Tuesday, 17 February 2015

Health: People's Commission urges health reform

An extraordinary meeting of Calderdale Council saw the official unveiling of the People’s Commission on Healthcare’s report on local health and social care provision.

The 32-page document entitled Improving Healthcare Together offers 15 recommendations for local health providers and commissioners, including calls to restructure the debt at Calderdale Royal Hospital, for patients to be put before finances and for health bosses to work more closely with the council’s Health and Wellbeing Board.

The council meeting, held at Halifax Town Hall, heard from the Commission’s independent chair Professor Andrew Kerslake (pictured) of Oxford Brookes University who spoke to the full council and members of the public about the report’s findings.

Prof Kerslake told the meeting: “We always have a tendency to hark back to a golden age - however the days of a gruff but kindly GP as in Dr Finlay’s Casebook is about as close to the current health service as Dixon of Dock Green is to modern policing.

“We all know that times have changed - surgery, medicines, equipment and techniques have all advanced dramatically,” he said.

“The level of healthcare we have now wasn’t available 25 years ago, but of course all that comes with a pricetag.”

He told the meeting that we have a health service that is very good at keeping people alive, but that seriously ill patients’ quality of life has not seen much improvement for a long period of time.

He said that this is likely to get more pronounced as the number of elderly people living in Calderdale increases over the coming decades.

“Calderdale currently has 9,200 people aged 80 and over, by 2030 there will be 15,400 - that’s a 60 per cent increase in the number of people aged 80 and over,” he said.

“Emergency hospital admissions by people over 65 have increased year-on-year since 2001 by around 46 per cent.

“If the rate of growth continues, I can’t see any political party proposing to spend the amount of money that would take.

“At some point we’ll have to address how we can reduce demand rather than pretend we can always beat it.”

He said that the proposals presented by the Trust in its Outline Business Case “simply didn’t add up.”

“The financial modelling is unconvincing; it outlines problems at the start of the document, but does not show how it would resolve those issues; it says that planned care will require far fewer beds, but no data is presented extrapolating current planned care over how many bed-days are needed at that hospital,” he said.

“We agree with the Clinical Commissioning Group that other options need to be explored, they need to be evidenced and they need to be presented.”

He explained that many of the issues facing accident and emergency departments, both locally and nationally, are that there are too many gaps in out-of-hours health provision, or that patients are unaware of the services available to them locally.

“Up to a third of A&E patients could have been dealt with elsewhere, but the critical word here is ‘could’,” he said.

“Few people go to A&E because it makes a good outing.

“However, if you have a condition which you feel requires treatment now and other services are not available - or people believe the services are not available, which is equally important - then you will turn up at the one service that is 24 hours a day,” he said.

He recommended that elected councillors should take a leading role in bringing together the various organisations with a stake in local health and social care provision.

“The Health and Wellbeing Board is the right body to bring together all these organisations in the health and care sector and can ensure that any decisions made are evidence-based and take forward the recommendations of the Commission,” he said.


The recommendations put forward by the People’s Commission were debated by members of the three main political groups on Calderdale Council.

The debate focused chiefly on the £10 million annual debt generated by the Private Finance Initiative (PFI) deal drawn up to fund the building of Calderdale Royal Hospital which opened its doors to patients in April 2001.

When the debt is paid off in 2061, the hospital trust will have paid £770 million for a building which cost £64 million to build.

Coun James Baker (Lib Dem, Warley) told the meeting: “We’re going to pay about 12-times what that hospital cost to build - it is essentially the ‘pay-day loan’ of public finance.

“We need to examine ways which we as a council can work with the NHS to try and restructure that debt.

“That £10 million a year debt is eye-watering, and the hospital shouldn’t be placed under that burden,” he said.

Coun Jenny Lynn (Lab, Park) said: “It may very well be that the question of finance has taken an overbearing role in some of the decisions that have been made.
“We’re certainly against being locked into a PFI contract which has crippling interest charges.”
Coun Adam Wilkinson (Lab, Sowerby Bridge), told the meeting that he would have liked to have seen the role of community pharmacists highlighted more in the report’s recommendations.

“Pharmacists have a big role to play in public health initiatives and can help stop people smoking, cut down on alcohol and tackle obesity,” he said.

“I’d like to see the Health and Wellbeing Board do more to acknowledge the role of pharmacies - I think it’s time we gave community pharmacy a seat on the Health and Wellbeing Board.”

Coun Janet Battye (Lib Dem, Calder) praised the work of the People’s Commission as an example of how councillors across the political spectrum can work together and said she was pleased to see the work of the Health and Wellbeing Board being placed at the heart of the report’s recommendations.

She said: “It’s important that the health providers work with us - we’re the elected representatives of local people and together we need to do our best for local people.”

Coun Barry Collins (Lab, Illingworth and Mixenden) said: “When the NHS Trust brought forward its proposals, I think the response across Calderdale was partly disbelief and partly despair.

“We wanted to give a voice to the local people who just felt it was a done deal and we wanted to examine the Trust’s case,” he said.

“I think the report is quite unequivocal - there must be a local hospital, and there must be emergency services in some form or another.”

Coun Geraldine Carter (Con, Ryburn) reflected on the six month process of the People’s Commission which saw the panel members meeting health bosses, patients and campaigners over a series of meetings, public forums and on-site visits to hospitals and care homes.

“This was groundbreaking work - we started this process with absolutely no remit whatsoever - there’s nothing in law to say we were allowed to do what we were doing,” she said.

“There’s nothing in law that says the council can start investigating the Trust, the CCG, NHS England, the mental health trust and the ambulance service - I think it hit them with a bit of a shock that we had the audacity to do that.

“What struck me very much was the difficulty we were presented with when we were being fobbed-off about seeing the Trust’s Outline Business Case.

“We didn’t see this document until we’d actually finished seeing everybody, so we weren’t able to delve into it like we wanted to.”

The recommendations of the People’s Commission’s Improving Health Together report were passed unanimously by the council and will be used to inform the work of the council’s Health and Wellbeing Board.


*** Changes are necessary to the health and social care system, but these changes should be right for the people of Calderdale.
*** Calderdale Health and Wellbeing Board should ensure that local health commissioners and providers work in partnership.
*** The Health and Wellbeing Board should invite health providers to join the board as members.
*** People with urgent, life-threatening conditions should have access to the best possible care.
*** People with urgent, but not life-threatening conditions should have local access to advice and treatment.
*** The current proposals for hospital reconfiguration should be abandoned and alternative proposals drawn-up.
*** The Trust should work to restructure the Private Finance Initiative (PFI) debt related to the construction of Calderdale Royal Hospital.
*** The system for financing health services should be the servant of service delivery, not its master.
*** Any reconfiguration plans should include a realistic travel analysis drawn in partnership between the ambulance service and public transport operators.
*** Community health services should have time to ‘bed-in’ so their benefits can be fully assessed before other services are withdrawn.
*** NHS England and Calderdale CCG should work together to ensure a consistent and high-quality GP service across the borough.
*** GPs should sign up to community health arrangements and be fully consulted on any hospital reconfiguration.
*** The Adults Health and Social Care Scrutiny Panel should assess the benefits of the Better Care Fund at least once a year.
*** The Adults Health and Social Care Scrutiny Panel should assess how well the council is fulfilling its statutory duties on health at least once a year.
*** The CCG and partners should run a high-profile campaign so people can have a say on options for future changes to health provision.

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