WHAT YOU NEED TO KNOW BEFORE YOU MEET THE

CCGS
We believe, on the basis of evidence outlined below, that the CCGs!
plans to implement the Right Care community health care system - now
rebranded as Care Closer to Home - amount to a signicant NHS service
change that requires public consultation now.
To go ahead with Phase 1 and Phase 2 of the Care Closer to Home
system without rst consulting on the whole Right Care service
transformation that it is part of, would predetermine the outcome of any
later consultation on the proposed acute and emergency hospital cuts
and closure. We believe this is not lawful.
Predetermining the outcome of a consultation takes place when changes are
made that only make sense in relation to future planned service changes.
Implementing Care Closer To Home only makes sense in relation to cutting
acute and A&E hospital services.
The reasons Caldedale CCG give for wanting to delay consultation are
self-contradictory. They can!t both be true. And neither is self-evidently
true
On the one hand, the CCG!s Care Closer to Home commissioning
intentions Report justies the delay because (p8): The absence of a direct
understanding of the improvements that the new community model would
bring, means that the consultation is likely to be focussed on changes to
hospital services.
But this is at odds with the Report!s repeated claims that the CCG!s public
engagement has shown strong support for the Care Closer to Home
proposals, and that these proposals give the public what they!ve told the CCG
they want.
And just because they can!t both be true, doesn!t mean either of them is true.
The 2013 Ipsos MORI survey of Calderdale CCG stakeholders, including its
member GP practices, found that most of the stakeholders don!t think the
CCG acts on their suggestions when they make them in response to
#engagement activities. Nor do they agree that the CCG involves and
engages with the right individuals and organisations when making
commissioning decisions.
And why would it be a problem for the consultation to focus on changes to
hospital services? Apart from the fact that the public would say no.
The Right Care community health care /Care Closer to Home proposals
are about NHS cuts and sell offs
They will involve big changes to the ways GPs work, despite Dr Brook!s
denial to Calderdale Scrutiny Panel (SP) that this is the case.
For example at the moment it is mostly GPs who treat patients with Chronic
Obstructive Pulmonary Disease, but Ms Graham, CCCG!s Head of Service
Improvement, told the CCCG Quality Committee on 29th May 2014 that
there was a huge opportunity to provide services differently.
The CCG!s Phase 1 approach to market is to re-specify 15 community
health care services that CHFT currently provides. The rst of these services
that they have re-specied, Respiratory Services, is to be commissioned from
a lead provider, which will subcontract different services in the care
pathway.
Dr Brook told Calderdale SP not to get too tied up on who the provider/s for
the re-specied community health care services would be - whether the
CHFT or private providers - and that services would be put out to tender and
the best bid would win the contract.
But where community health services have already been privatised, the
effects on staff and patient care have not been good. NHS staff are effectively
gagged and fear to speak out, but Save our NHS campaigners have reliable
information that where NHS services have been TUPE!d this has had the
following effects:
the creation of a 2 tier service, with only a basic service being provided free
at the point of need and charges made for services above this basic oor
1
the pursuit of prot has over-riden proper patient care and increased risks
to patients
staff pay and working conditions have suffered, placing great stress on staff
who fear for their ability to take care of their patients properly
services have become fragmented between different providers, leading to
all kinds of problems in coordinating care
It is far from clear whether the Care Closer to Home scheme will
improve patient care or save money
Despite what Dr Brook told Calderdale Scrutiny Panel on 17th September,
it!s not clear that GPs have the capacity to work in the new ways required by
the re-specication of the 15 existing community health care services, that
are currently provided by the CHFT.
The CCCG Patient Safety Clinical Associate told the 29th May Quality
Committee that he was not aware of any assessment of the capacity in
primary care to deliver the out of hospital care model , and was told that this
issue was under discussion.
Dr Brook told the Scrutiny Panel that the CCG want the hospitals Trust to
gure out how to reshape existing community health care services in line with
their new Care Closer To Home specications.
But he didn!t say that there are no tools or benchmarks available to help the
Trust with working out stafng levels for nurses in the community, as reported
in the Quality Committee.
Dr Brook told the SP that GPs already work in ways required by the Phase 1
re-specication of the 15 existing community care services, for example in the
Quest for Quality in Care Homes scheme.
But he didn!t mention that the CCG Finance and Performance Committee
had heard on June 14th that the Quest for Quality in Care Homes project is
currently RAG rated at red. Which is not good. This was because:
GPs had been unable to access patient records in care homes an issue
which should have been sorted in summer 2013 but was only recently
resolved
The Information Governance process had not been completed to allow the
Quest team access to the shared records. This requires a description of
what information different team members in different organisations can
access, and clear patient consent policies. Dr Brook raised concerns that
this IG process may be inhibiting matrons! capacity to deliver.
Dr Brook told Calderdale Scrutiny Panel that all GPs were on board with the
plans for the new community health care system, by virtue of all the GP
practices being part of the CCG Governing Body.
But the 2013 Calderdale CCG Stakeholder Survey carried out by Ipsos Mori
found that most organisations involved with the commissioning group -
including GP practices that are members of the CCG Governing Body - don!t
have condence that it can commission high quality services for Calderdale
people.
Dr Brook told the Scrutiny Panel that he couldn!t see why anyone would think
that the CCG would do anything other than improve services for patients.
But only 8 of the 41 stakeholders in the 2013 Ipsos MORI CCCG Stakeholder
Survey agreed that the CCG!s plans will deliver continuous improvement in
quality within the available resources.
Save Calderdale Royal Hospital
Hudderseld Keep Our NHS Public
c/o Jenny Shepherd, 19 Unity Street, Hebden Bridge HX7 8HQ
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