Go, or No Go for the next round of changes to Dewsbury Hospital due to begin on 4th September

Today, 3 August 2017, the North Kirklees Clinical Commissioning Group, met with Wakefield Clinical Commissioning Group, to accept or reject the assurances of Mid Yorkshire Hospital Trust (MYHT) and Yorkshire Ambulance Service (YAS), that the centralisation of Critical Care at Pinderfields Hospital in Wakefield addressed all the concerns raised by something called the Star Chamber, which as we understand it, is a group of doctors looking at safety for patients amongst service change at various Hospital Trusts.

https://www.northkirkleesccg.nhs.uk/wp-content/uploads/2014/06/Joint-Board-to-Board-meeting-with-Wakefield-CCG-3-August-2017.pdf

After looking at the papers for the meeting, this blog asked some questions. The general questions for which time should have been allocated at the start, were not answered. The comment was that they were questions about the STP and we don’t know the answers. These will be listed a the end of the account.

Questions about Service Changes at Dewsbury Hospital.

Q1

Centralising Critical Care in Pinderfields

Does this mean there will be no high Dependency Beds in Dewsbury?

Answer

There will be no High Dependency beds in Dewsbury.

Q2

If someone ‘goes down’ ie gets worse, while in the ambulatory care ward…where will they go for stabilisation and help?

Answer

There are protocols which are followed when something like this is happening. There are resuscitation and CRASH teams  on the Dewsbury site. There will be an anaesthetist at Dewsbury for 24 hours 7 days a week.

Q3

What is the priority for ambulances for inter hospital transfer? Has the implication for the ambulance service to move patients, been satisfactorily addressed?

Answer

Yorkshire Ambulance Service has been part of the discussions about the service changes at Dewsbury hospital and also in the Mid Yorkshire region where it is contracted by 23 CCGs. Other hospitals are also undergoing service changes and the two CCGs need to to be sure that a change in an area away from here, does not have a knock on impact and compromise the service when a patient needs it here. They (YAS) are coming up with a novel approach,  a new category which needs a response, but there are 2 issues here, response capacity  and resources.

Checks and balances will be at work and some of the changes will reduce pressure on the Ambulance Service. North Kirklees CCG and Wakefield CCG want something in writing to confirm that YAS is ready, with no commitment from the CCGs to provide more resources.

North Kirklees CCG Governing Body ‘Chair’ Dr David Kelly, stressed that they can not proceed with out this extra assurance in writing and that if it is not forthcoming there will need to be another ‘extraordinary Governing Body meeting to discuss the ‘risks’ associated with not going ahead with the changes. (This is because winter pressures will mean extra capacity is needed in the hospital while it is still trying to manage critical care.) Since all YAS’s services are funded by the 23 CCGs it is not easy to separate out one hospital, but they would need to assure themselves about resources.

The North Kirklees CCG Chair said “The two issues are resources and assurance that YAS can deliver the service. If we can’t get it, we can’t push the button.”

In that case the changes would have to wait until May 2018, with all the risks associated with that. The Chief Operating Officer for both CCGs said ” We  constantly juggle resources with patient safety issues.”

Q4

Are there any instances of difficulties in getting people repatriated to the non critical hospital due to lack of ambulances?

Question not answered.

Q5

Are there any instances of difficulties getting patients into the Critical Care Centre due to lack of ambulances? Eg women in labour.

Question not answered

Q5

What is a definition of ‘Frail Elderly?’

Answer

Frailty is about  a vulnerable person with multifaceted and a number of conditions, not always age related, who deteriorate quickly.

Q6

What is the Frail Elderly pathway?

This includes the new Clinical Decision Unit (CDU) and ambulatory care. It is so that the Frail Elderly don’t wait in A&E and don’t stay in a bed too long. There is a National Process for ‘quality and safety’ which will be followed.

END OF QUESTIONS

The Chief Operating Officer for the 2 CCGs Pat Keane,  went on to say that the extra service changes were mitigated against the Equality Impact Assessment.

The Recommendation from the meeting was that “We proceed subject to assurance by YAS but that this assurance will not commit us to funding.” There was more to the recommendation but not all of it was read out.

The wider  MEETING the CHALLENGE programme.

The Chief Operating Officer for both CCGs said that the CCGs had engaged “Good Governances” because the Meeting the Challenge has yet to complete and the Star Chamber’s metrics did not take into account the promises made to patients. There has been a lot of activity and “Good Governances” had begun to take interviews from parties involved although the Chair of North Kirklees CCG said he had not been approached.  One of the Governing Body members from Wakefield CCG said that it would be good if people can know how their conversation feeds into the report. It was also said that patients and the public will be involved in this Good Governances initiative. If interested, get in touch with your local CCG and request to be involved.

QUESTIONS UNANSWERED: look for the answers in the papers for North Kirklees CCG  Governing Body; 30 August 2017

Q1

City & Hackney CCG are reluctant to hand over responsibility for local decisions about NHS organisation and funding, to the East London Health and Care Partnership, based on advice from their lawyers as to the legality of ELHCP’s proposed arrangements.

Have North Kirklees CCG had legal advice about the West Yorkshire STP decision making process?

Q2

City & Hackney CCG are reluctant to hand over responsibility for local decisions about NHS organisation and funding, to the East London Health and Care Partnership, based on advice from their lawyers as to the legality of ELHCP’s proposed arrangements.

Have Wakefield CCG had legal advice about the West Yorkshire STP decision making process?

Q3

Are North Kirklees CCG Governing Body going to hand over responsibility for local decisions about NHS organisation and funding to the West Yorkshire STP?

Q4

In the light of the ongoing issues with the Care Closer to Home providers, this handing over would not seem wise since the local CCG has to carry the risk/responsibility for commissioning and subsequent problems. Has the NKCCG got a strategy for this eventuality ie problems and what is it?

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