Dewsbury Hospital reconfiguration in the slow lane. Assumptions were wrong in 2013!

Main entrance to Dewsbury District Hospital

Next Phase of Mid Yorkshire Hospitals Trust acute reconfiguration.

No definitive timeline was given in the Full Business Case, although it was expected that all the changes would happen by the end of May 2017.

The assumptions made in 2013 about ‘Care Closer to Home’ reducing the number of people having to stay in hospital for treatment were wrong. More people than planned for, are needing to stay in hospital for medical care. The failures in the Care Closer to Home(CC2H) programme have been exacerbated by the ‘drive time of ambulances’ whatever that means ..presumably what campaigners said all along, that journey times from Dewsbury to Pinderfields were unacceptable (compounded by the changes to service sites at Leeds Teaching Hospitals so now, Leeds specialisms are further away than Pinderfields, for Morley patients according to Deborah Turner). The North Kirklees CCG Governing Body member Deborah Turner, admitted at the meeting of Governing Body North Kirklees CCG in parallel with Wakefield CCG, on 6thApril 2017, “Drive time of ambulances has also impacted on the inability to reduce beds.”

Yorkshire Ambulance Service(YAS) has had “input into the ‘model’ before it went to the Star Chamber”, said Jo Webster, CEO of Wakefield CCG. But did the Star Chamber look at aspects of staffing at the Ambulance Trust? Deborah Turner said that there was a risk of reduced staffing in the hospitals although there were no financial restraints on staffing at Mid Yorks and it has been actively recruiting, not least because a number of EU nurses have returned home.

The members of the Governing Bodies at the meeting had to approve the recommendations of the Star Chamber looking into the problems surrounding the full business case(FBC) of 2013.

It is recommended that the Governing Body approve the recommendations of the the Star Chamber held on the 23rd March 2017

as follows

  • To agree that hospital beds cannot be taken out of the system as originally planned to enable medical reconfiguration, as per Meeting the Challenge Full Business case, at this time

  • To agree the system mitigation is robust to support additional beds in the system

  • Agree deferral of the planned medical reconfiguration

  • Support the proposed phasing of changes between April 2017 and September 2017, subject to further QIA and Star Chamber process to assess the risks and mitigation of full implementation of the hospital frailty model, changes to acute inpatient services and critical care prior to implementation

  • Support the proposed reduction in the surgical bed base acute inpatient services and critical care prior to implementation

  • Support the proposal to develop enhanced rehabilitation services at Dewsburyand Pontefract, including rehabilitation for patients with fractured neck of femur in line with national best practice guidelines and with the commitments set out in the original FBC.

Dr Phil Earnshaw, Chair of Wakefield CCG was very keen to stress that this is ‘Phase One only’ that the CCGs were supporting at this meeting, because the implementation of the Multispeciality Community Provider model, due to be coming soon, would change the landscape yet again.

The Star Chamber process is ‘designed to assure patient safety’. So that’s all right then!

The notes on the background to this meeting say “Dewsbury Hospital now has a Children’s Assessment Unit (CAU) open 10am to 10pm.” This was no use to the woman on the bus traveling home from Pinderfields with her toddler, who had fallen and cut his face, just above the lip. She had presented with him at Dewsbury A&E and was sent straight to Pinderfields for which she had to hire a taxi.

All they did was glue it and put a plaster on” she said. “They could have done that at Dewsbury.” Keep All Services At Dewsbury hospital asks

  • So where is the 24/7 minor injuries unit in Dewsbury Hospital now?

  • Is there an age limit for accessing this Minor Injuries Unit facility?

  • Is the denial of care at Dewsbury part of the ‘managed care’ strategy which would see a low income or ‘strapped for time’ family, choose not to hire a taxi to get to Pinderfields therefore not get their child seen? Or just lack of staff?

In the ‘80s and ‘90s, there was much chatter in the press about negligence in families and great encouragement to present children who had experienced accidents, to medical facilities to be ‘checked out’. Has this attitude been abandoned on the alter of commercial decisions? Who decided that?

  • Is this a deliberate attempt to run services down, so that a Multispecialty Community Provider in a GP clinic somewhere, appears better?

The documents also state “Dewsbury Hospital has a new purpose built midwife led birth centre.” However in answer to a question about numbers of transfers to Pinderfields, from the Birth Centre, North Kirklees CCG Quality and Safety Officer Deborah Turner said “the Bronte Birth Centre is operating at a low threshold at the moment so there are more transfers.” This chimes with stories we have heard where women in labour, are whisked to Pinderfields without it being explained properly. Why? The documents state “ More than 100 babies have been born at the new midwife led unit at Dewsbury and transfer rates are consistent with the original plans.” It was revealed much later than the Meeting the Challenge Consultation, that MYHT was expecting a transfer rate of 30% to Pinderfields, however, it seems that Deborah’s answer indicates the papers are out of date at the time of this meeting on 6th April!

Other out of date examples are the mentions of complex colorectal surgery, which according to anecdote must be available occasionally rather than routinely, and the children’s example of the cut lip..

Have you been ‘Consulted’ about the changes to stroke services highlighted in the Sustainability and Transformation Plans…now Partnerships?

Jo Webster of Wakefield CCG assured the Joint Scrutiny Panel for all the councils in the ‘West Yorkshire Footprint’ STP in Leeds on 23 January 2017, that no changes will take place until there has been a Consultation.

The April 6th 2017 meeting discussed the development of rehabilitation services for both stroke and fractured neck of femur patients at both Pontefract and Dewsbury Hospitals. The Star Chamber supported the proposal if they were assured that

  • the model will be a partnership between medical staff, nursing and therapies

  • staffing models will be developed to ensure sufficient capacity to meet the needs of patients

  • Pathways will be designed in such a way that patients would be transferred to beds on each of the hospital sites according to their place of residence transfer will take place when the patient no longer needed surgical intervention and could be safely managed by the medical rehabilitation team.

This last point chimes with something that was said by Martin Barkley at the MYHT Board Meeting on 13th April 2017. Apparently the Clinical Lead on Stroke services at MYHT is not happy about the changes to stroke services SO Mid Yorkshire needs to make Pontefract a ‘Centre of Excellence’ for Stroke rehabilitation as an antidote. Sad then that patients who live in Dewsbury will not be at a centre of excellence! Sandra Cheseldine Lay member for Wakefield CCG said that they must make sure patients don’t go to Dewsbury who live in Pontefract but her question where do Wakefield patients go was not satisfactorily answered as far as Keep All Services at Dewsbury Hospital was concerned.

Deborah Turner, in the meeting in parallel said that monitoring where patients go is a central part of the plans. Fatima Khan-Shah lay member for public engagement at North Kirklees CCG, said ‘engagement needs to be done to keep the public up to speed.’

Watch out then for the Look North slots, leaflets at the Al-Hickma Centre and Ravenshorpe community groups. “If 500 people get to hear about the changes then they then spread the news” said Fatima Khan-Shah. Dr David Kelly, Chair of North Kirklees CCG said that GPs also need to be involved in ‘engagement’. Have you been engaged with or ‘Consulted’ about any of this? What happened there?

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