not the level of understanding about what an urgent care centre can offer. This is not about removing everything from Huddersfield. We are talking about a new state of the art planned care facility. The thing we have tried to be honest about is that we can’t do nothing.
6) Have you been surprised at the level of opposition and the emotions and public anger?
CMc: No, because we see that people have a real attachment to their local hospital, A&E particularly, and we also saw it with maternity services. We would not be going into this situation where people are marching on the streets unless we believed it was right. We are not doing this lightly. It must be important for us to do this.
7) What are your thoughts on the public meeting at the John Smith’s Stadium and will you open up the whole stadium for the next one?
CMc: It was hard but we didn’t expect an easy couple of hours. A number of people we spoke to afterwards said they could not ask questions in that environment. We want to learn from that for the next meeting. We have promised another meeting but we don’t have a venue yet. We are still sorting out availability.
DH: It was an opportunity for people to stand on a soapbox and get a good response from the crowd but it’s not a good way of getting information across. If we hadn’t had one we would have been shot down in flames!
8) Are you struggling to get your message across to the public?
DH: A lot of the public perception does not fully understand what we are proposing. The headlines are about losing A&E, or A&E closing, whereas actually what we are proposing is something that’s entirely different to A&E and a new model of care.
On the days I work clinically I see plenty of people everyday for whom this is real. I can see this is going to make a difference. For some people it’s going to be more inconvenient but I am quite happy to look them in the eye and say overall this will provide better clinical outcomes. People, on the whole, have respected what I’ve said. Overall I have had a respectful listening and persuaded quite a number.
CMc: This is why we want people to come along to the information sessions. You can have a much more informed conversation in a way you can’t at a public meeting. They might go away saying I’m still not happy because Huddersfield is losing but I understand the problems.
I think we are struggling to get the message across but when you have those individual conversations it’s much richer. We understand there’s that emotional attachment to the hospital but we want to build something better for the future that’s going to last.
9) At the start of the process people were led to believe Huddersfield’s A&E would be saved but that was suddenly changed. Why?
CMc: In 2014 the outline business case suggested that we might be looking at emergency care in Huddersfield but things moved on considerably after the Calderdale and Huddersfield NHS Foundation Trust process with Monitor. There was a change of financial position that re-opened all options. Really we have been talking about this need for change since the CCGs were formed in 2013. These proposals have been refined and re-developed because the world has changed around us.
10) How concerned are you about the extra distance to Halifax and the fact Yorkshire Ambulance Service are not meeting its targets and critically-ill people will have to go a lot further for emergency care?
DH: It’s five miles further, it’s not a lot further. If you talk to the Yorkshire Ambulance Service they run emergency ambulances through longer distances than the Elland Bypass. They do it on the M1 when the M1 is blocked and run around the Leeds Ring Road, They are well used to weaving through traffic. I completely accept it will take longer to do that bit of the Elland Bypass in the morning and evening than it does when it’s empty. However the outcome you get for having the relatively modest increase in travel is being dealt with more by senior staff and with a co-ordinated emergency care centre system. I believe this will more than compensate for the detriment of the slightly increased journey time. We know this from London when they developed specialised trauma centres. They decided they would have trauma centres and an ambulance would drive past the local A&E and go to a specialist care centre and outcomes would improve dramatically. We do the same now for heart attacks. If you are found by ambulance staff to have a potential heart attack in Huddersfield, whatever time of day, you will be taken to Leeds, not Huddersfield or Halifax, because specialist care is there and outcomes are better. It’s the same with strokes, at the moment in Huddersfield you are already going to Calderdale.
CMc: A lot of intervention takes place in the ambulance. It’s not a case of putting someone in and getting there as fast as you can. Ambulance services have changed dramatically over the last few years.
11) Does reducing HRI beds from 400 to 120 not mean that Huddersfield people are going to be second class citizens compared to people in a smaller town?
CMc: They are not second class citizens. They have a brand new planned care hospital so those beds will exist alongside 10 operating theatres. That’s a sizeable facility. It will have an urgent care centre, that’s important to emphasise. That urgent care centre will deal with over half the people who currently go the Huddersfield A&E so the majority of people who go there will still have their needs met across the road at the Acre Mills facility.
12) Huddersfield MP Barry Sheerman says ‘health chiefs’ told him to keep quiet about the proposals. Was he told to keep his mouth shut?
CMc: We meet regularly with the MPs Barry and Jason (McCartney) and we certainly never told anyone to keep quiet. We met regularly all through last year. We made an effort to make sure we briefed the MPs once the financial work was complete. We were quite open about the process.
13) Given all you have seen and heard in terms of reaction to the proposals, are you still convinced these are the best options?
CMc: We have been quite open with people about the options we considered. In a lot of ways it would have been disingenuous to go out and consult on a number of proposals when we knew we only stood a chance of delivering one of them. We have chosen the option with the best chance of success. Genuinely if people feel we have not taken something into account then we want to hear.