• 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 this STP aims 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.

An overview of public engagement and consultations up to March 2017 can be found here. The report does not mention the new models of care (integrated care systems) planned for the area.

Wakefield CCG has conducted a consultation using focus groups on the new model of care, a Multispeciality Service Provider (MCP) approach, which is being developed in the Wakefield area. The report can be found here.

A public engagement by HealthWatch has taken place on changes to stroke care in West Yorkshire and Harrogate and the results have been reported here.

The major change in acute care is the closure of the Huddersfield Royal Infirmary (HRI); 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 took place in 2016, prior to the STP. Then it was confirmed in July 2017 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. The reduction in beds numbers is approximately 300.

All emergency care would be relocated to an expanded Calderdale Royal Hospital in Halifax.

The plans to close the HRI are now subject to a legal challenge and a review by the Independent Reconfiguration Panel of the Department of Health (see What are the issues with the plan?)

Under NHS England plans all STP areas will develop into Integrated Care Systems (ICS), previously known as Accountable Care Systems (ACS). This is a new model of care that aims to integrate hospital, community and social care. For further details see our pages on New Models of Care and Accountable Care Organisations.

As part of a move towards a more integrated way of working, changes to the way services are commissioned are planned:

• 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;

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 January 2018, it was confirmed that the Independent Reconfiguration Panel will do an initial review of the suitability of the hospital reconfiguration. In a detailed submission to the IRP, the campaign group Hands Off HRI highlighted dozens of flaws with health chiefs’ proposals to downgrade HRI.

The document finds fault with many of the key issues and claims in Calderdale and Huddersfield NHS Foundation Trust’s plans to demolish the hospital and build extra capacity at Halifax.

As well as the IPR  submission, Hands off HRI lodged a legal challenge to the downgrade plan in autumn 2017; in late 2017 the judge denied the challenge, but the campaign group are appealing and the appeal hearing began in March 2018 in Leeds.

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