5. West Yorkshire & Harrogate
What issues have been raised about this STP?
Health planners are trying to reduce NHS deficits and think about ways to re-organise care. However getting a large deficit under control could prevent facilities being developed that can cope with the health and care social needs of local people.
The closure of Huddersfield Royal Infirmary A&E and the consolidation of services at Calderdale Royal Hospital (CRH). The move has been criticised by GPs as putting lives at risk.
Changes in who organises our care
The STP includes a proposal to develop an Accountable Care System, in Airedale, Bradford and Craven, and Wakefield; and a primary and acute care system in Harrogate.
The North Yorkshire County Council Scrutiny of Health Committee raised a number of concerns with the plans, warning of an over-emphasis on deficit reduction coupled with a lack of understanding about the impact of the cuts. The cuts could see the downgrading of ‘consultant-led maternity and paediatric services’.
The current average ambulance journey to an A&E is 15.54 minutes, this would increase to 22.13 minutes if a single emergency centre was established at CRH. The move would also increase journey times by public transport to 45 minutes and 15 to 20 minutes extra by car according to independent research conducted by the CCGs.
What are the proposed aims of the STP
- Elimination of the projected deficit of £1.07 billion by 2020/21;
- Increase the focus on self-care and prevention;
- Improve the overall health of the population
- Increase access to primary care and new models of community care, with an emphasis on improved mental health services;
- Increase integration of services
Like other areas they plan to transfer services out of hospital and into the community. A major concern is that financial pressure will mean that cuts in hospital care will be made, helping to achieve savings, but without proper investment in community health services.
The major change in acute care focus on the closure of the Huddersfield Royal Infirmary; although a new hospital will be built it will not provide the same services and will be a downgrade from the original hospital, without a full A&E service. The emphasis is on moving full A&E services to Halifax.
The initial public consultation on the plans for HRI were in 2016. Then it was confirmed in July that the plan is to demolish the HRI site at Lindley and replace it with a 64 bed hospital with a small urgent care centre for minor injuries and a midwife led maternity unit.
All emergency care would be relocated to an expanded Calderdale Royal Hospital in Halifax.
Changes to the way services are commissioned fall into three areas:
- Strengthening the region-wide committee of CCGs to commission some specialist services at a West Yorkshire and Harrogate level;
- Bringing together CCGs, councils and NHS England to integrate commissioning in the local authority area; and
- Set up new “accountable care organisations” to manage capitated budgets for their local populations.
Specifically the STP refers to setting up ACOs in Airedale, Bradford and Craven, and Wakefield; and a primary and acute care system in Harrogate.
A major campaign is underway to prevent the downgrading of HRI. Public consultation on the HRI plans took place in 2016. However, when the plans were revealed in July 2017, both the campaigners and the council were shocked to find they were different from those outlined in the original consultation. Mike Ramsden, chairman of campaign group ‘ Let’s Save HRI ’ said the details in the final document, the Full Business Case (FBC), are very different from the plans in 2016 and he claimed he had never seen an NHS reconfiguration plan handled as badly as this.
In July 2017, the joint health scrutiny committee of Calderdale and Kirklees council opted to refer the plans to the Department of Health. The council were not informed of significant changes to the plans until eight days before it was due to make a decision about supporting the plans. In the council's letter to the DoH, it noted that unexpected alterations to the plan included: the reduction of one HRI site at Acre Mills from 120 to 64 beds, moving more planned care to Calderdale, and news that only PFI funding was available. The plan will now go before an Independent Reconfiguration Panel.
In November 2016, the leaders of five councils in West Yorkshire wrote to NHS England to voice concerns they had not been given proper scrutiny of the West Yorkshire and Harrogate STP.
Councillors have warned that the targets for savings outlined in the STP will be impossible to achieve.
There has been criticism over the use of management consultants to help produce the STP. The board is reported to have spent £378,000 on consultants.
A report by the North Yorkshire County Council Scrutiny of Health Committee dated 18 November 2016 highlights a number of concerns raised about the STP process. This include:
- A lack of governance and democratic accountability
- A lack of engagement of non-NHS organisations and the general public
- An over-emphasis upon deficit reduction
- A lack of understanding of the impact of funding cuts in other areas for partners, such as public health, social care and housing
- Doubts as to whether the STPs will be able to deliver the promised financial and performance improvements
- A shortage of the capital funding needed to transform and modernise health services, especially in 2017/18 and 2018/19
Specific local concerns include:
- That it "could result in the downgrading of accident and emergency, consultant-led maternity and paediatric services"
- Accessibility to specialist health services and increased journey times