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Transcription of Public Meeting:

NHS North Kirklees

Dewsbury Town Hall11th March 2013

Printed 6 May 2023

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John Buck:Ladies and gentlemen, good evening and welcome. I'm John Buck. I've been asked to chair this evening's meeting. It's a great pleasure to do so. This evening's meeting is the first in a series of public discussions about proposed developments in healthcare for people in North Kirklees and the Wakefield district.

The healthcare available to us is, of course, crucial to the quality of our lives. So I'm very pleased, but not surprised, that even on such a cold evening, so many people have found time to come and learn more about, and I'm sure to ask questions and comment on, some planned changes in the way that healthcare is delivered locally.

I'm not personally an expert on healthcare. I worked closely with health professionals during an earlier career in social work, but I've spent most of my working life doing jobs which have involved listening to and trying to understand different points of view, and sometimes mediating between them. So my job this evening is to ensure that different views are heard and that our conversation is as useful to everyone as it can possibly be.

There are a number of healthcare experts, some of you may know them, who will be speaking this evening. They are Chris Dowse who will be Chief Officer of the National Health Service's North Kirklees Clinical Commissioning Group, when it begins operating at the beginning of April; Dr David Kelly, general practitioner, who will be Chairman of the Clinical Commissioning Group; and Dr Simon Enright, consultant anaesthetist, who is the hospital Trust's clinical lead for the Mid Yorkshire clinical services strategy. There are a number of other experts, including Stephen Eames, Chief Executive Officer of the Mid Yorkshire Hospitals Trust, who will be available to answer particular questions.

Chris, David and Simon will begin this evening's consultation by outlining, during the course of 20 minutes or so, the changes proposed to healthcare delivery locally. Could I ask you not to intervene with questions or comments until the presentation has finished. That will give everyone the best opportunity to understand what is being proposed. We shall then have about an hour and a half for people to ask questions, raise any concerns, offer comments. I may try, depending on the number of questions we have, to take related questions in groups of two or three, which I'll then ask our speakers to respond to. But it may well be we can take questions individually.

The hall has to close promptly this evening, so we'll have to finish at ten o'clock. In order to give the maximum number of people an opportunity to speak, could I ask you to try to keep your questions and comments reasonably concise and to the point. If you wish to raise a number of different issues, it may be best to do so during the course of the evening, as we move on to those different issues, rather than ask them all at once. And if you're not sure you've understood something that's been said, please don't be afraid to ask for clarification. If you've not understood something, the chances are other people haven't understood, or aren't sure they've understood either.

The key aim of this evening's discussion is to increase understanding of what has been proposed; of the questions and concerns that people may have; and of how those concerns might be met. The consultation period will last six months, so there will be opportunities to continue the conversation in other ways. In the meantime, if you have any questions, concerns or comments that you don't have the opportunity to ask this evening, you can raise them by dropping a piece of paper with your question on it into the

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comments box, which is close to the door at the back of the hall, and somebody from the team will respond.

A few housekeeping points. There will be roving microphones, and I will direct the people with the microphones to questioners, as I identify them. If you wish to identify yourself, fine. If you don't wish to identify yourself, that's fine, too. We are recording the meeting so that its conclusions and the discussion can be available to everybody.

One further point. There is no fire drill planned for this evening. But if there is an emergency, in the unlikely event that there is an emergency, there are stewards around the hall who will lead people out of the building.

So to begin this evening's discussion, I'll now hand over to Chris Dowse.

Chris Dowse:Thank you, John. Good evening, everybody. And thanks to John for that. I am Chris Dowse. I am the Chief Officer of the emergent organisation, which is North Kirklees Clinical Commissioning Group. And I am accountable and will be accountable, from the 1 st

April, for ensuring that we commission - that is, buy - the right services, health services for you in North Kirklees; and that we spend our money - which is taxpayers' money - wisely.

As John said, this is a start of a period of 12 weeks when we are consulting on a set of proposals around the future services within North Kirklees and Wakefield. And it's very important to us that we hear and listen to your views and comments. It's important to us because we, in the end, after 12 weeks, alongside Wakefield Clinical Commissioning Group, will need to make the decisions about what services we have for now and for the future.

And it's so important that many of my governing body members are here today to hear your views and comments. And I just wonder if my governing body members could just make themselves known in the room by just raising their hand. Okay. Thank you.

I'm here with my Chair, Dr David Kelly, who is a local GP in Heckmondwike. And he also lives in the area. And he will be following on from me with a set of slides which will outline some of the reasons why we need to think about making changes to the services.

Although we're emergent, we've done quite a lot of thinking about what's important to us as an organisation, as a commissioning organisation. And I've put this slide up here really to outline some of the key decisions we've made about how we want to be in the future. And first and foremost in there is about keeping our patients in mind when we are making decisions. That is going to be very important to us. Patients, public, local community members, we need to make sure that we always think about what's the best for them when we make our decisions, going forward.

So I want to just say two things before I pass on to David, which is myth-busting really. One is, we do not have any plans, now or in the future, for closing Dewsbury Hospital. We do not have any plans, now and in the future, for closing the A&E department. So those two things are not going to happen, okay. What I do want to do is to demonstrate for you what the proposals actually mean for us as a community, going forward, okay.

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Okay, I'm going to introduce David now, who's going to come over and talk a bit about that.

Dr David Kelly:Thank you, Chris. I recognise several faces in the audience. You've probably heard me talk at previous meetings. We've had a series of pre-consultation meetings with many of you in the audience. For those of you who don't know me, as Chris says, I'm a GP in Heckmondwike, and I've been a GP there for the last 22 years. I also live locally in East Bierley and so I am aware of the situations locally and the feeling around some of these changes.

As Chris said, we're an emerging organisation. I am the Chair of the Clinical Commissioning Group, and we're made up of a number of representations from all the practices in North Kirklees. So that's 31 practices. And there is a number of GPs who are equally local to the area and equally have been around for a number of years who are involved in that Board. But also, some practice nurses and practice manager, and some senior NHS managers who are involved in the Board. And we take over the commissioning of health services locally on the 1st April.

We've been involved in these discussions now for some time, probably 12 to 18 months in terms of talking about the possible changes that might be needed prior to this consultation. And we've been working quite closely with our colleagues in Wakefield CCG, but also various partners within the organisation, such as our local authority reps, our community providers, and our local Trust providers; as well as having conversations with patients already, and voluntary groups and third sector groups.

I'm trying to get this slide to move on. There we are.

Before I tell you a little bit about why we need to change, we just wanted to introduce a patient of ours, Doris. And we've developed a series of patient scenarios. And we feel actually that having a reflection about people like Doris, ordinary people, and actually how the changes might affect Doris and others, actually it helps us to actually understand, and for you to understand, how that might happen to…what the changes might mean for Doris both now but also in the future. And Doris is our example of a frail, elderly patient. And I might refer to Doris through the conversations I'm going to have through the slides, as to what might happen with Doris now, but what actually might happen to Doris in the future, to give you an idea of what these changes mean to individuals.

So why do things need to change? Well, healthcare and technology has changed rapidly over the years. There's been an increased unprecedented demand for services in the NHS, particularly around accident and emergency services, and unplanned admissions or emergency admissions into hospitals. There's a need to improve the quality of services. And that's come out recently from things like the North Staffordshire Inquiry, sorry, the Mid Staffordshire Inquiry, not the North Staffordshire Inquiry, and the Francis Report. We do know there's a national drive for specialisation and centralisation of some services. And this has been shown to save lives and also improve outcomes for patients.

Some examples of that, that's happened over the years already, and currently happening, are patients with heart problems previously may have spent about a week on bed rest in hospitals, and now go to central specialist centres and get put stents into the arteries. Patients with hip fractures might go to a specialised trauma centre, where they're treated

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quicker and are up and about after operations more quickly. So there are several examples of where specialisation and centralisation of services have gone on, and need to continue.

We also know that separating services into different planned or…between planned services and also sort of emergency services, actually improves the services for patients. We get less cancellations of operations; we get less infections or lower infection rates. We also know there's a national reduction in the number of doctors that are available locally to our Trust. There's a reduction in trainee numbers. There's various EU directives on workloads, which has meant that working hours are not available for doctors. And there's an increased reliance on locums in our local hospital in Dewsbury.

But we also know that many of the services that our local hospital provide can actually be provided equally well outside of hospital, in primary care or in the community services. And we can get as good quality services out in practices, in a possibly more affordable way. So there's a need for thinking about how we can actually deliver some of these services differently.

So what specifically, apart from hospital services, does North Kirklees CCG want to do? Well, we want to improve our general practice services. And that's particularly around improving access to primary care. Certainly when I've had conversations with patients, both in my own surgery but also patients at public meetings like this, that's one of the key factors they tell me about, that actually they want quick and easy access to their local practice and to their local GP. There's also a national drive for 24/7 services, not only in primary care but across the whole range of the NHS. So we need to think about how we can provide that differently in primary care or in the community.

We also want to make sure that the services we do provide in practices and primary care are of a good quality, and actually want to work with our practices, which we are doing already. And the member practices who make up the CCG are working very closely and looking at how we can actually drive up quality and reduce the variation in services locally in our practices.

Some of the things we want to do in the community services there are outlined. Particularly, we want to look at better long term conditions management for our patients, both in primary care but also for our patients who are housebound, with our community services. And more focus on preventative services and preventing health issues from arising.

We want to also make sure that we have what I would call true integration of services, rather than the split we have currently, that Doris, our patient I referred to earlier, wouldn't necessarily recognise. So that actually, we have primary care, community services and secondary care services working closely. And already that's happening in our area, because practices and community teams come together on a regular basis to have conversations about patients. And we need to look at options around perhaps more outreach services from our consultants into community care and into our primary care teams.

But we've got a challenge. I've got a challenge of moving these slides on. I'm pressing the next button, but it doesn't seem to work. Ah, there we are, got it. So I've got the challenge of the buttons out of the way, so I'll tell you about the challenge locally.

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We do know that most of our patients want to go locally. And when I mean locally, when I talk to my patients, they mean Dewsbury Hospital. It says there Mid Yorkshire, but the majority of my patients have an affinity to their local hospital, which is Dewsbury Hospital. And we want to make sure that Doris, when she does need to go to hospital, goes to her local hospital. We want a strong, vibrant local hospital, with a full range of services provided for all our patients, so that when Doris does need to go to hospital, it's available locally.

That means things like outpatient services all being available, where possible, on our local Dewsbury site, where we can't provide them in the community. As an exception, where a specialised service might need to be available, then they may need to travel. But we'd like to see most of our patients locally at Dewsbury.

We also want to make sure that our patients who…patients tell me they go to one site for an outpatients appointment, a different site for a pre-assessment for an operation, at a different site possibly even for their operation. But most of their operations, be them inpatients or day case operations, happen locally at the Dewsbury site as well.

We also recognise that there's obviously a financial issue with the Trust, and also the workforce problems that I recognised and mentioned earlier. Currently, all three sites are losing money. And this is not a situation that can continue and it's not sustainable. The changes we are talking about are not based on finance, but obviously that's a situation we have to take into consideration as well.

So we want to help the Trust to recover. We want to do that through partnership working with the Trust and our other providers, to stabilise and retain local NHS services for our patients locally. There are already signs, I think, that the Trust has turned things around in the last 12, 18 months. Things like the mortality rate has decreased at Dewsbury Hospital, and is continuing to stabilise at a lower rate. So less people are dying locally in our hospitals.

There's been a lot of improvement in the outpatient system in our Trust. And certainly, that's one thing that patients have complained to me about for some time, in terms of the appointment system locally. We also know from things like the CQC inspections that have gone on in the Trust that the quality of services and the quality of care is improving. But we need to do more and need to move services on to a higher level. There are still areas that we need to focus on to improve. And Doris, as I referred to earlier, wants the best service she can get locally from the hospital.

Some of the decisions, I think even for Doris and yourselves are going to be difficult to accept. They're certainly difficult to accept, even for myself and my Board. But we've worked through the issues and I think we've got the solutions. And hopefully, we'll have the answers to many of your questions later on in the question and answer session.

So how would they benefit people locally? As I said earlier, more lives would be saved. The mortality rate has reduced locally. We'd have better consultant cover, better 24/7 consultant cover in many areas. Patients like Doris would be dealt with much better in the primary care and also in the community service, which we plan to improve and integrate better.

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We want to make sure that where Doris does need to go to hospital, that it's better assessment facilities, with better diagnostic facilities and better tests for Doris, so that she actually doesn't need to necessarily stay in hospital unnecessarily, but can actually be turned around and discharged back to her own home, with the appropriate support that she needs locally.

So there'll be more access to specialists. Second, in terms of A&E, there may be more access to senior opinions in accident and emergency departments. And quicker access for follow up care from specialists in outpatient clinics from those assessments that are carried out in the emergency care centre or A&E. We want to make sure that the right specialists are at the right place, at the right time for the patient. Rather than having to go to several different sites, they see the right specialist at the right time.

And that means, for instance, if you're admitted currently with, say, a heart problem, you may be looked after by a general consultant. But hopefully, in the future, this will be by a cardiologist. And likewise, if you've got a breathing problem or respiratory problem, you'll be looked after by the right specialist in terms of respiratory consultant.

And we also want to look at the options around community services having consultant specialist opinion within those teams as well. And much better dialogue between primary and secondary care for advice and for opinions, to avoid the need for referral to hospital.

So what have we done already? We've already provided or moved a lot of services from secondary care, some of which you may have used yourselves or be aware of. But examples of that include things like dermatology service or skin problems, muscular skeletal services, vasectomies out in the communities. And in practices, things like 24-hour blood pressure measurements and blood tests in practices.

Also, later on this year, we're going to be moving, or it's going to be available to our practices, more diagnostics; ultrasound scans, MRIs, and audiology or hearing tests are going to be available in your local practices. And we are looking at what other options in our plans and our priorities we need to look at, to actually move out into primary care.

Now doing that means better access for patients, because it's at your local practice. And that will obviously reduce travel, which is another issue I'm going to come on later, which patients have raised as a problem in our area, with the changes. But I think it's important to mention all that because Simon's going to come on and talk about the hospital changes, but we can't do any of the hospital changes without some of the changes we need to do in primary care in the community, to actually match the change in services that we want to deliver.

So we want to make sure that the hospital is only there when it's needed and when there's no alternative available locally in primary and community. So we're looking at other options around the increased use of technology and tele-health in practices and in the community. Already some of our practices are, this year, going to be starting to see some minor injury patients in their practices, rather than them needing to attending accident and emergency departments.

We are improving the training for our community staff and teams, to improve the management of long term conditions. And we want to make sure that the care that those patients received is done in a seamless manner, so that the practices and the community

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staff are working together and meet regularly in all our practices to make sure that happens.

The other thing is obviously to give our patients and the public more control of their own health and their own say. So we're looking also around self-care management schemes and better options around that. And we want the community services to be local but actually also 24/7. They need to be available every day 24 hours a day.

We want to make sure that the IT systems we have are better used, and there's better sharing of information. Currently, there's so many different…there's different systems in the hospitals to practices, and they often don't talk together. And that actually gets in the way of patient care. And we want to make sure that the IT systems work better, so that actually your records about your consultations and your medication are there when you need them to be there, whichever setting you're in.

We also want to make sure that there's not any blockages in the system in terms of patients who are admitted to hospital actually getting a discharge assessment quickly, as soon as they're in, in terms of a discharge planning process, to stop some of the delays in the discharge of patients back to home. Which I think will help in terms of patients actually not languishing on wards unnecessarily.

A couple of examples of things that we have already done, other than things I mentioned earlier. Breathing problems; we already have a range of community matrons, district nurses and specialist nurses, outreach from the hospital who deal with patients with respiratory or breathing problems. We have heart failure nurses in the community, who help to deal with and manage patients outside of hospital. This will reduce the need to stay in hospital, and actually allow patients to be discharged home and actually managed better in the community setting.

Another area where we've been doing some work on and moved out into the hospital is on stroke care. Rather than patients needing to spend several weeks in hospital, we've got an early supported discharge scheme, which allows patients to be discharged home and to have their rehabilitation out in their home setting, with OTs and physios, et cetera, being provided by our community services provider.

And we're doing a lot of work on making sure that community based teams do better work with our long term conditions patients who are housebound, by increasing the training of those staff, but also, making sure that those patients have the social care backup when they need it, through the rapid response teams. And one of the key things we're looking at in the integrated services is to make sure we have both health and social care joined together for Doris, when she does need to have that important support.

I'm going to pass over to Simon now, who's going to tell you a little bit about the hospital changes. And I'm going to come back later and tell you a bit more about some of the other things I wanted to cover. Thank you.

Simon Enright:Can I have my first slide, please? Hi, my name's Simon Enright. I've been a consultant in intensive care and anaesthesia at Mid Yorkshire for 15 years. And I'm going to talk you about our proposed changes to hospital services. Next slide, please.

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I'm going to talk in four main areas; maternity, and in particular where ladies give birth; children's inpatients; accident and emergency, and unplanned care; and surgery. I'm going to talk about what we do now, what we're proposing to do, and how that will make things better, particularly from a perspective of patients from Dewsbury and from Dewsbury Hospital. Next slide, please.

First of all, births. Before I start, I need to tell you that when you're pregnant, it's decided based on your birth that you are either low risk, which is the majority of ladies, or high risk. And this becomes important as to where you're able to give birth. At Dewsbury presently, low risk ladies either give birth at home or in Dewsbury Hospital; high risk ladies give birth in Dewsbury Hospital. Since 2010, if there's been a high likelihood of your baby requiring neonatal intensive care, that has been carried out in Pinderfields. Next slide, please.

What we're proposing is that we centralised all of our high risk births to a consultant-led unit on the Pinderfields site. This means we will have a midwife-led unit on the Dewsbury site. So ladies who are deemed to be at low risk can either give birth at home, on the midwife-led unit, or at Pinderfields. But if you are high risk you will deliver at Pinderfields. At the same time, we will be keeping all of your antenatal and postnatal care local, and home births are an option for all low risk ladies. Next slide, please.

Why is this better? Well, first of all, low risk births, the majority. We know that nationally, midwife-led units are as safe as consultant-led units for low risk births, and provide a better experience for the mother. We have at least ten years of local expertise in delivering midwifery-led services both in Wakefield and Pontefract. So we're not starting this new. And we believe our changes promote choice for the majority of mothers.

For high risk births, from ladies from Dewsbury, they will take place at Pinderfields. There are very strict national recommendations around about, for example, the number of hours we have to have consultants actually sitting on the labour ward, dependent on the number of deliveries. And at present, we can't offer that service on both sites. We believe by centralising the high risk births to Pinderfields, we'll have more consultants, increasing safety, and more specialist obstetricians. This will improve care for high risk births and for sick babies. It will also have some other advantages, such as more flexibility for ladies who require caesarean section. Next slide, please.

Next, children's inpatients. At present, at Dewsbury, we have outpatient and emergency care. We have inpatients for children, but since 2010, if your child has required surgery and needed to stay in hospital overnight, that has been done at Pinderfields. At Pinderfields, we have our neonatal intensive care since 2010, and all inpatient surgery, with very specialist care being carried out in Leeds. Next slide, please.

What we're proposing is that patients or children who require inpatient care from Dewsbury, will have that care at Pinderfields. We will keep urgent assessment and outpatients at all three of our hospitals, including Dewsbury. And there will be a new children's assessment service for the majority of children who presently attend the A&E at Dewsbury. Next slide, please.

Why is this better for children? Well, less poorly children, they'll be treated locally, more quickly, and they'll be able to go home sooner. For sicker children, the ones that need to stay in hospital, they'll be seen sooner by senior doctors, there'll be more consultant

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presence on the ward, and they will have a better, safer service; while keeping as much of your child's care as local as possible. Next slide, please.

Thirdly, emergency care. Presently, people needing emergencies can go to Dewsbury, Pinderfields or Pontefract. People with very serious conditions are taken by ambulance to the nearest appropriate hospital, either within the Trust or to a regional centre. At the moment, people who attend Pontefract A&E who need admission go to either Pinderfields or Dewsbury. Next slide, please.

What we're proposing is that Pinderfields will continue to see the full range of cases. It has been our specialist trauma centre since 2010. And we are proposing it becomes our major centre for emergencies, and emergencies that require inpatient care. At Dewsbury and Pontefract, we will have open access for emergency care, full resuscitation facilities, with a resident anaesthetist on site in the hospital 24 hours, able to treat a whole range of conditions, with some ambulance attendances. And we reckon we will treat around about 70% of the patients we're currently treating in the A&E in Dewsbury, under our proposals. In an emergency if you call 999, trained paramedics will assess you and start your treatment straightaway. They will then decide which is the best place for you to have treatment, if you need more treatment, with the more serious conditions going to either Pinderfields or a regional centre such as Leeds. Next slide.

Why is this better? Well, patients will be treated in the right place, by the right teams, with the right support, at the right time. Seriously ill patients will get straight to specialist care. If you require inpatient care after an attendance to A&E, you'll be seen and managed by specialists much quicker, and you'll be seen by the right specialist. For example, if you've got a problem with your heart, you'll be seen by a cardiologist sooner, because we'll have teams of cardiologists; if you have a respiratory problem, you'll be seen much sooner by consultants who are trained specifically in respiratory diseases.

Consultants will be on site for longer periods where they are needed most. And people will have to travel no further than Dewsbury to Pinderfields, or Pontefract to Pinderfields, for emergency and inpatient care. Patients with less serious conditions will be seen, as children, more quickly and locally, with the majority of patients, around 70%, still being seen on the Dewsbury A&E. We will also develop what we call emergency day care. Next slide.

Just to explain what emergency day care is. Many of our patients, we know from doing audits and so on, have very short lengths of stay; one day or two days, or less. They're often sitting there waiting for tests or treatments which could be easily carried out on an outpatient basis, as day care. Once we've ruled out more serious conditions quickly, such as chest pain, ruling out whether this is a serious heart attack or not, these patients can be managed on an ongoing basis, without the need to have a hospital bed; keeping them having their care more local. This reduces admissions and the need for inpatient beds. And we know it works well in other places around the country that we've visited, such as Middlesbrough. We're due to start work on emergency day care this year at Dewsbury. Lastly, the changes affecting surgery. At present, Dewsbury has short day and day surgery, inpatient general surgery, planned orthopaedics, and gynaecology. Next slide, please.

What we're proposing is that Dewsbury becomes our major centre for planned elective surgery, with far more surgical specialties than are delivered from Dewsbury at present.

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We will continue to have day surgery and some unplanned surgery, but the major change is the development of a planned surgical unit on the Dewsbury site. If you need emergency surgery or you have complex surgery that may require intensive care, which is the minority of cases, this will be carried out on the Pinderfields site. Next slide, please.

Why is this better for surgery? Well, we know that separating, as Dr Kelly said, emergency surgery from planned surgery is better for patients. They do better and they have a better experience. We can get then guarantee more rapid access to urgent surgery. There'll be more senior and specialist care for our sickest patients, with more specialist rotas, and the right surgeon seeing you at the right time. There'll be less variation during the week and better weekend care. And there are other advantages in separating planned from unplanned care, such as you're less likely to be cancelled; you have less risk of infection; you can have local treatment at Dewsbury for straightforward planned surgery, which is the majority of surgery. We'll also reduce the need to stay in hospital, with our moves, and we'll increase the available surgical specialties on the Dewsbury site. Next slide.

I've given an awful lot of information there, it's a lot to digest, if you've not heard all this information before. And there'll be some discussion after this, I'm sure. But to summarise, if you live in Dewsbury, most of your routine healthcare needs will be met locally. Outpatients; x-rays; tests; scans; planned surgery, both inpatient and day case; antenatal, postnatal care; birth, if you're deemed to be low risk, which is the majority of ladies; and rehabilitation. If you need care urgently, most of that care will still be provided on the A&E at Dewsbury. We will develop emergency day care for those patients I discussed, which will mean fewer people will need to stay in hospital, and their care can stay local in Dewsbury. But if you're very sick or you need specialist treatment, or have complex needs, you will go to Pinderfields, where more of your care will be provided by consultants who will be on site and on the wards for more hours of the day and the weekend, and specialist trained nurses.

Thanks. I'm going to hand back over to Dr Kelly now.

Dr David Kelly:Thank you, Simon. This slide is really just to say that, with all these proposed changes and the changes in the healthcare system, it's often difficult and confusing to know who to contact and when. This is really saying that, in the future, there'll only be three numbers you'll need to remember in terms of accessing healthcare. 999, for obviously emergencies, where the ambulances and paramedics will be able to assess patients and direct you to the right site in terms of whether you need to go to Pinderfields, in these changes, or to Dewsbury, or even can be assessed and actually be dealt with by our community changes that we were talking about earlier. 111 is the new number that's coming out, and it's going to be live come mid-March, be publicised and advertised nationwide. And this is a number for anything that you need contact with that's of a non-urgent basis. They will have a directory of all the local services that are provided, and will be able to direct patients to the right service. Then the third number is obviously your local doctor's surgery number, which will remain as it is currently, in terms of providing not only what it does currently, but hopefully an increased range of services, as I outlined earlier on.

When we've had discussions prior to this launch of the consultation, one of the key things that have come out of that is issues around transport and travel for patients, with these proposed changes. We set up, as a result of that, a group to look at transport and travel

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arrangements, and to produce some recommendations for yourselves during the consultation process, to actually look at and give us comments and feedback about. We can't do that on our own, and we've obviously worked with people who run transportation systems, such as the bus company, the voluntary sector, the council. But it's been led by one of our Board members on the CCG, who's our non-executive director, who's got a particular interest in patient and public involvement. So what has that group done and what has it come up with in terms of some recommendations for you to consider?

Well, these are some of the recommendations there that actually, there should be more flexible appointment times for patients, so that actually, you can work around your own work arrangements or your own family arrangements, to make sure you get the appointment time and day that you actually need for your appointment. That training should be better for all staff involved in the transport system, and actually they should understand and be able to give better advice to patients about which transport arrangements might suit them best. There's some recommendations about looking at extending the shuttle bus service or the route 111 bus, which I believe is a service from the centre of town in Wakefield to Pinderfields Hospital. There also should be options around more booking of transport for patients and more utilisation of the options around voluntary sector transportation.

The other thing to assist patients would be to support them getting home, perhaps when they're taken to hospital and it's three o'clock in the morning and they don't need to stay in hospital, as to what the options are for patients, in terms of getting home at that time. And what are the options or the recommendations to look at free Metro cards for A&E patients who have no other alternative to how they might…

US:[Inaudible - microphone inaccessible 0:42:51 - 0:42:52]?

Dr David Kelly:No, not at three o'clock in the morning. And that followed on probably not at the right time, but that three o'clock in the morning might be a taxi. But these are options that we want people to look at and consider, and give comments back on.

We also want to have better travel information for patients, and actually have a travel helpline that perhaps people could contact. And provide outpatient letters with information on that about what the travel arrangement or transport requirements are available to patients.

My final few slides are some comments about some myths or concerns that have been raised throughout this process. I think some of them were referred to earlier throughout this presentation. The first one is, it's all about saving money. Well, I can say it's not all about saving money. The first concern we have as a commissioning group is to provide quality, safe, effective services for our patients locally. Yes, the financial issues are something we've got to address and tackle, but actually what we need to do actually would happen regardless of the financial situation of the Trust. Some of these changes we've talked about earlier make clinical sense and are of a quality nature for patients. So it's not about finance, it's about improving services for patients. And by doing so, that will actually address some of the financial issues and concerns that the Trust have .

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Another concern is that Pinderfields won't be big enough to cope. Now we've heard about some of the changes about split between elective and non-elective surgery, and about Pinderfields becoming the centre for urgent care. By splitting things up and actually moving patients around to different sites, this will ensure that actually Pinderfields is big enough to cope with the urgent care, because a lot of the planned services will move from Pinderfields to either Pontefract or Dewsbury; creating the capacity within the hospital for those urgent care services. There's also some investment in the proposals for actually improving some of the services, not only at Pinderfields but also at Dewsbury, our local hospital, around the changes we might need to provide the services there.

The other concern is there won't be enough beds. And there's been a lot of work done on the modelling of these services, and how that might affect the bed numbers. The reductions we heard about earlier in terms of the reductions of length of stay for patients; the alternatives we're putting in place in terms of avoiding the need for patients to go to hospital; improving the discharge planning process; the emergency care centre that Simon's just referred to. All will mean that actually, there's a need for less beds in the system. But actually, the number of beds that are still there will still allow some degree of flexibility for situations that might arise where there's some surge in healthcare demand.

The next one is about this being the thin edge of the wedge. And I can't seem to get the next slide on, so I'll do Simon's trick of next slide. There, it seems to work.

This is definitely not the thin end of the wedge, and I certainly wouldn't be standing up here, none of my Board would be standing up here if this was the thin edge of the wedge, or we thought it was the thin edge of the wedge, leading to the closure of Dewsbury Hospital or even Pontefract Hospital. We intend to make sure that we support and facilitate a vibrant local hospital in Dewsbury for our patients. And we've certainly no plans at all for Dewsbury Hospital to be closed.

Next one is about this being a hidden agenda to close A&E. Again, we heard earlier on from Chris and also from Simon, there's no hidden agenda. This is about redesigning services and actually improving the way we deal with patients with urgent care problems, not only on the Dewsbury site but also in the specialist centre, when they need to travel to the specialist centre in Pinderfields. And this is not something that is in the pipeline at all. And I'd like to quash that, if anybody has that thought at all. And as we heard from Simon, the majority of patients who currently attend Dewsbury Hospital, in terms of the accident and emergency department, will still attend Dewsbury, in terms of accident and emergency department.

That's all I wanted to cover. I'm going to hand back to the Chair, just to close the discussion. Thank you.

John Buck:David, thanks very much. Can I just check that everybody can hear me with this microphone? Can you hear me now? Is that okay? David, Chris, Simon, thanks very much. There's a lot of information, that I'm sure will provoke a number of questions…

US:We can't hear you very well 0:47:57

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John Buck:Is this working? Is this better?

US:Yes.

John Buck:Okay. As I was saying, there's a lot of information in that presentation. Some of it may be familiar to you through leaflets through the door, Although I understand that process has only just begun. A lot of it will be new, so there's a lot to digest. But I'm sure it will have provoked some questions in your mind. And I'd like to give as many people as possible the opportunity now to put those questions to members of the team here. There may be a lot of questions. If there are a lot of questions, I will try to group them together. But I see there's a gentleman there with a beard, who had his hand up first. And there is a microphone coming to you, sir.

Question and Answer Session

KEY: M = Male; F = Female; PM = Unidentified Panel Member; US = Unidentified Speaker

M1:I have listened very, very carefully to what people have said, but I know how I felt before I come to this meeting and I know how I feel now. I am totally opposed to the privatisation of the National Health system.

[Applause]

Totally opposed to it. So I haven't many questions, but I have three. Well, they may be questions or they may not, you'll have to wait and see. Dr Kelly…oh, no, the first one is I would like an answer, with your hands held high, who is for privatisation of the NHS and who isn't? So let's have the hands up of those who are for the NHS privatisation. Nobody? Nobody? Are you all against it?

US:Yes.

M1:Nobody from the platform? You've had your say, let me have my say now.

John Buck:I'm very happy to give you your say but if you could keep your questions relatively to the point, that would help.

M1:Dr Kelly said there was a need to change. And he said it several times. But why is there a need to change? I'll tell you why, it's perfectly simple, because the Tories brought the NHS Privatisation Bill in without a mandate. And that's why there's a need to change because you're dictated upon by the NCB and the CCGs. That simple.

The third point. For months now, you have had no meetings whatsoever, and now when the Health and Social Care Act comes into force on the 1st April - I call it the April Fool's

15

Act, not the Social Care Act - you're having all these meetings. You're having them in town halls, you're having them on the streets, in the centre of towns, you're covering all the areas. I can't remember the number of areas you're covering but there must be about 20, Agbrigg and places such as that. You're holding them in hospitals, and you're also holding them in supermarkets. Now if that isn't to convince the mass of the population that this is a good thing, I don't know what is. So who's paying you? How much are you paid, each one of you? You must be on a fortune. That's all I have to say.

[Applause]

John Buck:Thank you very much for those comments. I think, rather than ask any other questions at the moment, I'll ask Chris Dowse which member of the platform would like to respond. But can I just say we could spend a lot of time at this meeting discussing the broader health picture. I think it would be useful for most people here, who will have concerns about what happens locally, if we can focus specifically on those concerns. But Chris, how would you like to respond to that?

Chris Dowse:Okay. Can I ask my technical boys to switch on the mike, please? Thank you. Okay, I'm going to invite Dr David Kelly to respond to that.

Dr David Kelly:Thank you. Now there were several questions there within your comments. I'll try and cover them as best as I can. Firstly, to say that the consultation process we're talking about tonight is not about the privatisation of the NHS, it's about actually how we can provide the best services locally, using NHS services and NHS providers locally.

F1:It's how you think it should work. It's not what us the public think, it's how you people sat here think it should work, so we'll brainwash you into doing it.

Dr David Kelly:Okay, this is about consultation. This is not about us saying this is what's going to happen. This is about you having the opportunity to give us the feedback on the proposals. And that's what the purpose of this meeting is tonight, for you to say what your thoughts are.

M2:[Inaudible - microphone inaccessible 0:53:32 - 0:53:49] things like that.

F1:[Inaudible - microphone inaccessible 0:53:47 - 0:53:47].

M2:Sorry, I think most of us here are actually opposed to the proposals that you're telling us about. That's why we're here.

Dr David Kelly:I mean, I'm quite happy to answer the question but I'm not quite sure that's relevant to the consultation process. I mean, I do not have any shares in a pharmaceutical company or a

16

chemist. I am a director of a local pharmacy but I do not have, personally, any financial interest in that pharmacy, personally.

M2:Okay.

John Buck:David, thank you very much. There was a gentleman over on the side there who had his hand up for some time, waving…the gentleman there, waving the paper.

M3:Can I ask whether you have done a proper equality impact assessment of the proposals, and how they're going to impact on disabled people and others who may not be able to access the services that you're proposing to change? By law, you're required to do an equality impact assessment. Has that been done, and is that publicly available? That's the first question.

The second question is…

John Buck:Could we just take one question at a time, because I think it's going to rather confused if people are asking lots of different questions? Who would you like to respond to that?

M3:The first one's a very simple yes or no.

John Buck:Can we ask Chris to respond to that, please?

Chris Dowse:Okay. The answer is yes. Yes, there has been…

M3:Is that publicly available from whoever you consulted?

US:[Inaudible - microphone inaccessible 0:55:14 - 0:55:17]

Chris Dowse:No, because there are a number of people involved in this whole process, I don't necessarily get involved in every detail. But there has been a full impact assessment. I'm looking to my colleague to just advise me whether it's now in the public domain.

M3:Has that been done under disability, race, gender, et cetera?

Simon Enright:Okay, thanks for your question. It's a really important question, isn't it? Of course, we want to make sure in any service that we provide, we provide access for anyone who's disabled. And, of course, many people use…

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US:[Inaudible - microphone inaccessible 0:55:48 - 0:55:48].

John Buck:Could I ask people not to interrupt while others are speaking, please, because that isn't very productive.

Simon Enright:I think it would be helpful just to allow me to answer your question. Show me the respect that we showed the questioner, and let me answer that question.

So coming back to the point. Obviously, it's really important to provide in healthcare that we look after people particularly who are disabled. And many of our patients are disabled, with long term conditions. So we do impact assessments on every single service we provide in every premises, every year. It's a requirement for Health Service institutions. All of that is publicly available.

As far as these proposals are concerned, we've done an initial assessment on the outline of the proposals that we have, because we're consulting. So, of course, until the consultation concludes, we don't have any firm proposals. When those firm proposals are put in place…

M3:No, with all due respect, I'm sorry, the requirement of the law is…

John Buck:Can I please ask…I'm sorry, could I please ask you not to interrupt, please?

M3:The requirement of the law is that when you set out proposals, you don't wait for the consultation to end. As part of the proposals, you do an impact assessment. That is what the law asks for.

Simon Enright:Yes, we've done that, which I said. But what you have to do is allow us to answer your questions, please. That's what I'm…I'm trying to answer it, and you keep…

M3:I'll give you the benefit of the doubt.

Simon Enright:So what I was…just in finishing up your question, we do an assessment now of what's proposed. But, of course, normally, in our experience nationally, as again I guess you'll appreciate, when consultations happen, things change, before anything's implemented. So at that point, there will be a further assessment done before anything's implemented. And that would then become part of the routine assessments all healthcare bodies need to do.

M3:A supplementary to that, what does the race impact assessment show you?

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Chris Dowse:Sorry, can you repeat that, what does the…?

M3:What does the race equality impact assessment, from the assessments that you've done on the proposals, indicate?

Chris Dowse:Okay. Stephen?

Stephen Eames:I think we're quite clear about the implications. They stand whatever the nature of the services are. If you want us to share that in some detail, which I think is part of your question, then we can just pick up your details this evening and we'll do that. Is that…I think that's the best way to take that one forward.

F2:I'd like to know the answer to [inaudible - microphone inaccessible 0:58:09 - 0:58:13] It's a really important one.

M3:I think there are lots of people here who'd be affected by it. It would be useful to give the answer.

Chris Dowse:Okay, so we'll pick that up. And what we can do is, we'll put that on the Meeting the Challenge website, with the whole answer. Would that be okay?

F2:Not everybody's got [inaudible - microphone inaccessible 0:58:28 - 0:58:29].

Chris Dowse:Okay.

US:[Inaudible 0:58:35] asked the question if I'd have answered yes or no.

Stephen Eames:I think I answered very clearly that we've done an impact assessment. We do that routinely. We'll make it available. If you'd like a copy yourself, we can provide that for you, if you leave some details this evening. And we can certainly publish it in all the ways that we're communicating around this particular consultation. So I don't think that could be any clearer, but I'm happy to respond in more detail.


John Buck:Thank you. And there's a gentleman there with, is it glasses, who's been waiting for some time, I think.

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M4:Is this working?

US:Yes.

M4:Okay. You've probably got the idea that nobody around here trusts you. And the reason for that is that Dewsbury's marginalised. We're marginalised politically, central power's in Huddersfield; we're now marginalised medically; everything's been shifted over to Wakefield. Both my parents are, you know, reasonably seriously ill. One had a stroke, one's got endless breathing problems. I've been back and forward to Pinderfields. You know, lots of the things you've said, you think, yeah, that's good, that's going to work. The true is, we don't trust you. You're a commissioning group to commission external providers to come in and provide services. Dewsbury's just going to get screwed again. Bored of it.

[Applause]

John Buck:Chris, do you want to respond to that?

Chris Dowse:Okay, I'm going to ask David Kelly, Chair of…


Dr David Kelly:Well, presumably because you want me to give some sort of response. I mean, I think, as I said earlier…


John Buck:Can I just say, there are a number of people on the platform, and I think it's useful - and also down there - where there are specialised questions, it would be best if the person best placed to answer them, answers. And I think your judgement is that David is.

Dr David Kelly:I mean, myself and my family are registered with a local practice. Myself and my family have used Dewsbury Hospital services. We live in North Kirklees. I do think I am a local. I've worked for 23 years and put my heart and soul into general practice. I do believe I am a local doctor and a local person, and have that local knowledge. I have contact with patients from my area on a daily basis. And all of the Board are local, as I said earlier, patients and also professionals.

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M4:[Inaudible - microphone inaccessible 1:01:05 - 1:01:08].

Dr David Kelly:I'm aware of the concern and the actual…I'm not so sure about trust. I would like to think that you have…

M4:Go in town and ask, go and ask people. We've been stuffed by Kirklees and now we're being stuffed by the Health Authority, shifting everything over to Wakefield. [If you have 1:01:30] anything complicated, out of Dewsbury.

Dr David Kelly:But I think I tried to make it plain earlier that actually we're not just stuffing everything over to Wakefield. We are looking at…

US:[You are 1:01:38].

Dr David Kelly:We are looking at improving services for our residents locally.

[Voices overlap 1:01:42 - 1:01:44].

John Buck:Can I please ask that we have one question at a time and that the responder is allowed space to respond? There's somebody there who has had her hand up for some time.

F3:I've worked within the NHS now since 1998, and I see that service is getting worse. But I can't see all this is going to make things better. By taking services away from Dewsbury, where I know a lot of patients need the services, i.e., people with respiratory problems, Dewsbury obviously, you know, they take patients from a vast area throughout Huddersfield, Kirklees, you know. If people are then getting transferred over to Pinderfields but these people that have got these bad breathing problems, by the time they get to Pinderfields they're going to be dead. Because their oxygen levels are so low, people that have COPD, that they need to have special breathing machines, bipap, cpap. Paramedics don't provide that, all they can give is 98% oxygen. So, you know, you talk about patient care and patient services, I just…it doesn't protect our patients whatsoever.

[Applause]

John Buck:Chris, do you want to…?

Chris Dowse:Okay, I'd like to invite Dr Matt Shepherd to respond to that. Matt is a consultant in emergency medicine at Mid Yorkshire Trust.


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Dr Matt Shepherd:No, I haven't. Well, if you have a patient who has breathing difficulties, what we want to see in the future is that we extend the services that successfully keep people with breathing difficulties safely at home, by having specialist nurses who are able to respond when people start to become unwell with their COPD; which is a very successful model that's been celebrated nationally, that's been working at Wakefield. And we want to extend that to the whole area. So first of all, we want to prevent people getting to the stage where they're really sick, and that they need to come to hospital at all.

Secondly, our ambulance service colleagues are capable of delivering a whole lot more care than they previously did. It's no longer about being in the back of an ambulance and just travelling somewhere. So they start the care. They don't put everyone on lots of oxygen, they put people on the right amount of oxygen. And they start the treatment with medicines that open up the tubes in the lungs. And then by the time they get to the hospital that can deliver the right care, those patients are already starting to improve, in the vast majority of cases. And where those patients are very ill indeed, what you need is the services to be available, with the right specialists to improve that patient's care very quickly.

And what we're proposing is to be able to have those specialists available more of the time. Because we know that currently, trying to provide those specialists on two and three sites makes it very difficult to have all the hours that you need to cover, because patients don't become ill conveniently between nine and five, they become ill at all times of the day and night. And what we want is the specialist to be there when the patients arrive. And that's what we're trying to propose. We're proposing that those patients arrive and they'll be seen by doctors like myself in accident and emergency, but…

US:[Inaudible - microphone inaccessible 1:05:16 - 1:05:19] you personally?

Dr Matt Shepherd:Me personally, I've worked at both.

US:Permanently?

Dr Matt Shepherd:Yes, permanently. So what we're proposing is, once they’ve seen a doctor like me, and hopefully…and what we're proposing again is more senior doctors like me available 24 hours a day at Pinderfields, they will then be able to see the specialist who can take their care on, get them better quicker and get them home quicker. And that's what's right.


Dr Matt Shepherd:That was the point I was trying to make. It's about the specialist nurses…

US:[Inaudible - microphone inaccessible 1:06:01 - 1:06:05] change over at Pinderfields?

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Dr Matt Shepherd:I'm not…how is it going to change from what it is now?

US:[Inaudible - microphone inaccessible 1:06:09 - 1:06:11] how is it going to change the treatment that patients get, when they don't get it at the moment? In multi-disciplinary teams, i.e., you know, physios.

Dr Matt Shepherd:It's the same argument again. If we were trying to provide multi-disciplinary teams to two different sites, you're limited in the ability to cover the 24 hours in the day. And so you have to spread everything much more thinly. With us being able to concentrate where the sick patients go, we're able to make sure that that provision there is for more hours of the day. And that means when patients get there at whatever time of day or night it is, their access to the people, not just the doctors but you're right, the specialist nurses and the physios, and everyone else that's there…

US:[Inaudible - microphone inaccessible 1:06:55 -1:06:56].

Dr Matt Shepherd:…to deliver that care through the 24 hours will be much quicker than it currently is.

John Buck:Can I move on to the next question, please. There's a lady there who's had her hand up for a long time.

M5:[Inaudible - microphone inaccessible 1:07:09 - 1:07:13]. I have COPD, asthma and emphysema, and I've [inaudible - microphone inaccessible 1:07:16 - 1:07:19] for a long time now. And then what they do is, they send you to ward six. I've been there as well [nearly seven weeks 1:07:27 - 1:07:28] and I finished up in a bad way. [Inaudible - microphone inaccessible 1:07:32 - 1:07:40] which has now been taken over [inaudible -microphone inaccessible 1:07:3 - 1:07:52]. So they're telling me, that's [inaudible 1:07:53 - 1:08:00] at five o'clock in the morning, because they found out [inaudible - microphone inaccessible 1:08:04 - 1:08:10] and put me a temporary pacemaker in. And I've been looked after at Dewsbury for a long time now, and I'm [inaudible - microphone inaccessible 1:08:18]. I've just come out of hospital with pneumonia, and I went into A&E, half an hour. Went from A&E into [inaudible 1:08:29]. I were there two nights. They moved me into short stay, because they said I wasn't fit enough. They moved me then from there to ward nine, which were a [swear word] disgrace. And then they moved me then…they discharged me. The first ambulance went and they were going to call me a taxi. I said, you're not calling me a taxi because they're not insured. [Inaudible - microphone inaccessible 1:08:52 - 1:09:01]. I said, where's the other medication. You haven't got none. I said, I have. Well, where is it? I said, go up to ward nine and go into [his lockup 1:09:14] and it's in an orange Sainsbury's bag that I went in with. I said you can go and fetch it. [Inaudible - microphone inaccessible 1:09:19 - 1:09:24] giving the medication out, he said, oh, I didn't give him it because I thought I were going to overdose him. [Inaudible - microphone inaccessible 1:09:29 - 1:09:33].

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John Buck:Can I…thanks very much for that contribution. Chris…

Stephen Eames:Sorry, Chris, could I intervene for a moment. Thanks for raising that. We did have a conversation just before. I just wanted to re-emphasise that with that story, it would be easier if we can, as we've already done, just follow that up with you individually, to make sure we cover all the ground that you talked about there. Because I was going to say, other colleagues will talk…


Stephen Eames:Yeah, but some of the things that you were describing there about your experience are the things that we're talking about doing locally. That's not really related to some of the bigger changes we're making here. But I think in terms of your personal experience, and I think…


Stephen Eames:Yeah, it's a general point for everyone, it's a general point…

M5:And they're going from Castleford and Pontefract into Dewsbury [Inaudible - microphone inaccessible 1:10:28 - 1:10:32].

Stephen Eames:Yes, that's the current position which will change if these proposals are implemented. But the point I'm trying to make is, for anyone like yourself who may be concerned about an experience you've just had, then I want to hear about it, and so do my colleagues. But the best way to deal with that is to take a lot of details from you, so we can follow it up and get back to you straightaway. So we'll do that.

John Buck:Stephen, thanks very much. Can I go back to the lady here who was waiting patiently to ask her question.

F4:Pinderfields Hospital cost £138 million to build. It was built on a PFI. Currently, they're paying £40 million a year for the next 25 years to pay off the PFI. Now it doesn't take a rocket scientist to work out what the APR on that must be.

[Applause]

It's like buying your house on a credit card and just paying the minimum payment. You wouldn't do it, I wouldn't do it, any sensible person wouldn't do it. I don't believe for one minute what you're saying. All this, we're doing it for safe services. How you can tell me that if somebody's seriously ill and they then have the transfer time, how you can say that's

24

safe, I just cannot understand that in my wildest dreams, what that is. Excuse me, you didn't like it when people were talking, don't you dare do that to me. That is rude.

[Applause]

John Buck:Stephen, would you like to respond to that question.

Stephen Eames:I'm sorry, I was just saying to Simon that part of your question's better for him to answer. So I apologise I wasn't looking at you when I did that. But could I just pick up the question about the PFI. Actually, it was £400 million, not £100 million. That's the actual figure of the PFI investment in Mid Yorkshire Hospitals.

F4:Well, even if you call it £400 million, you work out what £40 million…and it will increase year on year.

Stephen Eames:If you let me answer, I'll answer. Let me answer your question.

John Buck:I know these questions are important, can…

Stephen Eames:Let me answer your question, because…which I'm going to, about the PFI. But the PFI process in this area, and the investment in hospitals in this area, was part of the Labour Government's policy, which obviously was implemented up and down the country. And it was the Government's policy at that stage in all public services to use the PFI [voices overlap 1:13:08] - let me finish - to use the PFI for railways, for hospitals, for schools, to provide much needed new facilities up and down the country. That was the policy. Now none of us are here to either defend or support that policy. That was simply what it was.

Now, come back to the substance of your question, which is what do we pay. You're absolutely right, we pay - it's not £40 million actually - we pay £34 million per year. And we'll be paying…

F4:No, it will be £34 million but it will go up year on year on year.

Stephen Eames:Let me explain. We pay £34 million per year for the life of the contract. And the contract has got another 27 years to run. Now when the case was made for the PFI to be built, there was a whole process right through to Treasury nationally, making the case about how that would be paid. It amounts to about 7% that £34 million of the total spend of the hospital Trust, which is nearly half a billion per annum. So it's completely sustainable to make that payment, because if you weren't making that payment, you'd be making other payments regarding your estate. But where you're right, which is…

F4:No, that's wrong.

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Stephen Eames:Well, we could have that debate, but where you're right about…

F4:And it's not a debate, I'm telling you it's wrong.

Stephen Eames:Okay, we'll have a difference in view then. But where you're right about the impact of the PFI over time is, if the hospitals continue to make the efficiencies that they've made this year - for the first time, by the way, in a number of years - so it's running in an effective way financially, then the overall cost base of the Trust goes down, therefore the contribution goes up. And that is an issue for the commissioners and the providers of services. So you're right about that part of it. But…

F4:I'm right about all part of it. It is all down, you have to save that money. It's costing the Trust all that money, £38 million a year or £34 million but it will rise, and it's costing, and it is down to money.

Stephen Eames:Yes. Absolutely. But the funding regimes, without going into all the details, take account of that. That's the point I'm making to you. I agree with you that it has to be paid for but so do any developments or any sort of provision of services, whether they're funded by PFI or by national [capital 1:15:27]..

F4:And also, if the proposed law changes goes forward - which I hope it does - if somebody goes to Dewsbury Hospital and they have to be transferred because the downgrading of A&E, and they die en-route - can I finish please - and they die en-route, then you will be guilty of corporate manslaughter.

Stephen Eames:Okay. Well, indeed.

F4:Yes, you will. There is no doubt.

[Applause]

Stephen Eames:That's the second part of your question I was going to ask Simon to deal with. But just finally on the point about the financing of the PFI and the buildings in the Trust. Bear in mind, in these proposals, we're talking about spending nearly £40 million, some of which is going to be spent at Dewsbury. That also…

F4:And I hope that's not going to be another PFI.

Stephen Eames:

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That also has to be paid for year on year [voices overlap 1:16:17]. I'm going to hand over to Simon for the second part.

John Buck:Can I just repeat, please give the responder a chance to respond. Simon, you wanted to add something there.

Simon Enright:Yeah, I think the clinical issue you mentioned was about ambulance transfers and patients deteriorating in transfer. I mean, I think Matt's probably already stated this, but an ambulance isn't just a transit van that delivers patients any more. There's treatment that goes on in ambulances. Paramedics are highly trained, they do a number of years of specialist training…can I finish please.

US:They're stuck on the motorway. [Inaudible - microphone inaccessible 1:16:46 - 1:16:48].

Simon Enright:Can I finish this point. In my own area, which is intensive care, we have specialist intensive care ambulances, which safely take people from here to Scotland in a very safe way. I would prefer to get in an ambulance and go a few miles down the road, where I knew there was a specialist on call every night, if I had a respiratory condition. We can't offer that on both sites.

US:You've already got a…my daughter was in Dewsbury Hospital in intensive care, in January of last year. If it hadn't have been for Dewsbury Hospital, my daughter would be dead. There is no doubt at all, she would be dead. If she walked…the day before, she went into the walk-in centre, they sent her home. Luckily, the day after, she went into a consultant-led A&E. That consultant spotted straightaway what was wrong with her, and within hours she was in intensive care in an induced coma. If my daughter had have had to make that transfer from Dewsbury to Wakefield, she would have been dead. There is no doubt she would have died, and you would have been guilty for negligence.

Simon Enright:I can't answer that, I'm sorry.

John Buck:Can I repeat what Stephen said earlier on, which is if there are individual cases - and some of you may have individual cases that you're particularly concerned about - there are other means of taking that up.

US:But that could be anybody's…

John Buck:I recognise there are strong feelings here. I'd like Simon to respond to that, if you wouldn't very briefly. But I am conscious there are a lot of people with their hands up who have been waiting very patiently, and we do need to move on. Simon, did you want to say anything?

27

Simon Enright:All I can say…I can't comment on that individual case because I don't know anything about it obviously, you've just told me about it. All I know is that critical care, intensive care transfers in the whole of Yorkshire are done extremely safely. They have the right staff, they have the right equipment, they have specialist ambulances that take patients who are critically ill, on life support machines, from hospital to hospital. They go from hospital to hospital; they go from Pinderfields into Leeds; from Pinderfields to Sheffield; from Dewsbury to Pinderfields very safety.


John Buck:Can I…if you do want to add something at this stage, I think you will need to…


John Burke:No, I know, but we have a lot of people who are waiting here. If you want to pursue the discussion, there are other opportunities to do so, I'm sure. Can I ask that lady in the pink jacket to speak, please.

F5:It was noted at the very beginning, the very first slide that it's got 'NHS North Kirklees'. Can the team tell me why we have to join with Pinderfields? What's wrong with Huddersfield? After all, that's all Kirklees. And at the same time, by closing children's ward, I know you're going to have an assessment ward from eight 'til eight, but there will be no inpatient beds for children overnight in this area, which is going to cause a great deal of hardship. That is the whole of Kirklees. Thank you.

John Buck:Chris?

Chris Dowse:Okay. I'll just respond on the first point, and then I'll hand over to Karen Stone to respond on the clinical point. North Kirklees is a distinct area, and that's the area that my clinical commissioning group covers and which my governing body oversees. The majority of our acute services we commission from Mid Yorkshire Trust. And alongside us, our neighbour, Wakefield Clinical Commissioning Group, do exactly the same. They commission services from Mid Yorkshire Trust.

Now Mid Yorkshire Trust consists of three hospital sites. And that’s why we're working together on this consultation exercise, because the majority of our patients who live in North Kirklees choose to go to Dewsbury Hospital, and for some of their bigger surgery they go to Pinderfields. So it is our main acute hospital that we commission most of our services from. So that's why we're working alongside Wakefield CCG, Clinical Commissioning Group, on this consultation exercise. Okay, that's the first point.

And can I just hand over to Karen for the next bit.

28

Karen Stone:Hello, I'm Karen Stone and I'm a paediatrician, a children's doctor in the Trust. We are proposing that we have our inpatient children looked after at Pinderfields under these changes. But what we are doing for Dewsbury, and we want to do very soon actually, is to provide a brand new children's assessment unit right next to the A&E department that, you're quite right, won't be open 24 hours a day but will be open for the times of day that we know children present at. We have very good evidence of the high levels of demand that we see for children during the hours that we intend the unit to be open for.

If I tell you that we see just over 3,000 children through our children's ward at Dewsbury at the moment per year, and of those we're expecting to only send about one a day to Pinderfields. Because nearly 3,000 of those children have such a short length of stay that we will be able to see them. And because of having a dedicated assessment unit, we will be able to see them much more quickly by a much more senior doctor, get their treatment plan decided. And that treatment plan might be to have treatment in hospital or it might be to have treatment and then go home, or it might be you need no treatment.

And we're also going to be looking at making sure we're working really well with our community nurse specialists in your local area, so that some children don't even come up to see us and we manage them in their own home, which will be better for particularly children with long term conditions that we really don't want to come to hospital unless they absolutely have to.

John Buck:Thank you. There's a gentleman there who had a question.

M8:Yeah, hi. I'm an activist in the community. I'm also in the caring field. I've got a large extended family and many contacts in the community. And the hospital is one of the places I invariably end up on a regular basis throughout the last many, many years. I've got questions about the fundamental operational matter, as well as more inherent, in terms of the consultation process.

As you've heard, there's been many, many questions been put forward, resolved or unresolved, remains to be answered. One of my questions is, you are declaring this as a consultation process, right. This is the first time I've had an opportunity to talk with any of you guys of the Board. I have been to one or two campaign type of meetings and I've learnt that it's been very difficult to get in touch with you.

So first question, are you aiming to railroad through your plans? Because the language has been important when you've been presenting it; you know, this is what we do now, this is what we will be like. You should have had an extra column to say this is what the people of Batley and Dewsbury have asked us to do. I mean, I've noted that, you know, one or two of you do live in the Batley and Dewsbury area. That shocks me, because if you did, you would know about the historical way in which we've got to this position; the way healthcare, especially as far as hospital is concerned, was provided, and how completely dismantled it's been.

The people of Batley and Dewsbury will not be fooled any more. Enough is enough. We do not want any more dismantling of our services. We're not dumb. You know, we've heard all you said about the distinction between planned and unplanned care, right. You

29

lot have been singing completely from a different box, you know. If you did want to improve services, all you have to do is employ more staff, create another building in the current complex, buy adjacent land. It's n'owt to do with going to Pinderfields or Wakefield, it is completely, you know, out of order. I want it to be…

[Applause]

John Buck:Can I suggest that…

M6:I want you to - can I just finish - I want it to be noted in no uncertain terms that the people of Batley and Dewsbury area will not stand by railroading of the proposed plans as it stands now. And we will do anything in our power that we can, if no one else leads the campaign I will myself, right. And that might include going to a judicial review as well. Okay. Thank you.

[Applause]

John Buck:Okay. Thanks very much. Chris, would you like to respond to that?

Chris Dowse:Yeah. I'd just like to say a few comments, then I want to just hand over to my Chair, David Kelly, to say a few things as well. This is the start of a consultation exercise. There are 12 weeks, which there will be lots of opportunities to see more information, hear more people talk about what these proposals mean. It is a consultation exercise. They are a set of proposals. We're asking you questions about what you think about them. And that's why we're here. We want to hear your views. It's very…


Chris Dowse:Okay. It's very important…


John Buck:Could I please say again, please…could I please ask you, if you have a question, to wait patiently, but first allow the respondent to respond.

Chris Dowse:Okay.


John Buck:

30

Can we please…sir, with due respect, you've already had a question. There are a lot of people here with their hands up, and I'd like to organise this in an orderly way. So Chris, would you please carry on.

Chris Dowse:Yeah. I just want to finish off by saying two things. One is, if you've found it difficult to talk to us, then let me and you catch up before we finish this meeting and we'll talk about this. And I'll make some time to talk in more detail about this. Secondly, David…


Chris Dowse:Yeah. And I'm very happy to arrange that with you. Yeah, happy to do that.

Secondly, one of the things that David was doing at the beginning of this presentation was to set out a case for change. Because we are very clear as commissioners, our new commissioners here, is that the status quo is not sustainable, and that we have to make some changes. And it is about what those changes are that we're asking you to tell us more about your views about that. But we are very clear that doing nothing is not an option. Okay.

John Buck:Thank you very much. I'm going to have to move on, because there was a lady at the very back who was waiting for a long time to…

Chris Dowse:John, David was just going to…

John Buck:Oh, David, I'm sorry, you wanted to add something.

Dr David Kelly:That's alright. I just wanted to add. Certainly, it's not about railroading anything through. I see this process as a…


Dr David Kelly:Well, my view is, it's not about railroading. Our view is that this is about a consultation. It's about listening to the patients, as you referred to, in Batley and Dewsbury, and our public. I've already been, prior to this consultation, to several public meetings where I've had these discussions with councillors and a variety of members of the public. Our Board are willing to come anywhere to talk about these proposals.


Dr David Kelly:No, this is not a fait accomplice. This is about asking for views from…

31

US:You've made your mind up

Dr David Kelly:We haven't made our mind up.

John Buck:Can I please ask you to have patience and allow the responder to respond? Thank you very much.

Dr David Kelly:We've tried to outline through the documents and through the presentation why we feel there is a need for change. And change is difficult to accept, and change needs to be explained…


Dr David Kelly:Well, there's obviously going to be a variety of opinions and we need to listen to the variety of opinions. And some people are going to be completely opposed to this. Some people hopefully will see the rationale behind this and…

[Voices overlap - microphone inaccessible 1:29:15 - 1:29:23]

John Buck:Can I please…I don't think the discussion is pushed forward if people simply shout from the floor. There is a lady at the back there who's been waiting very patiently, I'd like her to ask her question please.

F6:Is this on? I'd like to know if you're comfortable with the consultation document, the summary consultation document? Because there's no mention in here about the reduction of services at A&E. You said both hospitals would have an A&E department for treating a wide range of emergency and urgent but non-life threatening conditions, but there's no detail. It doesn't tell people exactly what's happening. It's a whole leaflet of spin. We've been having this discussion…

[Applause]

We've been having this discussion for a few months and we've been saying you must give the information out, you must tell people what you are planning on doing, what the proposals are. And you've promised us all along that you will do, and this is what's come out. And I've tried to get the full consultation document, that's not available yet. We're 11, 12 days into the consultation. Surely this information should be available by now.

[Applause]

John Buck:Chris, can I ask you to respond to that?

32

Chris Dowse:Okay. The full consultation document is available and it is, it should be on the website. And if it's not, then I will look at that tomorrow morning back in the office. So I will take that away with me and make that right for you.

US:What about the other points?

John Buck:Sorry, there's a gentleman who's been waiting a very long time to ask a question, just behind you there.

F7:Excuse me, it was me that actually had my hand up. Is it alright if I just make a comment quickly? Stephen, I've spoken to you many times about this, and I believe passionately, Dewsbury is paying the price for the white elephant you built in Wakefield. And it doesn't matter…

[Applause]

…how much you dress that up…no, Stephen, it might be a joke to you, but people in Dewsbury care.

Stephen Eames:Yeah. Okay.

F7:And Dr Kelly, I think it's an absolute sham that you can actually sit there saying you consulted people. You've not spoke to anybody in Dewsbury.

[Applause]

Where have you consulted? You've not got my voice and you've certainly not got the people round here. Because you're saying, how can we make your voice heard. Every time somebody here gets up to say something, I'll speak to you later. It's not divide and conquer, it's listen to what people in North Kirklees want. And we're the seventh biggest local authority, we deserve the best.

[Applause]

John Buck:Stephen?

Stephen Eames:Just to make a comment on that passionate contribution. We've had quite a lot of passionate exchanges in a number of meetings already, as you refer to. And we all understand the strength of feeling. I think it is fair to point [voices overlap 1:32:15] two or three things in response to what you said. It's very fair, I think, for us to point out that Dr David Kelly has been at a lot of those meetings with me and with you. [Voices overlap -

33

microphone inaccessible 1:32:23 - 1:32:26]. That is true, and that's on…and it's on the record.

John Buck:Can I please say again, please allow the answerer to answer.

Stephen Eames:The second point, which is more of a general point to the audience. I mean, I don't expect any of you to trust me, I don't expect any of you to believe [Voices overlap - microphone inaccessible 1:32:38 - 1:32:40]. I don't expect any of you to believe in what I say or what anybody else says, if you don't want to. But I think what I'm…

US:[Inaudible question - microphone inaccessible 1:32:46 - 1:32:46].

Stephen Eames:Let me finish, you've had your say. If we're going to have an exchange, you need to listen to back as we're listening to yourselves. The point about the PFI and privatisation has actually got nothing to do with this consultation.

US:[Yes, it has 1:33:00]

Stephen Eames:This consultation is all about saving lives. And the gentleman [voices overlap 1:33:03 - 1:33:05] over here, I don't think he's still there, who was talking about the community, can I just say that I started my career here in this community, where I lived for 20-odd years before I moved away. My mother who is 80 lives in this area, uses Dewsbury Hospital regularly. My stepfather passed away in Dewsbury Hospital. My two sisters had their six children in Dewsbury Hospital. And what we're talking about [voices overlap 1:33:33 - 1:33:34]. Let me finish. So we have actually tried to set out…back to councillor at the back, talking about the detail.

Simon and other colleagues presented exactly what we're proposing in this consultation, which is [voices overlap 1:33:46 - 1:33:48] I personally would want my mum, who lives in this area, is a North Kirklees resident, to get exactly the same [voices overlap 1:33:55 - 1:33:56]. Let me finish, because it's the same for all of you too, to ensure that when your mum goes to hospital on a Saturday night, any time in the week, that she gets first class treatment from the specialist she needs. That doesn't happen [voices overlap 1:34:12 - 1:34:13]. No, that doesn't happen in any…that doesn't happen currently in any of our hospitals in this area [voices overlap 1:34:18 - 1:34:20] never mind in Dewsbury. So these are what these proposals are about. They're about saving lives, better care. I think all the other issues around PFI and other things are very important, but the most important thing is saving lives and better outcomes for patients. [Voices overlap 1:34:34 - 1:34:36].

And I think, you know, you have to get those messages. I think the thing about the data in the leaflet, if I might just pick that point up as well, too. I think you're absolutely right about the leaflet, but the leaflet was never intended to provide all the information, the detailed consultation document is. And all of the data that we're putting on the website does that.

[Voices overlap 1:34:53 - 1:34:59]

34

John Buck:Stephen, thank you very much. Can I just say to the lady in the front row, your views are important but there are lots of other people who have been waiting patient, and particularly [voices overlap 1:35:09] the man just behind you with the microphone. Sir, would you like to…?

M7:Thank you. We've already heard about the immense PFI debt. There is also about £44 million on the current debt. You're proposing to take on another £38 million to finance the disbandment of the services that we've got, to finance the changes. You've got a £24 million saving to make with the CCG by 2014. And you're trying to tell us that this has got nothing to do with finance. If the appropriate amount of finance had been spent on Dewsbury Hospital, then the clinical outcome for surgery, et cetera, would be exactly the same as at Pinderfields. I think that probably you can't afford to pay for the doctors to service both Dewsbury and Pontefract. It's a financial thing all the way round. And about the…it's not been mentioned as option one and option two. Many months ago, you'd already decided on option two, because it's already taking place.

[Applause]

John Buck:Thank you. Chris, I'm not sure whether you or Stephen would like to respond to that?

Chris Dowse:Stephen, do you want to deal with the finance. I think just referring to the options, I mean, we've discussed some of that before, I think, with some of you, because I recognise some of your faces. We did have a massive exercise that led up to this, where we are now on consultation, where there were a number of proposals, where they were all looked at and evaluated with a wide variety of stakeholders and partners, including members of the public. And they were measured and evaluated against a set of criteria which included lots of things like quality and safety, effectiveness of services, and affordability - it did come in - and affordability. [Voices overlap 1:37:16] And this is what emerged as the one [voices overlap 1:37:19] as the set of options that gave us the best service delivery against all of those criteria. So that's what's out in the consultation document right now.

I'm just going to hand over to Stephen now, to talk about the financial stuff.


Stephen Eames:Can I just come back to you? Of course, every service providing any public services, the financial issues have got to be considered. And the best run hospital services in this country have high quality services and balance their financial position. And they have PFIs as well. So, you know, finance is an issue but the point we're making here, which was made in the presentation is, if we had a £10 million surplus, we'd have to address these issues. It's not about money, it's about the quality of care [voices overlap 1:38:10] and the critical mass of clinical staff to provide the outcomes that we would expect if we want to be the best in Europe. So that's the first thing to say. But finance is important

35

because if you don't have your finances under control, you get into the sorts of difficulties that this Trust has had.

US:[Inaudible 1:38:24 - 1:38:24].

Stephen Eames:Undoubtedly. Nobody denies that. That's why I'm here to sort it out, along with other colleagues. Now let me just finish something else, at the end of…

US:[Inaudible 1:38:32 - 1:38:33]. Stephen Eames:Just listen to what I've got to say to you. At the end of this year, in terms of Dewsbury Hospital - and David alluded to this - and let me just set it out. For the first time in [voices overlap 1:38:46] in four years, nobody will have waited…or should I put it this way, that all the patients who come through our emergency department, we've met the national standard; the first time in four years that that’s happened. We've met our waiting time targets.

US:[Inaudible 1:38:58 - 1:38:59].

Stephen Eames:Let me just…

John Buck:Can you please allow the answerer to answer the question.

Stephen Eames:We've met our cancer waiting targets. The Care Quality Commission has, for the first time, given the hospital the clean bill of health. In fact, it's on our website, you should go and read it. You should read about the pride that the staff and patients have in your local hospital; which is absolutely fantastic, and we want to maintain. Right, let's just be clear about all of that, and we publish all of that. You know, you've got a really good hospital that we're trying to maintain. On the finances, the issue this year, this…

US:[Inaudible - microphone inaccessible1:39:34 - 1:39:35].

Stephen Eames:I'm responding to the question that I've been asked, I'm putting some facts out, which is the finances this year for this Trust is being managed perfectly well. Every healthcare organisation in the country has to make an efficiency saving. That's what the taxpayer expects us to do. We've done that. There is an underlying [voices overlap 1:39:55] financial problem which we're still trying to resolve, which will take another couple of years to sort out. But the finances are not the main driver of what's going on here.

US:When you said…

36

John Buck:No, I'm sorry, you've spoken a lot this evening. There's a gentleman there who's been waiting.

Chris Dowse:John, before we just move off, can I invite Mike Potts to just make a comment. Mike?

Mike Potts:Okay. I'm not quite sure how we convince you about the PFI. The PFI…

US:[Inaudible - microphone inaccessible 1:40:22 - 1:40:24] don't waste your breath.

Mike Potts:No, hang on. But I am going to waste my breath, because we need to just understand the facts, okay. The PFI is not the straw that breaks the camel's back with this organisation. I have looked at this over the 12, 18 months, two years, really in depth. And the PFI is expensive, PFIs are expensive. You've heard Stephen explain that the cost of the PFI is about 7% of the Trust's turnover. We know that there are organisations, Trusts and hospitals elsewhere that have got PFIs that are costing a lot more than that. Just hang on a minute, just hang on. And that some of those PFIs are costing over 10%, 12%, and even higher than that.


Mike Potts:Just hang on. So we know…


Mike Potts:What, in terms…?


Mike Potts:Across the country?

Stephen Eames:Nationally, about 80.


Mike Potts:Right, okay. But I want to just try and say to you, yes, the PFI is expensive, PFIs are expensive, but it's not the one thing that causes the problem within this organisation.

37

There's all sorts of other things. The organisation's had a chequered history, in terms of how it's been managed; the finances, how the finances have been managed. And together, we're trying to put that right. And we must be careful we don't get hooked upon it's the PFI that's causing the problem, it isn't.


Mike Potts:No, I don't. It isn't. If it was the PFI that was costing a lot more than it is, and it went over…there's a threshold of about 10%. So if the cost of the PFI is more than 10% of your turnover, then there is a national recognition that that's not affordable within the money that goes through the system. So we've got a tariff based system [voices overlap 1:42:20]. Just hang on a minute. So the PFI in this organisation is about 7%.

US:It's £34 million a year, talk [voices overlap 1:42:30].

Mike Potts:Yeah, but you're not talking about the money that the organisation gets in. So how much money does the organisation get?


Mike Potts:No, it isn't. Okay. Right, well, I don't know how we persuade you then, [voices overlap 1:42:43] but all I'm saying is that if we're going to continue [voices overlap 1:42:44]. Okay, if we're going to continue and say it's the PFI that is the problem, then we're addressing the wrong issue.

US:Yes, you are.

Stephen Eames:If I could just say, on the PFI, what I think would be a really good idea for us to have a separate discussion about all the detail of that. Because the reason I'm saying that is, there's a lot of people with their hands up, one gentleman's just left because he had his hand up for a long time. And I actually think that [voices overlap 1:43:08]. But what I'm saying to you is let's arrange…


Stephen Eames:Let's arrange to have that conversation with you about the PFI. I do think it's very important that the people who are wanting to speak are allowed to speak.

John Buck:Absolutely. Can I…there's a man there who's had the microphone in his hand for ten minutes and has been very keen to speak.

38

M11:Yeah, I mean, I'd just like to make the point, you're saying that this has got nothing to do with the PFI scheme. But I think, you know…and you're saying it's not about saving money. What I'd like to ask the panel is, are you seriously leading us to believe that we'd be actually here if the NHS Trust wasn't in so much debt? Because I think actually, we are in so much debt or the Trust are in so much debt, and I think we wouldn't be having this meeting if it wasn't for that fact.

Chris Dowse:Okay. Can I invite David to respond to that?


Dr David Kelly:Well, we had people saying you hadn't heard from me, and now you're saying you don't want to hear from me. But I'm quite happy to do it either way. But I want to actually listen to you, and hopefully you want to listen to us. In terms of the response I would like to give to that is, yes, I do believe - and I think I alluded to that in my presentation - that actually these changes are needed for clinical reasons. There are workforce issues, there are national drives towards specialisations, national requirements. And all of these would need to be looked at regardless of the financial position of the Trust.

I am not saying that finances are not part of this equation, they are. And I think we're all saying that. I think what we're saying is though, primarily what we're talking about is this being about clinical change; about improvements in quality; about improvements in experience for our patients locally. And that actually produces a financial benefit which helps to solve the situation.

We have to look at finances. I, as a Chair of an organisation, are statutorily responsible to making sure we balance the books locally. There isn't an ever-ending pot in the NHS, and we have to look as finances as part of the deal. But I wouldn't be here standing up for this if it was about finances. If it was about a deterioration in quality of services for my patients locally, I would walk away from this CCG, I would not be standing here saying that. So I hope you trust a new organisation and a new group of GPs and members to actually act on behalf of you, because we are here acting for behalf of the patients.

M8:I'd just like to come back on that, if I could please.

John Buck:Can I just say, we only have ten minutes left.

M8:Can I just come back on a quick point on there, please?


John Buck:

39

Sir, can I please ask you not to interrupt. There is a man here with a microphone waiting to ask a question. Please carry on.

M8:Can I just expand on that point, please? You're saying that it makes more clinical sense for the proposals that you're making tonight that things should move to Pinderfields; you're saying the downgrade of A&E, yeah? Surely it would make more clinical sense if we expanded services to Dewsbury. But you can't do that because we are in so much debt.

[Applause]

And I think we've got an empty hospital and we need more support for the Dewsbury area.

Dr David Kelly:I think I tried to cover some of that in my presentation. Actually, what we're talking about is actually improving the services for patients locally in Dewsbury. Many of my...

US:[Inaudible - microphone inaccessible 1:46:31].

Dr David KellyIf you could let me finish. Many of my patients complain to me about having to travel to Pinderfields for their outpatient appointments. Many of my patients complain to me about having to travel to Pinderfields or Pontefract for operations. What we're saying is, they won't need to travel, they'll have that service locally. And indeed, the service will be available not only locally at the hospital but actually in the local GP practice for many things. Much of healthcare is not actually hospital based, it's actually based out in primary care and secondary care. And a lot of these changes are about improvements in primary and community services, not just about the secondary care activity. The majority of A&E attendances will still happen locally at Dewsbury.

John Buck:David, thank you very much. There's a lady in the fifth row there who's been waiting very patiently with her hand up for a very long time.

[Voices overlap 1:47:22 - 1:47:30].

F8:Can I just ask a question please about the children's ward? I know that you're going to have a children's assessment and that's going to be open from 8.00 am to 8.00 pm. What about the children like open access, like my child, he's got open access to children's ward. I can ring in, I can be there in ten minutes. If I have to get to Pinderfields, it's going to take me 40 minutes, he'll be dead by the time I get there.

[Applause]

It's not a question about calling an ambulance. The ambulance services are already stretched.

John Buck:Thanks very much for that question. It's an important question and it will be answered.

40

Karen Stone:Thank you for raising that. We are going to have that children's assessment unit. If you have a child…we give children who have complex conditions open access to our services across the Trust, so their parents and carers can phone us at any time of the day or night for advice and get quick access to our care, if they need it.


Karen Stone:I'd like to answer the question please. I do appreciate that you've got a lot of concerns, and I don't know your child personally so I can't answer you personally. But what we intend to do is to still have that access to specialist advice on the end of the phone, like we do now; that we will help you and help other people with children in the same circumstances to access the right healthcare, at the right time. We hope to keep your children weller with more community support, so you wouldn't need to come into the hospital. But where you do need to come into the hospital, as colleagues have already said, the ambulance service is there to transport sick patients. And they can start some treatment on the way in, and we can give them advice as well. So we would not be…


Karen Stone:Well, I'm trying to as much as I can. I can't answer you personally because I don't know your child's details. I'm happy to discuss that with you personally afterwards. But what we do want to do is to make sure that our children get to see specialists very quickly. And we can have better specialist care for children by concentrating our overnight stays into one unit, and providing the assessment unit at Dewsbury.


Karen Stone:I'm sorry you don't think it's been answered. And I have said to the lady I will quite happily talk about her child with her, but I would need more information to help her understand what we're doing, I think.

John Buck:Thanks very much. I'm conscious we have very little time left. There's a lady in the second row there who's been waiting a long time, and a man in the sixth or seventh row who has been waiting a long time.

[Voices overlap 1:49:57 - 1:50:00]

John Buck:I'll come back to you in a second, sir.

F9:

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Right. I'm not used to public speaking, so if I stutter, please go along with me. According to Kirklees, using the 2011 Census, Wakefield had 140,414 homes. Kirklees has 173,414 homes. North Kirklees is going to build another 30,000 homes. Why on earth are we putting all our efforts and resources into Pinderfields?

[Applause]

Earlier, we've got Dr Kelly use the figure of Doris. I would like to use my figure, and I am Linda. When I was younger, I was pregnant. I was a low risk pregnancy. I was in hospital, no problems. At 6.15 there was a problem, I needed a caesarean. By 6.30 I was delivered of a child. If that had happened as a low risk person in Dewsbury, where would I or my child have been? In this area, we have a high rate of Pakistani, Asian people, some of whom have got more problems, health-wise, than other people in our area. Those people have a right, just as anyone else has a right, to care in our community. They have a right to having a hospital…

[Applause]

…to having A&E; to being able to walk in there and say I have a problem, my child has a problem. Who wants to take a child on the bus to Pinderfields? Who wants, when you've got a child in school, to try and visit your child in Pinderfields, then get home, get to school to pick up your child at 3.30? You are not looking at the long term effects, you're looking at short termism.

[Applause]

You're not looking at the long term population increase in North Kirklees, where it is driving to. You need to be able to look at Kirklees, what we need; what the people here need; all the people here. We have 20%...we have, what, 90,000 people who are over 60. You need to look at their needs. We've got 20% of the population who are under five. You need to be looking at these things. These are the people who are going to be desperate in need. And you need to look at all the people who don't want to travel for hours and hours. You want to look at people who are going to need ambulance services, and not ambulance services. If you've got an aneurism, I'm sorry, you've bled out by the time you get to Pinderfields.

John Buck:Can I ask Chris, who are you going to respond to that?

Chris Dowse:Okay, I'll just…I'll deal with it in two ways. I want to talk to you about the planning, first of all, and how we do that. And then I'll ask one of my colleagues here, either Kath or Anne about what might be different around birth in the future. Okay.

In terms of planning, how we do planning, we take account of what we believe will be the changes in our population over time. And we do that in partnership with our local authority, Kirklees Council. And we do it with our public health colleagues, who do something called a joint strategic needs assessment; we call it a JSNA for short. But essentially, it's an ongoing process where we track and look at changes in population, the demographics, the aging population, the health needs, children, attainment in school; all of

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that. It all gets piled into that assessment and it helps us to look at what the now, the medium and the long term needs are of our population. And in doing that…


Chris Dowse:Yeah. And we know that. As we're doing our planning, we take it into account.

John Buck:Excuse me, can we…

[Voices overlap 1:54:18 - 1:54:20]

John Buck:Can we please allow Chris to respond to the question.

Chris Dowse:Okay. And we know that, we take into account in our planning. So we know it already. And the second point I want to make is, don't forget that most people access primary care, not secondary care services, when they need health services. So that's the focus for us, in addition to the changes in our acute services in Mid Yorkshire Trust and what we're doing in the community. It's about how much primary care, how many GPs do we need as the population starts to increase and their health needs change. So it's a very complicated planning process and we are…you know, there's a particular methodology we use, and we do it with partners and with the council. So it's all in there. Okay, that's the first point. I want to hand over…

US:[Inaudible - microphone inaccessible 1:55:12 - 1:55:18] you don't build a hospital where there is not as great a need. You build a hospital where there is need.

[Applause]

Stephen Eames:Yes, absolutely. Can I just say before I…Kath Fishwick, who's our expert obstetrician, will talk a little bit about maternity in a second. But can I just say, I really empathise with what you're saying about access and need locally. And what it says to me, which, with the feedback we're getting this evening is, we've still got to work quite hard to explain what we're doing. Because actually, what we're doing - and it was set out in the presentation - [voices overlap 1:55:53] is exactly that. Most of…


Stephen Eames:Would you let me please…

John Buck:Can we…we have very little time left, and I think that time's going to disappear if there are interruptions.

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Stephen Eames:If you're generally interested in these proposals, then you will listen, as we have listened to you. Because otherwise, it's not a fair exchange. But let me just come back to this [voices overlap 1:56:19] can we just come back to this lady's point? Because I think what you said is one of the most important things that have been said this evening, about the nature and the issues for this local community.

What I'm saying is, we have to get across some of the things that we say we are doing better than we have done tonight, because much of what we're saying is about dealing with those problems. Older people don't need to be in hospital. They default into hospital at the moment because we haven't got some of the services we're planning to put in place. The same for children. 3,000 children will still be treated in Dewsbury, you know, most of them are going to be still treated locally, either in their home or in the community, or at the hospital. 70% of people who attend our emergency services will still get those services in Dewsbury. That's not a closing hospital, that's a vibrant local hospital working much more closely with primary and community care, and social care. So clearly, we haven't got that message across, but what you said, and I hope we've recorded it, is at the heart of what we're trying to do.

I do think Kath should say something about what you said to start with about maternity services, so we can explain some of the background to that.

US:[Inaudible - microphone inaccessible1:47:27 - 1:57:32].

John Buck:He's going to speak next, but I think these are important points and I'd like Kath to respond to the particular one on maternity care.

Kathryn Fishwick:Hello. Can I just answer the lady? I'm an obstetrician and I'm a Dewsbury consultant. I was…


Kathryn Fishwick:Sorry. Hello, can you hear me now?

US:Yeah.

Kathryn Fishwick:I'm a Dewsbury consultant. I was appointed 15 years ago and I've only ever worked in Dewsbury. So I'm a local person to you. I'm from Lancashire initially but now in Yorkshire, obviously. And actually, what you were saying is actually very important, because - and I can only answer from the maternity point of view, I can't answer for children or elderly people, because I'm an obstetrician. But obstetrics - and I have my head of midwifery and a colleague next to me - obstetrics is one of the areas that we really would like to do this, and wanted to do this before the PFI was even built. And that's because across the

44

country, obstetric services are better if they are pooled. And that's because we know that for those women who are not low risk, those women who have either babies with potential problems or mothers with potential problems, it's much better if there is 24/7 consultant care.

To provide 24/7 consultant care, we need at least 18 full time obstetricians. It's incredibly difficult to do that on three different sites. To provide that level of obstetric care, we need to pool our resources on one site. We've wanted to do this for a long time.

So for obstetrics, this is nothing to do with the finances. If we were the most cash flushed Trust in the country, we would still, as a group of obstetricians and midwives, want to do this because we know it's the best care.

US:So why isn't it in Dewsbury then [inaudible 1:59:25]?

John Buck:Well, we really are…

Kathryn Fishwick:Well, that's not for me as an obstetrician. As an obstetrician, it is about putting together the resources to provide the best obstetric care. Now clearly, if you have a pregnancy which is deemed to be low risk all the way through, and you were…


Kathryn Fishwick:Well, that is what antenatal care is all about. Every assessment, every visit is an assessment of care. Those women who can visit [voices overlap 1:59:54] well, yes, because you wanted me to talk. Those women who are able to deliver in a midwife unit are women who could effectively have a home birth. I think you said that you were in the hospital at the time, therefore you would not be in that…you would be in a unit where you could be an inpatient.

US:[Inaudible - microphone inaccessible 2:00:30].

Kathryn Fishwick: No, currently we're not. We are a lower risk unit only because of the neonatal beds. But we still take…we currently take high risk…


John Buck:I'm afraid we're running out of time here, Kath. If you could perhaps…if the lady wants to pursue this with you afterwards, that would be best.

Kathryn Fishwick:Yeah, I'm more than happy to have a chat with you separately.

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John Buck:We're already running out of time here, but I'm conscious of the gentleman who is standing, has been standing for a very long time. His will be, I'm afraid, the last question.

[Voices overlap 2:00:58 - 2:01:06].

M9:Thank you, Mr Chairman. I am a ward councillor in Batley and I represent around 12,000 adults, their families and their children.


M9:Now I'm very disappointed that the consultation, the way I see - and I'm being very, very fair, I'll give you the benefit of the doubt - is flawed. Not least because you can't answer the questions. Not least because you don't know who's going to answer what question and where the answers are going to come from. And I think you need to get your act in order first, before you start [inaudible 2:01:44] us. Because it seems very disjointed. Who do I talk to? Do I go to the CCG? Do I go to the PCT? Do I go to the PCT…after it's abolished, do I go to Mid Yorkshire? You know, if I don't know who to go to, how the hell are these people going to know where to go to and who to raise their voices to? That's point number one.

[Applause]

Point number two. I'm not convinced that the [gutting 2:02:11] of Dewsbury is purely led based on patient outcomes. You have not convinced me. I have seen no evidence and I have seen no evidence to see how that the concerns that are raised in this room are being addressed. They've just been washed away, not really taken seriously.

John Buck:Can I…

M9:Let me finish.

John Buck:Could you be very quick, because we are running out of time. We are running out of time.

M9:Very important. This is a very serious issue. The issue around growth in our local community. We are going through a process of developing the next plan in terms of where the houses are going to be built. And Batley and Dewsbury is going to be a major conurbation of growth. The lady mentioned it, and you're not taking that into consideration. I fear, in ten, 15 years' time, I will come back here and we'll have [inaudible 2:02:56] number two. Because if the dispersion is going to put more pressure on Wakefield and Pinderfields, then you are going to have deaths. I'm sorry to say that. You have to make sure that the dispersion takes account of the pressures that are going to happen all across Mid Yorkshire. We're not an affluent borough, we're not rich, we're very deprived. Our

46

health is really bad. We need to bring services more locally, and you're not doing a good job. You need to go back to the drawing board and think how you're going to encourage the communities to come forward and make sure that you actually get it right. And you're not doing a very good job. Thank you.

[Applause]

John Buck:Sir, thank you very much. I'm afraid that's the last question this evening. There'll be an opportunity for the specialists to respond to that. I'm conscious there are people who have been waiting to ask a question who haven't been able to. I think…could I suggest that if you do have a question, you put it into the box at the back of the hall and somebody will respond to you. Chris?


John Buck:Can I ask Chris to respond to the question?

Chris Dowse:Yeah, okay. I want to respond to my colleague, the elected member here. You'll recall that we've had several meetings with you about the proposals. We want to work with you around all the changes that are happening around North Kirklees, so that we can take them into account. And that's what we are doing. And so the comments you make are great. And thank you, we're taking those away.

In relation to the detail behind all the proposals, I just want to confirm that these are proposals, they are not done deals. They are a set of proposals that we want you to look at. And then, you know, over time we will work with our colleagues to develop more detail behind them. There is evidence for the things that are on the table, and that evidence is set out in the more detailed consultation document, which I will make sure is on our website, Meeting the Challenge, tomorrow. Okay.

Stephen, did you want to add something?

Stephen Eames:Well, just finally, because we've had some conversation and obviously met with all the councillors in Kirklees recently, to talk about these challenges. I'm sorry if it feels disjointed, but obviously a lot of the issues that have been raised actually haven't been about the consultation, they've been about other issues that we've tried to respond to. And obviously, we want to do that, to try and dispel some of the concerns that people have. It isn't about the PFI, it's not primarily about the money. Me and my colleagues here can't do anything about what's happened in the past, we're talking about trying to create top quality services for the future. So, I mean, I think, you know, it's a fair point you raise in the context of the way this meeting has gone.

On your colleague's point there about the analysis. There's absolutely a huge amount of analysis. And when we've done lots of public meetings with analysis, people have said, we don't that. So, I mean, I think what we should hear from you is, you want more analysis. We can give you that, we've got that. Take the issues around population. As

47

Chris was saying, we know…I mean, you talk about growth in Dewsbury, and I think you did say actually there's growth, isn't there, across Mid Yorkshire, it's variable from one area to another. So when we're in Wakefield tomorrow, we'll be talking about the same issue there.

Of course, we've taken into account in our planning looking forward five years what the population growth is. We can show you all that data. And I think, you know, if you want to see it, let's just pick that up at the end of the meeting, and we can share it, we'll try and get it out there.

But we were honestly trying to respond here to what people have told us over something like 40 public meetings between last April and now. So thanks for the feedback about how this has gone. I think they're important points.

But the point I want to finish on is, this is about saving lives; high quality services locally; pride in local hospitals; and trying to make sure we provide as much care as we can closer to people's homes.

[Voices overlap 2:07:15].

John Buck:Stephen, thank you very much. I'm afraid I do have to bring the meeting to a close. I'm conscious that this is an issue which raises a lot of passions, but there are three months of consultation and there will be other opportunities to make your views known. Thank you very much for coming.

End of recording

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Transcription of Public Inquiry Regarding: Web viewThey moved me then from there to ward nine, which were a [swear word] disgrace. And then they moved me then ... It was built on a