Hospital cuts clinical model rubbished by Clinical Senate
From Jenny Shepherd
Tuesday, 8 December 2015
Anyone wanting to ask a question at Calderdale CCG governing body meeting at Shay Stadium, Function Room 2, Shaw Hill, Halifax, 2-5pm on 10th Dec has until 5pm Tuesday 8 Dec to email it in, to firstname.lastname@example.org
The agenda and all the papers for the Gov Body meeting are online here.
There are many questions to ask about Agenda item 8, changing the hospital services. The Report for this agenda item for the Governing Body meeting says, "We have submitted our Clinical Model to the Clinical Senate".
The Yorkshire and Humberside Clinical Senate is another organisation set up by the Health and Social Care Act 2012. Their review of the Clinical Model is downloadable here
The Clinical Senate report is produced by people who have buy-in to the Clinical Model proposals, because they're all in the same kind of positions as the people who produced the Clinical Model. As a result, their criticisms are about detail, not the overall direction of travel.
But despite the lack of critique of the overall direction - that the Clinical Senate probably aren't allowed to come up with - they have pretty well taken everything else apart.
It's hard to make any sense of whether they're right or wrong because they didn't include the clinical model or anything else such as the "case for change" as an appendix, so we don't know what they're talking about.
But they basically say the clinical model is a rehash of national standards and policies, with little evidence of local clinicians' input or of the deliverability of the model - ie, that it will work.
So basically Calderdale CCG has dutifully done what the Commissioning Support Unit and NHS England have dictated to them. But the Clinical Senate has said this won't wash.
The Clinical Senate review says:
- They can't tell if the proposed clinical model is "deliverable", because there's no clarity about key factors including staffing levels.
- There's no clarity about the current services including geography, population, patient access etc. or about how this current model will change.
- There's not enough information about what role primary care (and social services) have in the Right Care Right Place Right Time plan... "the links with the work on care closer to home do not come through here clearly enough." Nor is there any clarity about the link to mental health services, or about End of Life care and palliative care services. In other words, the whole Care Closer to Home thing is a dark void. But this is what is supposed to make it ok to cut hospital services including an A&E.
- There is no information about commissioner strategy on the supporting data and intelligence systems (which are a big part of the Right Care Right Place Right Time scheme).
- There's no clarity about the non-elective service that will continue to be provided on the hospital site that isn't the acute and emergency care site.
In addition, the Clinical Senate review totally rubbishes the proposals for 3 Urgent Care Centres.
It starts out by saying, "There is a lack of detail within the evidence supplied about the urgent care centre model."
But it says that talking with the Commissioners produced the following info about the urgent care centre model:
There will be 3 centres, "medically-led by a clinician with the knowledge and skills to undertake triage and autonomous decision making regarding the next steps in an individual's care. We expect this is likely to be GP's but have to recognise current and future workforce issues."
So there might not even be a GP present to see patients who come to Urgent Care Centres. And you will only be able to go to the new Emergency Care Centre, whatever that turns out to be, after being triaged. So you either have to go to an Urgent Care Centre first or call an ambulance who will assess and triage you.
The Clinical Senate review says, "patients in the remote UCC(s) who have serious illness will be triaged, stabilised often with technology assistance (Skype) from the specialists at the ECC, and then transferred."
So someone who may not have the diagnostic and treatment skills of a GP will Skype the Emergency Care Centre to ask what to do with a seriously ill patient while they're waiting for an ambulance to come. Somehow this doesn't inspire confidence.
The Clinical Senate didn't think so either, they say, "...an inexperienced staff member seeking advice from colleagues via Skype does not offer a rounded solution."
And they have told the CCG to "consider the skills of the workforce. The triage skills and staff clinical portfolios need to be sufficient to enable them to make timely and informed decisions. There is always the possibility that a very ill patient will attend the Urgent Care Centre and commissioners need to ensure that staff have the medical and nursing skills, experience and capabilities to safely stabilise that patient. Currently, the Senate has no information on the staffing of these centres...We are also not clear on the paediatric expertise at each centre."
So basically the Clinical Model is rubbish. according to the Clinical Senate.
So we the public need to see it, and the sooner the better. So we can make up our own minds.
And if Calderdale CCG are to stick to their already twice delayed public consultation schedule, they only have til the end of December to come up with a clinical model that works. Is that possible?