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‘Right Care, Right Time, Right Place’
Report of Findings - Engagement Phase
April – July 2014
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Contents
Page
1. Purpose of the report
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2. Background
2.1: The case for change
2.2: The Providers’ response
2.3: NHS Calderdale and Greater Huddersfield Clinical
Commissioning Group (CCG) Commissioning
Intentions – the commissioners’ response
2.3.1: NHS Calderdale CCG – five year strategic plan
2.3.2: NHS Greater Huddersfield – two year operational
plan and five year strategy
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4
5
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3. Legislation
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4. Principles of Engagement
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5. Methodology
5.1: How did we deliver the engagement plan?
5.2: What did we do to deliver the engagement plan?
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9
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6. Findings from the engagement process
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7. Findings from the Providers’ engagement process
7.1: Findings from the SOC survey
7.2: Findings from the wider stakeholder meetings and
events
7.3: Other findings
7.3.1: Staff engagement
7.3.2: Stakeholder event: locality and community services
key messages
7.3.3: Stakeholder event: specialist hospitals key messages
7.3.4: Stakeholder event: self-managed care key messages
7.3.4: Stakeholder event: emergency and urgent care key
messages
7.3.6: Letter from Barry Sheerman
7.4: Equality findings
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8. Findings from the Commissioners’ engagement process
8.1: Findings
8.2: Findings from the community assets
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6
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8.2.1: Responses from Mixenden, Illingworth and Ovenden
area in Calderdale
8.2.2: Cornhome and Walsden residents, Calderdale
8.2.3: Calderdale Basement project
8.3: Findings from Greater Huddersfield CCG ‘Care
Closer to Home’
8.4: Equality monitoring
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9. Equality and Diversity
9.1: Equality recommendations
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10. Overall findings and common themes
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11. How the findings will be used to inform our plans
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Appendices
Appendix 1: CCG, Communication and Engagement Strategy
Appendix 2: Provider, Communication and Engagement
Strategy
Appendix 3: Joint engagement Plan
Appendix 4: Providers engagement document – SOC
summary
Appendix 5: Providers engagement document – SOC easy
read version
Appendix 6: CCG engagement document – 5 year plans
Appendix 7: CCG engagement document – easy read versions
Appendix 8: Comments cards
Appendix 9: Providers stakeholder engagement
Appendix 10: Letter from Barry Sheerman
Appendix 11: Equality Monitoring from SOC respondents
Appendix 12: Cornholme and Portsmouth Old Library focus
group
Appendix 13: Equality Monitoring from Commissioning Strategy
respondents
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76
89
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1. Purpose of the Report
The purpose of this report is to present the findings from the recent engagement activity for
‘Right Care, Right Time, Right Place’. This report describes both the Providers’ and
Commissioners’ response to the case for change and the engagement process we followed
to gather public, staff and stakeholder views. The engagement was delivered through a
‘Communication, Engagement and Equality Strategy’ and action plan, these plans were
written to describe the process required for each of the engagement processes; this
included one for the Providers and Commissioners (see appendix 1 and 2). The report
provides feedback on:
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The engagement process delivered, including methods and approaches and the
target audience reached
Findings from the Providers’ engagement activity
Findings from the Commissioners’ engagement activity
Specific findings relating to equality, and
Overall findings and key themes
The background to the engagement activity and the ‘Case for Change’, is described to set
the context. This includes a brief introduction to the Providers’ response to ‘Right Care,
Right Time, Right Place’ and Calderdale and Greater Huddersfield commissioning
intentions. The report also sets out the legal obligations for engagement and the principles
by which the Commissioners’ want to engage, which forms part of their organisational
strategy.
2. Background
2.1
The Case for Change (Right Care, Right Time, Right Place)
The case for change sets out the way we deliver health and social care services and the
need to change if we are to make sure we can meet current and future needs. Huge
advances in medicine have changed the way we treat illness and injury; we have a growing
and an ageing population; our illnesses are different and people’s expectations of health
care are growing. We know people want care closer to, or at, home and a choice about
how, when and where they’re treated.
The cost of health and social care across Calderdale and Huddersfield is now more than
£600 million a year. Growing demand, price inflation and the costs of new drugs and
treatments mean we need to look at how we spend budgets to get maximum benefit for
everyone. We need to ask some serious questions;
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Can we do things differently but maintain high quality services?
Can we keep people out of hospital for everything but the most serious illness by
improving the way we care for them at home?
All seven organisations involved in health and social care in Calderdale and Huddersfield
are working together on the ‘Right Care, Right Time, Right Place’:
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2.2
Calderdale and Huddersfield NHS Foundation Trust (CHFT)
NHS Calderdale Clinical Commissioning Group (CCCG)
Calderdale Council
NHS Greater Huddersfield Clinical Commissioning Group (GHCCG)
Kirklees Council
Locala Community Partnerships
South West Yorkshire Partnership Foundation Trust (SWYPT)
The Providers’ response to ‘Right Care, Right Time, Right Place’
A Strategic Outline Case (SOC), prepared by three providers: Calderdale and Huddersfield
Foundation Trust, Locala Community Partnerships and South West Yorkshire Partnership
NHS Foundation Trust (SWYPFT) set out a response to ‘Right Care, Right Time, Right
Place’ which included a review by the National Clinical Advisory Team (NCAT) in spring
2013.
The Providers’ response describes a new model for the provision of hospital and community
services across Calderdale and Greater Huddersfield. Under this model, the three
providers would work together and closely with general practice, social care and voluntary
organisations to deliver integrated care and support services in the community. This would
include including moving current hospital-based services closer to where people live.
The response states that: integrated community services would work seamlessly with acute
and emergency services based on one specialist hospital site and with planned and elective
care on a second specialist planned care hospital site. It also identified significant benefits
to patients, services users, local people and service providers and commissioners.
However, it is important to note that a decision will not be made about significant changes to
the future of services in Calderdale and Greater Huddersfield without a period of formal
consultation. Any decision of this significance will be made by the Commissioners’ and not
by the Providers’.
2.3
NHS Calderdale and Greater Huddersfield CCGs Commissioning Intentions –
the Commissioners’ response
Calderdale and Greater Huddersfield Clinical Commissioning Groups (CCG’s) are
responsible for commissioning a range of services in Calderdale and Greater Huddersfield.
The CCG’s need to ensure their commissioning intentions meet the needs of the local
community to deliver these intentions, each CCG has a five year strategy based on what
they already know about the community and the health needs in the area.
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2.3.1 NHS Calderdale CCG – five year strategic plan
NHS Calderdale CCG set out a five year ambition which includes a vision for the future.
This vision is the Commissioners’ contribution to the delivery of change as a partner for
‘Right Care, Right Time, Right place’. The plan builds on the organisational aims,
intelligence gathered from previous engagement and patient experience activity and clinical
insights. The aim is to ensure changes needed to deliver the outcomes for local people are
safe and of high quality.
The focus over the next five years is to continue the shift of services and resources from
unplanned hospital care to integrated health and social care - delivered in community and
primary care settings. In addition a number of improvement programmes will drive delivery
over the next three to five years. These programmes are:
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Cardiovascular
Diabetes
Respiratory
Alcohol conditions
Musculoskeletal
Cancer & tumours
Mental health
Strategic Review
Better Care Fund
Each programme is described in more detail in the strategy and the aim is to ensure any
plans reflect the needs of the local community.
2.3.2 NHS Greater Huddersfield CCG – two year operational plan and five year
strategic plan
Greater Huddersfield CCG has developed a two year operational plan and a five year
strategic plan. The vision for the larger health and social care system in the next five years
has been developed in partnership with North Kirklees CCG and Kirklees Council. The
geographical footprint has been important when bringing together the partners to develop
proposals for transformational change. The two year strategic plan is based on the
contribution to ‘Right Care, Right Time, Right Place’.
Greater Huddersfield Clinical Commissioning Group’s operational plan sets out a unique
and innovative vision of health and social care service delivery for the next two years in the
area. The focus of this change programme is to continue the shift of services and resources
from unplanned hospital care to integrated health and social care - delivered in community
and primary care settings. The outcomes delivered by these aspirations can be
characterised into a number of themes:
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Increasing opportunities for self-care, especially for people with long term conditions
Making best use of technology and innovation
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Optimising delivery in primary and community care by providing secondary care
services or hospital services, in the community and thinking about innovative ways of
doing this
Optimising delivery in secondary care
Building community capacity to deliver better health and wellbeing
As a result of this, local people can expect:
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Services delivered as close to home as possible
Improved health and wellbeing
Opportunities to have a say in the design of health and social care provision
Accessible, non-discriminatory service provision
Integrated services
Services that maximise dignity and respect for vulnerable groups
The plan sets out the pathway for the organisation to navigate a course through external
change and uncertainty towards stable, responsive and sustainable health and social care
services for Greater Huddersfield now and in the future.
3.
Legislation
Health and Social Care Act 2012
The Health and Social Care Act 2012 makes provision for Clinical Commissioning Groups
(CCGs) to establish appropriate collaborative arrangements with other CCGs, local
authorities and other partners. It also places a specific duty on CCGs to ensure health
services are provided in a way which promotes the NHS Constitution – and to promote
awareness of the NHS Constitution.
Specifically, CCGs must involve and consult patients and the public:
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In their planning of commissioning arrangements
In the development and consideration of proposals for changes in the commissioning
arrangements where the implementation of the proposals would have an impact on
the manner in which the services are delivered to the individuals or the range of
health services available to them, and
In decisions affecting the operation of the commissioning arrangements where the
implementation of the decisions would (if made) have such an impact
The Act also updates section 244 of the consolidated NHS Act 2006 which requires NHS
organisations to consult relevant Overview and Scrutiny Committees (OSCs) on any
proposals for a substantial development of the health service in the area of the local
authority, or a substantial variation in the provision of services.
The Equality Act 2010
The Equality Act 2010 unifies and extends previous equality legislation. Nine characteristics
are protected by the Act, age, disability, gender reassignment, marriage and civil
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partnership, pregnancy and maternity, race, religion and belief, sex and sexual orientation.
Section 149 of the Equality Act 2010 states all public authorities must have due regard to
the need to a) eliminate discrimination, harassment and victimisation, b) advance ‘equality
of opportunity’, and c) foster good relations. All public authorities have this duty so the
partners will need to be assured that “due regard” has been paid.
The NHS Constitution
The NHS Constitution came into force in January 2010 following the Health Act 2009. The
constitution places a statutory duty on NHS bodies and explains a number of patient rights
which are a legal entitlement protected by law. One of these rights is the right to be
involved directly or through representatives:
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

4.
In the planning of healthcare services
The development and consideration of proposals for changes in the way those
services are provided
In the decisions to be made affecting the operation of those services
Principles for Engagement
NHS Calderdale and NHS Greater Huddersfield CCG both have ‘Patient and Public
Engagement and Experience Strategies’. These strategies have been developed alongside
key stakeholders. The strategies set out an approach to engagement which describes what
the public can expect from any engagement activity. The principles in both strategies state
that the CCG will;
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Ensure that the CCG engage with public, patients and carers early enough
throughout any process
Be inclusive in all engagement activity and consider the needs of the local population
Ensure engagement is based on the right information and good communication so
people feel fully informed
Ensure that the CCG are transparent in their dealings with the public and discuss
things openly and honestly
Provide a platform for people to influence thinking and challenge decisions
Ensure any engagement activity is proportionate to the issue and that feedback is
provided to those who have been involved in that activity
The strategy sets out what the public can reasonably expect the CCG to do as part of any
engagement activity and the process required to preserve these principles to ensure public
expectations are met.
5.
Methodology
Both the Providers and Commissioners undertook engagement activity to identify if the SOC
and the five year strategies were capable of delivering service improvements and meeting
the needs of the local population now and into the future by gathering public, staff and
stakeholder views.
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The process involved two conversations taking place simultaneously, one on the Providers’
response and one on the Commissioners’ response. The Commissioners’ responsibility is
to ensure they commission services from providers that will ensure the health and wellbeing of the local population of Calderdale. The Providers are commissioned to provide
services that support that vision.
The engagement activity for both the Providers’ and Commissioners’ was supported by a
joint delivery plan (see appendix 3) which was delivered during an eight to 12 week period.
The Providers commenced engagement prior to Commissioners’ and the process involved a
number of planned engagement activities aimed at a variety of target audiences. The
process followed is described in diagram one.
Diagram One
Case For Change
Providers’ Strategic Outline
Case
Commissioning
Intentions
Existing
Mechanisms
Drop in Sessions
Asset Based
Approach
Stakeholder Events
Development of Joint Report of findings
Stakeholder Event
Commissioners’ Service Change
Proposals
5.1
How did we deliver the engagement plan?
The purpose of all the engagement activity was to capture the views of local people with a
specific focus on key stakeholders. Both the Providers’ and Commissioners’ engagement
required different activities but both were brought together at 10 drop in sessions which took
place in eight locations in Calderdale and Greater Huddersfield. The methods of
engagement used were supported by a number of documents:
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
A summary (see appendix 4) and easy read version (see appendix 5) of the SOC
which contained a feedback and equality monitoring from
A summary (see appendix 6) and easy read version (see appendix 7) of the
commissioning intentions for each CCG and a feedback and equality monitoring form
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
Comments cards used in both drop in sessions and as part of the asset based
approach (see appendix 8)
The methods of engagement set out in the diagram are described below in more detail,
which describe what we did.
5.2
What did we do to deliver the engagement plan?
Existing Mechanisms:

Calderdale and Greater Huddersfield CCG both have a ‘relationship matrix’ which
enables the CCG to engage with a number of key organisations. The matrix is a list
of voluntary and community organisations which are willing to work with us to engage
their clients and staff. These organisations are mapped by the target audience they
reach and the protected characteristics they cover.

Calderdale CCG also work closely with the third sector and have invested in ‘health
connections’ a third sector hub which ensures they can engage with third sector
colleagues providing support to health. Greater Huddersfield CCG work closely with
third sector leaders and local authority colleagues to target specific communities.

Third sector organisations were targeted using ‘North Bank Forum’ which has a
regular e-newsletter and Voluntary Action Kirklees (VAK).

Close working relationship with staff and member practices, including patient
reference groups and work with the Calderdale Health Forum and Greater
Huddersfield Patient Network have been utilised.

Membership of the three provider organisations and the Right Care, Right Time,
Right Place reference group were engaged through electronic or postal surveys.
Drop in sessions:
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10 Drop in sessions were set up in 8 locations across Calderdale and Greater
Huddersfield to ensure all members of the community had an opportunity to have
their say. Each session was delivered on a different day to give as many people as
possible the chance to attend. The drop-in sessions provided a platform for the public
to talk about commissioning intentions, the provider response and ‘Right Care, Right
Time, Right place’. The sessions were delivered between 2pm-7pm.
Comments cards – These were available at the drop-in sessions and in other service
areas for people to write down any comments, issues or concerns they may have.
Asset Based Approach:

Calderdale CCG use an ‘asset based approach’ to engaging with the local
population, this means they train and fund local groups to talk to the public on their
behalf using the methods and approaches appropriate to that community. The CCG
work with over 40 groups in varying localities representing some of the most seldom
heard residents in our area.
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
A similar approach took place in Greater Huddersfield utilising community
development workers from Kirklees Council to have conversations at a community
level with existing groups and organisations who already have a good working
relationship with staff in the area.
Provider Stakeholder Events:

A number of stakeholder meetings and events were arranged by the Provider
organisations to gather views. These activities took place over a number of weeks
and included conversations with the voluntary and community sector.
To ensure the views gathered were a representative sample all engagement activity was
equality monitored. This will help the engagement team further understand if we have
reached protected groups who may have different experiences of health and social care
services.
In addition to the engagement activity there was a number of other mechanisms operating in
order to gather views, these are below:

Dedicated website which contained information on how to contact the programme
management office and also opportunities to post comments. This includes the use
of social media such as Twitter.
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PALS and complaints service who were asked to capture public views as part of their
customer facing role.
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Close working relationship with Healthwatch colleagues to ensure we listen to
people’s views through consumer champions.

Existing consumer websites were reviewed including those attached to the local
media, patient opinion and NHS Choices to gather feedback.
A variety of communication channels were used to disseminate information and provide
opportunities for patients and the public to give their views. The methods below were
supported by the communication leads for each organisation and centrally managed by the
Programme Management Office. All communications have been centrally logged.
Target Audience
Service users, general
public, third sector
OSC/Health and Wellbeing
boards
Staff
Delivery Method

Partners’ intranets, websites and social media
platforms
 Relationship matrix
 Patient reference groups
 Third sector umbrella organisations.
 Patient groups and Carers groups
Meetings/ briefings
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Internal bulletins
Staff Intranets
Cascades at meetings through managers.
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Healthwatch
Elected members /
Councillors
Media
6.
Email and personal discussions
Newsletter articles
Information to be circulated electronically – explanatory
email with a link to web survey
Proactive media releases
Social media
Findings from the engagement process
The engagement process took place between April and July 2014. These were a number of
activities taking place throughout this period and the responses we received are as follows:
Method
Drop in Sessions
Calderdale and Greater Huddersfield
Asset based approach Calderdale
Contact / attendance
202+ attendees
Asset based approach
Greater Huddersfield
Existing networks Calderdale and
Greater Huddersfield: postal, email,
social media
Stakeholder activities Calderdale and
Greater Huddersfield
477 contacts
1,263 contacts
18,000+ contacts
20,500 contacts
Responses received
153 responses
received
1,244 responses
received
57 responses
received
215 responses
received
806 + responses
received ( not all
numbers recorded)
(Figures including + mean we did not always count the numbers attending therefore the target
audience was greater than the numbers recorded)
In total we received 2,475 responses with the majority of these responses 85% on the
Strategic Outline Case (SOC) and the remaining 15% on the CCGs commissioning
intentions. 1,306 equality monitoring forms were completed (this comprises; 1091 from the
SOC engagement, 126 from the 5 Year Strategy engagement and 89 form the drop in
sessions) and from these we know +we received the majority of our responses from
residents in Calderdale who provided 51% of the total responses, Greater Huddersfield 3%
and 46% where there was no postcode provided. It is worth noting however that this does
not take into account the remaining 891 responses where some may have come from
residents in the Greater Huddersfield area.
As well as our planned engagement activities a number of meetings were held with key
stakeholders. These contacts have not been counted in the contact or response figures in
the table above. However, feedback from these organisations can be found in the findings
for both the CCGs and Providers’. The meetings attended by both the Providers’ and the
CCG are tabled below:
Target Audience:
Meetings attended
Overview and Scrutiny Committee –
Calderdale
Overview and Scrutiny Committee – Kirklees
Monthly
Monthly
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Health and Well Being Boards - Calderdale
Health and Well Being Boards - Kirklees
Local councillors and MPs - Calderdale
Local councillors and MPs - Kirklees
Local Medical Committee
GPs
Healthwatch - Calderdale
Healthwatch - Kirklees
Yorkshire Ambulance Service
Community Pharmacy
Local Care Direct
Unions
Voluntary and Community Sector
Monthly
Monthly
Regular briefings and information
exchange
Regular briefings and information
exchange
26.03.14, 30.04.14 and 28.05.14
01.04.14, 03.04.14 and 03.06.14
01.04.14, 07.04.14 and 15.05.14
19.03.14
03.04.14
15.04.14
20.06.14
27.02.14
10.04.14, 27.05.14 and 28.05.14
We have evaluated the process we followed to deliver the engagement on both the
Providers SOC and the CCG commissioning intentions using the feedback we received
from community assets, members of the public and the drop in sessions. The key learning
points are:

People found the SOC and commissioning intentions information too much, it was a
lot to take in and people found it complicated to understand. There was a lot to
consider and people did not know how to provide feedback resulting in a lower
response rate in some areas.

People in Greater Huddersfield were harder to engage than those in Calderdale, this
can have been for a number of reasons including the perception that changes may
not affect people in that area.

The equality monitoring form was not attached to the commissioners’ engagement
questionnaire and therefore whilst many people completed it, it was not possible to
align the responses to the equality detail. This meant we were not able to comment
on views held by those with particular protected characteristics.

The evaluation from the drop in sessions found that from those completing the form
(77 in total), 47% stated the drop in was what they expected with only 8% stating it
wasn’t. Comments received were that the Information provided was vague and the
drop in could have been better set out and publicised and appeared to be poorly
attended. However the positive comments were that it gave people time to talk to
people at length and for some it exceeded their expectations and they found it
informative. There were suggestions that the drop in sessions should be more formal
and that we should go to community groups.
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7.
Findings from the Providers’ engagement process
The focus of the Providers’ engagement was to gather views on the ideas set out in the
SOC. The full SOC document was made public on the Right Care, Right Time, Right Place
website.
The content of the document was then developed into a summary format (see appendix 4)
and an easy read version (see appendix 5). The document was circulated to the community
assets in both Calderdale and Greater Huddersfield along with comments cards, at the drop
in sessions and via the website. In addition the providers hosted a number of conversations
to engage stakeholders (see appendix 9). The findings from the engagement process are
reported below. It is worth noting that not everyone replied to every question so 100% is
based on the total number responding to that question not 100% of the total responses
received.
7.1
Findings from the SOC survey
The providers asked: Q1. Do you think we have reflected the things people have already
told us?
Those responding told us:
From the 1,039 responses we received to this question 82% stated that they felt providers
had considered the things that they had already been told during previous engagement
exercises and other forms of feedback.
The 18% responding No have provided a response to their answer in the additional
questions highlighting some of their concerns or ideas. Those people who chose not to
respond may account for people who had not previously been engaged or people who have
not previously given their views.
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The providers asked: Q2.What do you think about the ideas described in this leaflet?
The feedback received was grouped into positive (green), negative (red) and neutral
comments (amber). The chart above shows that the majority of comments are neutral
with all the feedback we received falling into the following themes:
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Hospital services
Travel and transport
Care and services in the community
Delivering the model
Engagement process and information provided
The weighting of those responses as positive, negative or neutral against each theme are
highlighted below:
The table suggests that the majority of negative comments received relate to the providers
ideas about the hospital model with travel transport highlighted as an area that had not been
properly considered.
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Whilst the majority of people provided positive responses to looking at care in the
community and delivering the model people felt the information provided described the
ideas in a way they could understand and welcomed the opportunity to respond.
Those responding told us:
Hospital services:

Positive comments included: Some people liked the plans and the idea of a
specialist hospital with planned care on one site. People like the idea of cottage
hospitals and services closer to home.

Negative comments included: The majority of negative comments related directly
to the plans to create one A&E and the message came very clearly from the
population of Calderdale that they did not want to lose their A&E. People expressed
worry and concern if this happened.

Neutral comments included: People did not understand how it works now so felt
unable to comment fully, there were a number of comments about keeping things as
they are and that it currently works. There were a lot of people who stated they
needed more information on the A&E plans and wanted more detail, that language
like minor injuries needed describing and was confusing.
Care in the community:

Positive comments included: People welcomed the idea of more services in the
community and closer to home. There were comments that GP practices would be a
better option than going to A&E and there were some requests for more walk in
facilities.

Negative comments included: People felt that the plans were not diverse enough
and would suit only a sector of the population. Access issues for people who are
deaf, and those who have a first language that is not English requires addressing.
There were comments about current poor appointment systems and whether
community services could cope with demand. Care is not coordinated and there is
concern that older people may deteriorate through lack of support.

Neutral comments included: People wanted more services from the GP i.e. health
checks but there was concern that GPs were already busy. Appointment and waiting
times are a concern and need to be addressed; people would like more face to face
contact such as home calls. Streamlining and coordinating services better were
mentioned and more links to the third sector to support delivery.
Travel and transport:

Positive comments included: There were few positive comments on transport and
travel but those that were related to encouraging walking to appointments and
positive experience of the ambulance service.
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
Negative comments included: Too far to travel for those who are unwell and the
cost of travel were both common themes. Longer journey times are more stressful,
particularly for those visiting and for parents/carers. Car parking was also a big issue
and concerns about the dual carriageway and Ainley Top with a focus on peak travel
times and congestion which would increase journey times or slow down access to
services which could be serious. For those who can’t drive taxi journeys would be
expensive including the cost of travelling from rural areas.

Neutral comments included: People stated that current transport arrangements
needed to be improved such as the shuttle bus.
Delivering the model:

Positive comments included: The ideas were good and well thought through.
People commented that the model would make a difference and needed to be
implemented or put into action straight away. More joined up thinking and a solid
structure would help with delivery.

Negative comments included: People stated that the plans were about cuts not
spending more and that the plans would be a waste of money. There was a view
that plans had not been thought through properly and people wanted things left as
they are. There was no consideration for specific groups like BME or people living in
rural areas and some people felt that plans would just not work. A few stated the plan
to move/close A&E would cost lives and that services would not be able to manage
certain health conditions as effectively.

Neutral comments included: The majority of neutral comments were that the ideas
looked good on paper or in theory but would they work in practice. There were
comments that any changes should not be at the cost of quality and that more detail
was needed to help people understand how the model will work and that vulnerable
and diverse groups are considered. People wanted to know the cost of the changes
and how money would be spent in the future and for the commissioners and
providers to be honest and transparent about this. There was a general feeling that
the plans could be too ambitious, a comment that pharmacy services are not
mentioned and that prevention needed to be more of a focus.
Engagement process and information provided:

Positive comments included: The majority of comments received about the
information provided were positive. This included comments that the information was
good, clear, informative, and people were able to understand the content. There
were comments that the information helped people to understand the ideas for future
services and it was good to keep people informed. Some respondents felt solutions
were described and people stated there were lots of good ideas which were to the
point if not a lot to digest. The easy read version was described as easy to
understand and very useful.

Negative comments included: The negative comments referred to the information
being provided was a ‘smoke screen’, the ideas were a done deal and that the leaflet
17
was about convincing people of what will happen. In addition there were some
comments that the information was hard to understand, too complicated and too
much information for the average person to understand or to take in. There were a
few requests for future information to be available in Urdu. Calderdale residents felt
their views would be ignored and we needed to listen to the public more.

Neutral comments included: The neutral comments related to the information being
reasonable but not enough detail with more information needed to have an informed
view. Some people stated they did not know what to believe as there had been too
many conflicting messages and there were a number of comments with people
wanting to know what it meant for them. There was a request for more engagement
to help people understand this further.
Quotes:
‘I agree that you need to reorganise healthcare to reflect changing needs of the population but I
share the concerns of many that concentrating emergency care in HX or HD will make it much
harder to access particularly for those that do not have access to a car. I think there needs to be a
minimum level of A&E provision at both hospitals’.
‘I can see for and against for several options! I do not want to travel to hudds or Bradford for tests
which can be done in my local community and I want easy access to A&E. However it’s Catch 22
and will get very costly which has to be addressed wisely’.
‘The proposals are really good. I would like more diabetes services.’
‘I think moving A&E care from Halifax to Huddersfield is a bad idea, people from this area needing
a+e care could be at’
Community teams may have improved 24/7 reactive service but decentralised services can create
silos with breakdown
‘They don’t deal with how people can contact health and social services and I am deaf and don’t use
the telephone’.
‘I would be very concerned if the only emergency / A&E were in Huddersfield, I have a child with
asthma and getting to’
‘Ideas are ok, but getting people to actually care about the health care service, community teams
and services sound’
‘GOOD, like idea of specialist units’
I want to have a hospital in Halifax with A&E and planned care because I have 2 children. I can’t
afford to travel to Huddersfield. I speak little English so I feel more confident if I can see a doctor
face to face.
I think moving A&E care from Halifax to Huddersfield is a bad idea, people from this area needing
A&E care could be at risk as it takes much longer to arrive at hospital, also once they are there it is
much more difficult to get home if you don’t have transport
18
It’s about making existing services more effective, making them more widely available. It's
all about improving access to effective services - all providers in community to work together
‘Don't like them I am dyslexic and moving services makes it worse’
‘Ideas are good if followed through; however need more details on how it will affect us on
the ground’
‘Good to read about what is happening and it's important to involve the community in
hospital and community services and listen to their views’.
‘Smoke Screen. Decisions have already been made so why consult’.
‘They are reassuring but I feel they are slightly ambiguous. The justification has not been
put across why is this change happening’
‘There’s too much information and I don't know which bit concerns me’
The providers asked: Q3. Do you have any other suggestions for changing health and
community services?
The feedback received was grouped into positive (green), negative (red) and neutral
comments (amber). The chart above shows the feedback we received was again
predominantly neutral with all the feedback we received falling into the following themes:





Access and waiting times
Supported self-care/management
Community care
Hospital services
Staff care and treatment
19
The weighting of those responses as positive, negative or neutral against each theme are
highlighted below:
The table suggests that the majority of negative comments received related to staff care and
treatment and access and waiting times. There were a lot of positive comments relating to
hospital services and positive suggestions about how care could be provided in the
community. There were lots of ideas about how we could improve services in the neutral
comments across all the themes.
Those responding told us:
Access and waiting times

Positive comments included: People stated that same day appointments worked
well and longer opening times for some GP practices were working well. There was a
comment that out of hours mental health services were liked and home visits for the
vulnerable. Some comments supporting the need to share patient information out of
hours and a move towards 24/7 community care.

Negative comments included: The main comments were about travel times to get
to Huddersfield, these were raised by Calderdale residents and included comments
that people can’t get there, transport is inadequate and the travel times are too long
even for planned appointments. This followed comments that parking needed to be
improved on hospital sites, patient transport and public transport systems if changes
were to be made. The other main theme was to improve GP services which
consisted of a better appointment system and many examples were given of not
getting an appointment. Having to contact the practice to make an appointment was
problematic including ringing at a set time and the need to further consider the
working age population with more out of hour appointments. More work needed to be
done to reduce appointment cancellations and do not attends. Some people wanted
more time to talk once they had an appointment.
20

Neutral comments included: The suggestions included more walk in facilities and
improved access in the evening and weekends to community services with better
appointment systems, again working people were mentioned as requiring better
options for accessing services. Suggestions were made that more urgent care and
diagnostics could be provided at a GP practice level and that we should have more
GPs. Screening and testing it was suggested could take place in other venues such
as schools, workplaces and wider community facilities and there was a suggestion
about developing a 24 hour emergency clinic for the upper valley. Some stated we
needed access to more BME appropriate services and reduce waiting times at A&E.
The community want to be kept informed at each stage of developments and want
more information on services. Transport was raised as an issue that needed solving
and there were requests that services were in walking distance and that frail elderly
services were local.
Supported self-care/ management

Positive comments included: More help is needed for people to look after
themselves at home, things like phone chats and on line facilities would help. More
emotional support for families in the same way that cancer services help. People
stated they would like more care in a variety of settings such as schools, community
venues and youth groups. More health information in schools and healthier lifestyle
programmes. A number of people did state that people should take responsibility for
their own health and education was needed to support this.

Negative comments included: Responses included comments that there was not
enough done on the preventative agenda and we needed to stop people becoming
unwell. More frequent checks for people who may be subject to conditions such as
diabetes and more help for people with mental health issues. People stated there
was not enough help to use technology to support health and patients needed to be
involved in the design of services for self-care to work. There were a number of
responses that stated not enough is done to train and provide support to carers.

Neutral comments included: People put forward a number of ideas relating to the
delivery of self-care, these included:










Specialist local community hubs which could manage local need
Extending the minor ailments scheme to more products
Community awareness days which focussed on prevention
Regular health checks for the elderly and those with conditions
Leaflets in a more reader friendly format
More education and training for the patient, families, friends and carers
More local support groups
Subsidised or free activities such as gym memberships and access to gyms,
swimming and keep fit classes for specific groups i.e. older people in
community settings
More advice on diet, weight management and links into existing schemes such
as slimming world which are subsidised
After surgery clinics run by trained volunteers on healthy lifestyle
21

A focus on the young and part of the schools, youth clubs approach to working
with young people
In addition people wanted better trained receptionists who could sign post people for
appropriate support and treatment. More ownership of the self-care approach in the
local community, including services run by VCS groups and local people using local
facilities.
Community care and services

Positive comments included: Positive community suggestions were that GPs
should be given more of a role in delivering different services with the opportunity to
open longer. More district nurses were favoured and more home help and social
care services to keep people well in their own home.

Negative comments included: Negative comments included more help for those
people who cannot get to a GP surgery and more podiatry services in practices. Also
barriers to accessing services in the community need to be addressed particularly for
BME groups. More investment is needed in the community to support community
services including projects funded for longer terms and less dependency on grants.
More support should be given to community involvement including representation on
decision making forums with local communities represented, and targeted
discussions with communities about their individual needs and services assessed.

Neutral comments included: There were lots of suggestions on the model for
community services, these included:










Ensuring services keep people well in their own home
More targeted support for specific groups such as young people, BME
communities, people with mental health issues and those with dementia or who
have had a stroke
People wanted to see specialist GPs and nurses for certain conditions including
those with skills to work with particular groups i.e. deaf people
Community services need to respond over a 24/7 period including bank holidays
and using more support systems though phone lines
There needs to be more services for elderly people and women and some
separate services for men
People liked the idea of services you can walk into to get advice, support and
treatment rather than via referrals or appointments
More services to be placed in community settings and buildings such as
mosques, youth groups, supermarkets and the places people go and can walk to
There were comments requesting that commissioners and providers work more
closely with the community to plan and assess services but to deliver them too
More social groups, support networks and informal places to go to get peer
support, Brighouse was cited by a few as being under resourced in this area
There were a few suggestions that some services should charge people who
misuse them, whilst others did not want services to charge as they could not use
them if they had to pay
22
Hospital Services

Positive comments included: The majority of respondents stated they did not have
any further suggestions relating to the hospital. The few responses we received
related to elderly care being best placed in the community to ensure beds were not
taken up and 24/7 GP services to prevent people attending A&E. There were a lot of
positive comments about the current service and suggestion we should not fix that
which is not broken.

Negative comments included: The majority of suggestions were to improve
hospital waiting times and to improve both hospitals, some believed they were in the
process of being shut down and that any more changes would adversely affect
people. There were comments that services were already fragmented and needed
consolidating to work including information systems to share data which were
outdated and more training was needed for staff on things like mental health. Some
did not like the idea of community hospitals and there were suggestions to charge
people for using A&E. A few comments about getting the basics right first before
changing and a few comments about the coroners not being trained appropriately to
support those of a Muslim faith.

Neutral comments included: The majority of suggestions were to keep A&E in
Calderdale and to keep a facility in both hospitals. Most people wanted things to stay
as they are and services not to change. The suggestions were to improve waiting
times in A&E and keep both A&E and maternity services at both sites with a partial
facility in Todmorden and refer to specialist hospitals when required. There was a lot
of support for community hospitals with a few dislikes, and a request to increase
transport which is flexible and free and increase ambulance services and crews.
Some suggested that improved access to a GP and better prevention work in the
local community would decrease attendance at the hospital and if attending to treat in
order of priority to stop people dropping in to the service. There were a few requests
for improved services for mental health including more psychiatric beds in the
community.
Staff care and treatment

Positive comments included: That respondents wanted to see their GP and
community nurses and wanted to see more of these and other well trained staff in the
community. There were a number of comments relating to staff needing to share
information to work better.

Negative comments included: The need for more staff and less managers and
improved standards of care for the vulnerable. There were concerns that staffing
levels in the community were low and that in particular social care staff need more
time to spend with the person they care for. Respondents want to see the same staff,
this includes GPs and staff who can communicate clearly in the right language and
be understood. There were concerns that there is a lack of qualified nursing staff and
a need for more out of hours GP cover and that there may not be enough staff to
work in the community. Staff attitude was a also a problem and that people were not
treated as a whole.
23

Neutral comments included: Suggestions that more consultants needed to hold
community clinics and that health professionals needed to work together to look at
the person as a whole. That paperwork needs to be reduced to enable busy nurses
and more suitable qualified staff to work more effectively with services needing to be
staffed properly to work, including admin teams. There were a number of requests for
more female GPs and, more doctors in A&E and the chance to see the same doctor
at each appointment. There were comments that GPs could get overstretched and
that whilst community care sounded good that it may not work in practice .
Quotes:
‘Should be able to get doctor appointment on the day you need it not in 2 weeks’ time. Doctors
surgeries need to have more appointments and more doctors need to be available to accommodate
the patients’.
‘Each Doctors surgery should have a few available slots on that day which work on a first come first
serve basis. As it is very difficult to get an appointment within 1-5 days.’
‘I would like there to be more community groups for people with physical & mental health issues’.
‘Make more services available to patients nearer where they live to make transport easier and
reduce the stress of travelling on patients and their family’
‘Don’t’ discharge patients at 4.30am in the morning Will there be more beds for mental health to
stop patients having to be transported 100s of miles More and better care in the community for
people with mental health illness would be welcomed’
‘More community services for me to attend, I would like to be able to get a carer when I’m bad
instead of going to hospital, I hate it!’
‘I am in favour of more GP openings I support community hubs I feel there needs to be a proactive
approach to include BME VCS a real and meaningful partners’
‘Easier access to GP appointments, out of hour GP care not to go through 111 - to be direct to out of
hour number’
‘Less worried about accidents more focus on mental health and maybe down size both hospitals but
don’t change the areas for different treatment’.
‘There should be health check-ups particularly for older people as prevention, for early detection of
ailments is better, more efficient, and economic that treatment of advanced conditions and it should
be easier for people to see their doctors’.
Continue to develop a secure system allowing health professional the chance to access the same
relevant information’
‘I noticed the comment around staff training and attitude my response to that is that staff should be
given the time and support to train properly. not just video training. The government needs to
realise you can’t cut back in care’.
24
‘Although patient care is obviously the priority some thought should be given to the visitors to the
patient which has a great support to the wellbeing of patient recovery. Additionally, public transport
and certainly more car parking need to be addressed. Personally I would be prepared to attend
either Calderdale or Huddersfield as a long term patient of specialist’.
‘It’s a long way to HRI from the other side of Holmfirth. We need more local services and the
thought of A&E moving to Calderdale is totally unthinkable. Even planned appointments would be
difficult for many people. For planned operations where a stay in hospital is required it would make
visiting for many impossible’
We need to educate people more to take charge of their own lives. I do think we are improving with
fitness classes etc. but I still think there is a need to educate families on better eating habits. Without
NHS my husband would have died years ago, and my two sons wouldn’t be here today’.
‘provision of services seems to be becoming a very fragmented thing with different groups supplying
differing services, there needs to be greater consolidation of services’
The providers asked: Q4. Do you want to tell us anything else about hospital and
community services in Calderdale and Greater Huddersfield?
The feedback received was again grouped into positive (green), negative (red) and neutral
comments (amber). The chart above shows the feedback we received was again
predominantly neutral although the negative comments increased on this question. The
feedback received followed a number of themes:





The care people received
Hospital services
Access and waiting times
Community care and services
Quality and safety
25
The weighting of those responses as positive, negative or neutral against each theme are
highlighted below:
The table suggests that the negative comments were related more to access and waiting
and quality and safety. There were a lot of positive comments relating to the care people
received and once again lots of neutral comments across all the themes.
Those responding told us:
The care someone received

Positive comments included: There were a number of comments which related to
the care people received and they were all positive. Comments to staff that were
described as caring and helpful, second to none and professional. Quite a number of
people described particular examples where they were grateful for the care they
received.

Negative comments included: A number of comments relating towards being
understaffed, particularly A&E and the need for matrons. There were comments that
staff do not listen, or communication is limited and there is more paperwork than
care. Staff using phones on wards and not staying focussed or being caring or
sympathetic were also highlighted. In addition there were a number of comments
which suggested there is a lack of understanding of mental health, addiction, BME
and Learning disability. There was also a few comments about the care over 65s
receive which was deemed as poor in comparison.

Neutral comments included: Respondents told us that we need to look at the whole
person when we care for them and that included more training on elderly care,
mental health, BME and young people. There was a request for more bilingual
workers, advocacy and female GPs, trained staff to keep people in their own homes
and more staff in A&E. There were a few respondents who wanted to see happy
staff with vocational interests and to stop nursing degrees. Poor communication by
consultants needed improvement and so did discharge arrangements.
26
Hospital Services

Positive comments included: There were a number of positive comments relating
to hospital care received in the community including services received at Broad
Street and Todmorden Health centre both in Calderdale. Respondents wanted to
feedback the positive experiences of hospital services, there were comments that it
was well run, it was clean and people received good care and treatment. There were
also comments from some that they understood the financial challenges.

Negative comments included: There were quite a few patient stories about how
care has deteriorated, that food was not good, some wards were not clean and that
the discharge lounge at HRI was unpleasant. There were concerns that moving A&E
to Huddersfield would cost lives, that transport systems were not in place and travel
and parking would be difficult and journeys too long. In particular Calder valley
residents felt that access was poor already and that those in rural areas had not been
considered. Current hospital appointment and waiting times required improvement
and there were a number of examples of appointments not being on time. There
were quite a few comments from elderly people that they were frightened, worried
and scared about the plans. In addition there were some comments about being
discharged too early and a lack of cultural awareness or staff speaking community
languages.

Neutral comments included: The majority of neutral comments were from
Calderdale residents requesting that A&E services remained open and a few from
Greater Huddersfield residents about keeping services local. There were a few
comments about keeping ‘walk in’ facilities and a number of requests for more female
GP’s. We also received some comments about maternity services which varied from
people wanting more support to give birth at home to concerns about maternity
arrangements in the future.
Access and waiting times

Positive comments included: People wanted to see more community services,
open for longer. There were a few comments that people would be willing to travel
for the best treatment and lots of examples of services people had used where
access was good.

Negative comments included: The majority of negative comments were related to
travel and transport and came particularly from Calderdale residents who do not want
to travel to Huddersfield. Respondents told us that isolated communities had not
been considered and that longer journeys may increase mortality rates. Huddersfield
parking was poor and expensive and there were issues with disabled parking too,
there were worries that Huddersfield would become too crowded. Those on a low
income or without their own transport wanted services closer to home although some
would welcome improved and even free transport services. A lot of comments
relating to the need to improve appointment systems and waiting times in both a
hospital and community setting.
27

Neutral comments included: There were lots of comments that people wanted to
see longer opening hours in the community (i.e. 8am-8pm GP services 7 days a
week) and services that are accessible and convenient. The issues were described
as appointment systems which do not work and access to a GP decreasing. The
solutions were more telephone based consultations and shorter waiting times to see
a GP of choice. More local pharmacy services in some areas and less waiting time
for procedures such as operations.
Community care and services

Positive comments included: There were lots of comments about current
community services working well and these included continence services,
ophthalmology and cardiology. A number of people were in favour of the model and
services being placed closer to people’s home. There were some positive stories of
how patients had been trained by staff to look after themselves in for example
dialysis. There were requests to keep working with schools and educating young
people about their health.

Negative comments included: Current community services work but are disjointed
and systems need to work better. There were concerns that mental health was not
supported as well in the community including through GP services and mental health
beds, the suggestion was for more training and a focus on improving services in this
area. People were still concerned that the GP may prevent referrals and so people
will not receive the services they need and that some may be out of touch with
patients’ needs. There was criticism that the health gap had not been closed and
services needed to be expanded to meet the needs of poorer communities. More
information on services for the elderly and a stronger focus on isolation were needed.
There were comments that discharge from hospital was sometimes too soon and the
waiting time for mid midwifes was too long, there were a few comments that were
concerned that services will close or be lost.

Neutral comments included: Improved opening times and out of hour’s access to a
GP and other services was the key message. People wanted more time with the GP,
access to female GP’s and more walk in services. There were some comments
relating to improvements to home help services. There was a strong message that
the community wanted to help find the solutions to community care, be trained to
deliver the model and that VCS organisations should be used to ensure services
remain near to people’s homes and in local community settings.
Quality and safety

Positive comments included: Positive comments related to suggestions to use
more voluntary help to improve services already provided by hard working and
dedicated staff. There were a number of comments that facilities were cleaner and
some services were described as excellent.

Negative comments included: There was a concern that moving A&E to
Huddersfield will result in deaths. That staff were not patient focussed enough and
some required training to improve quality particularly in elderly care and for those
28
with dementia. There were examples of misdiagnosis and not enough follow up after
discharge. BME communities felt they received inconsistent care and that coroners
arrangements were inadequate. There were a few comments that maternity care had
deteriorated and that in general care was worse.

Neutral comments included: There were a number of suggestions that included a
need for joined up specialist services in the community to improve quality. Longer
opening hours and more weekend services. There was a need for better information
and communication and an improvement in staff attitude. Respondents felt that sign
posting to services was vital that more work needs to be done with the community to
improve quality for individuals by understanding each community and its particular
need.
Quotes:
‘I have recently suffered from a badly fractured leg and have received very good care over
the 5 months from Calderdale royal and the local physios. This is also true of my general
health care, eye clinic at Huddersfield inf, and Beachwood medical centre’
‘When you go in walk-in centres they are always very busy we are sent to A&E. So more
walk in services should be available and more staff should be recruited’
‘my experience have led me to wonder if paperwork has to take priority over face to face
contact and care’
‘I feel the standard of care has deteriorated in some hospitals and the food served is in
some cases appalling, People need good nutrition to recover successfully mentally and
physically’.
‘Huddersfield RI has given us fantastic support over the past 30 years. We are want to keep
our local NHS service’
‘Will minor injuries unit have doctors? What will be the opening hours of the minor injuries probably to 10pm what happens if an elderly patient falls out of hours? or in hours? Falls
team, telehealth etc. etc. Elderly lady - fall out of bed, staff couldn’t pick her up, had to wait
2 hours for an ambulance’
‘I am full of praise and confidence with CRH in them. They treated my husband with his
near death experience’
‘Following an explanation about the proposals people were generally understanding and
supportive of proposals - 7 people attending a focus group’
‘Cardiology and ophthalmology at Tod is used well’
‘I know of two lives saved because of being close to Halifax hospital. One an unborn baby
another a heart attack victim. It is a definite possibility if services are moved they may not
have survived. Having the NHS open to valid criticism.’
29
‘Totally against moving accident and emergency from Calderdale. Access is already poor
for the Calder Valley’
‘The Halifax emergency dept. should be kept open but it should be better organised with
perhaps a minor injury unit’.
‘I have had experience at the Halifax hospital and think it is well run and doing a great
service for its community’
‘Stand in the patient shoes more often’
‘We closed Hx Infirmary, St Johns, Northowram just in this area - where are the savings.
Bring Matrons back. Simple clean hospital standards with discipline and good quality
nursing care’.
‘My experiences have not been good. Long waiting times, passing information on and being
examined by 3 different doctors. No pillow or bedding offered .Not sure if we were staying
the night or going home’.
Remove smoking shelters and have an outright ban on smoking on NHS premises,
applicable to all staff and patients. Invest in renewable energy to reduce costs in long term
Provide covered cycling parking close to entrances What is the future role for home valley
memorial hospital?’
Care was only available in one of the hospitals. I understand financial implications and the
best care is a priority, Having recently had experience of A&E department in Calderdale I
cannot speak highly enough of the care I was given.’
‘As many insulin pump users live in the Hebden Bridge/Tod area we should have consultant
services at Todmorden Medical Centre. When I fractured my knee I spent 2/3 weeks in
Huddersfield hospital. It was very difficult for my husband to visit because he has
Parkinson's disease. He found public transport too difficult to use because of too many
changes to get to Huddersfield from Hebden Bridge (up at Dodd Naze) The distances to
both hospitals need better public transport for older people’.
‘I think we shouldn't have to wake up in the morning just to book an appointment, and this
still does not guarantee an appointment’.
7.2
Findings from the wider stakeholder meetings and events
Target Audience:
Key messages:
Overview and Scrutiny
Committee – Calderdale


Overview and Scrutiny
Committee – Kirklees
Health and Well Being
Boards - Calderdale
Updates received – no key messages
Need to clarify what minor injuries means
Concern about loss of beds at CRH
Updates received – no key messages
30

Health and Well Being
Boards - Kirklees
Local councillors and
MPs - Calderdale

Need to demonstrate topic 2 has a wider benefit for the wider
geography.
 Developments at Todmorden would be welcome.
 Good communication is key
Updates received – no key messages
Local councillors and
MPs - Kirklees
Local Medical Committee
GPs




Positive about proposals;
Anxious about impact on primary care
Factor in workforce issues
Need to clarify Trust and CCG boundaries re proposed visits
to practices


Agreed with the direction of travel
Wanted to know how to involve primary care contractors
further
Why has old primary care models been dismantled and cut?
Concerns about Social Services capacity
Strong support for self-care models
The need to understand and factor in changes in in patient
flows as a result of changes e.g. possible increased flow to
Barnsley
The importance of effective and integrated IM and T to enable
new ways of working
The need for more community beds as a result of changes in
hospital bed base
Agreed the system would benefit from some re-design
Pressures in both primary and secondary care
Keen to bring primary and secondary care clinicians together
to have conversations
How do we convince decision makers of the clinical evidence
base?
Could PHH become a 4th partner in the process?











Healthwatch - Calderdale 









Healthwatch - Kirklees
Yorkshire Ambulance
Service
Need to clarify what minor injuries means


Very concerned about the possibility of no A & E in Calderdale
Want to see more info re what a Minor Injuries Unit would look
like – the conditions/injuries it deals with.
The importance of provision of additional services out of
hospital
Overall, constructive dialogue which highlighted the
importance Healthwatch place on providing care out of hospital
and reducing the need for hospital admissions
Be honest about budget reductions
What’s the cost of the PFI at Calderdale
If both A & Es close how will we get home once treated
How will we address gaps in services, e.g. continence
What will happen if the M62 is shut
Is losing 100 beds safe
Will our-patients services be on both sites?
Moving services into the community is great but we have to
31

Royal College of
Midwives
Community Pharmacy
CHFT membership
Council and councillors








Local Care Direct


Unions


Third Sector
7.3
ensure we have resources in the community to manage them
How will cultural changes be managed – previously clinics held
at Todmorden were never that busy
RCM seeing these changes up and down country
Would we still be giving women the choice of service model
Role of Community Pharmacy in helping to build confidence in
self-care and prevention
Push boundaries on dealing with complex patients
Pharmacy could be developed into an intermediate service
We need to look at the bigger West Yorkshire picture in terms
of provision across the region
Location of individual services not important, but infrastructure
is
Important to have assurances that funding provided for
community services is used for that service
LCD would like to be part of discussions.
Want to be engaged further as part of the engagement
process
People less interested in big strategic plan – but whether they
will have a job at the end!
It’s a fait a complait /staff side concerned about the
connectivity in the community
 The 3rd Sector are/can be the ‘champions of prevention. Need
to consider how this is made a reality in the model
 Self-care model is understood by some, but not all – we need
to find ways of describing it better
 Consider ‘digital inclusion’ so that people aren’t disadvantaged
by digital developments
 Statutory partners need to be more inclusive of third sector,
with the potential for partners.
 Attendees generally supported the proposals in the SOC
document
 Discussion about a “super ambulance/ mobile hospital”
 Consider wheelchair/guide dog access to ambulances.
 High quality care is key
 Transport issues need addressing.
 Strong emphasis to Improve communications across voluntary
sector and hospital boundaries
Other findings
7.3.1 Staff Engagement:
The feedback received from staff is as follows;



Generally, staff are supportive of our preferred topic
Staff recognise the longer-term benefits of changing the way services are delivered
for both patients and staff
Staff want to work with us on the design of new services
32






















Staff recognised that this is one Trust with two hospitals – patients and staff are
already familiar with the two hospitals
CHFT Medical Division, had concerns over capacity and fit if HRI is unplanned site
but in general a positive response and a good understanding of the need to change
Estates staff in HRI stated spending capital in a building we own (if HRI) is good but
were concerned that A&E waiting times will get worse if there is only one A&E
Staff wanted to know if their jobs were secure
Nursing staff wanted to see more District Nursing staff
CHFT Nursing staff asked if A & E waiting times will get worse if there is only one
and thought it was good to spend capital building on a building the Trust own (if HRI)
Examples of poor service in community (poor palliative care)
What will happen to ISS staff if HRI is the unplanned hospital. Will they transfer?
What will be the impact on jobs at CRH if HRI is main site?
Conscious that more people will choose to call 999 for an ambulance due to distance
to travel from Calderdale(when maternity services moved to Halifax there was a
worry that more women in labour would call 999) but that has proved not the be the
case)
What are GPs doing about appointments and increased number of A&E attendances
because patients can’t get a GP appointment?
Staff understand the rationale behind the proposed changes, but want to know more
about how it might work in practice
Staff wanted to better understand the thinking behind the Trust’s stated preference
The services proposed would need extensive new build on the current HRI site and
wanted to understand PFI arrangements more, there was a suggestion for one big
hospital in Elland
Senior consultant presence was needed outside daytime hours
Staff wanted to know if the shuttle service will improve
Staff asked if beds in the hospital would be reduced
Social Care staff stated that a 7-day provision of Social Services is implicit in the new
Care Bill and Urgent Care Agenda
Community resources governed and managed by us, but not owned by us
Learn from Locala example. Staff want to come back into Hospital setting as they feel
isolated
Significant Consultant presence in the community is needed to show investment of
the current model
The intermediate care teams wanted to know if Dewsbury had been factored into the
A&E plans but were generally supportive of the plans
7.3.2 Stakeholder Event: Locality and Community services key messages:



Single Info system or shared record essential
Single assessment – build on through shared record
Is it affordable?
33
7.3.3 Stakeholder Event: Specialist Hospitals key messages:



There needs to be an unplanned site to meet all demands
Public education is needed on the revised health and social care system
Ensure proposals fit with a wider West Yorkshire plan
7.3.4 Stakeholder Event: Self-Managed Care key messages:


Change of culture is needed for both staff and patients
Not enough sharing of best practice currently to understand self-care
7.3.5 Stakeholder Event: Emergency and Urgent Care key messages:

Attendees generally supportive of service models described in SOC
7.3.6 Letter from Barry Sheerman:
Barry Sheerman MP, sent in a letter and a petition containing over 1,000 signatures
opposing plans to the closure of the A&E department in either Calderdale or Huddersfield
(see appendix - 10). The petition also came with 141 public comments relating to A&E
services. The comments covered the following key themes:











Keep A&E services in both Calderdale and Huddersfield, both local areas are large
enough to require their own services.
One A&E service will become overcrowded, services are already overcrowded.
Travel and transport for people particularly in rural areas will not be possible because
of the cost, time to travel and parking, if they have their own transport, will not be
sufficient to cope with demand.
The Elland by pass is gridlocked and will cause problems for emergency vehicles.
Ambulance response times were a concern, including the time it would take to reach
the hospital destination.
There were a number of concerns that lives would be lost.
Services were being cut as part of a cost cutting exercise.
Current services were valued and there were lots of examples to support this.
Local people want easy access to local facilities and there were a number of
comments that services may go to Leeds.
People want a say on what happens to ‘their’ services.
Services work perfectly well as they are and people do not want them to change.
34
Quotes:
‘The whole idea is ridiculous. The point of Accident and Emergency is to give rapid, often life-saving
access, help in a crisis. Increasing the distance of travel is plain daft, especially for the very young,
the elderly, and the infirm.’
‘No closure of life saving services, regardless of cost’.
‘The bypass between Huddersfield and Halifax is by no means free flowing. There is very little room
for vehicles to manoeuvre to allow emergency services through’.
‘My 16 month old grandson has quite a rare congenital illness (congenital Adrenal Hyperplasia) and
would not be alive if it were not for the A&E departments at both HRI and Calderdale. When his
condition is acute he does not have time to travel far; his condition is critical and life threatening and
he needs his local A&E department’.
‘The A&E in Huddersfield offers a fast and very satisfactory service in the community at present and
should stay a vital part of Huddersfield!’
‘One of the major reasons for living in towns the size of Huddersfield and Halifax is to have services
in the locality without having to travel outside the town you live in. This was also my reason for
supporting both towns having maternity wards several years ago’.
‘we need to keep the A&E our little boy Jake attended the A&E several times when he was a
youngster unfortunately he passed away when he was 2 and a half in Leeds but it was Huddersfield
who dealt with him first and they did a great job. Regards Carl (Jakes Dad)’
‘We Need and A&E in Huddersfield. Can you imagine taking a child on two buses to Halifax when
they have an accident…or will there be more ambulances and paramedics to meet demand as
people can’t access A&E easily’
‘Both these towns are large enough to warrant their own A&E units. The Elland bypass is gridlocked
at peak periods, patients will die in the back of ambulances in the rush hour times.’
‘I find this totally unacceptable, the NHS belongs to the people not management or government,
leave our services alone!’
‘In the past my husband has been taken to A&E by ambulance – each time he has been looked after
with dignity, compassion and medical care…’
‘How on earth are people who live in Todmorden going to get to HRI in an emergency. It is a joke!’
‘How can you possible move emergency services to Leeds. Emergencies need highly skilled and
specialist care within minutes not after a long arduous journey to Leeds. Where’s the common sense
and compassion gone!’
35
7.4
Equality Findings
1091 people partially or fully completed the equality monitoring form. The full detail is
reported in (see appendix 11).
To initially understand the validity of the data a comparison was undertaken with the local
demographics of the population. Calderdale CCG is co-located with the local authority do
the data is compared to the 2011 census. For Greater Huddersfield CCG the data (in the
most part) comes from the census 2011 which covers the Kirklees local authority area. This
mean the data cannot be a direct comparison. Any notable or expected variations will be
noted. For some equality groups we do not have local data available for comparison so
national data will be referred to.
Sex
There was no significant difference to the local demographics.
Age groups
The data for age was sourced from the mid 2011 population estimates for CCGs based on
the 2011 census, so reflects the most accurate picture for Greater Huddersfield.
There is significant difference in the under 18’s category with only 3% of survey
respondents compared to a population of 22-23%. This is to be expected as the under 11s
were not specifically engaged in this exercise.
The 26-45 group was over represented 38% compared to 27% for both Calderdale and
Greater Huddersfield CCG.
Ethnicity
There is a reasonable match to the local demographics with a couple of notable anomalies.
There is a significant over representation of Pakistani populations at 33% compared to 7%
(Calderdale) and at 10% (Kirklees). There is a commensurate under representation of White
British at 56.2% compared to local populations of 87% (Calderdale) and 78% (Kirklees).
Other less significant, but still notable differences are; the under representation of Indian
people, this may be due to the majority of respondents coming from Calderdale; the
underrepresentation of Other White people; there is a 1% ‘other’ ethnic group and an
increase in the number of Arab people compared to the local population; there are fewer
mixed White and Black Caribbean people, but more mixed White and Asian people.
Population
Calderdale %
Kirklees
%
Respondents
%
White:
English/Welsh/
Scottish/
Northern
Irish/British
2.1
Mixed/
multiple
ethnic group:
White and
Black
Caribbean
0.5
Mixed/
multiple
ethnic
group: White
and Black
African
0.1
0.0
1.8
1.2
0.2
0.3
0.6
0.1
0.1
White
: Irish
White:
Gypsy
or Irish
Travell
er
White
:
Other
White
86.7
0.9
0.0
76.7
0.6
56.2
0.8
36
Population
Calderdale
%
Kirklees %
Mixed/
multiple
ethnic
group:
White and
Asian
Mixed/
multiple
ethnic
group:
Other
Mixed
Asian/
Asian
British:
Indian
Asian/
Asian
British:
Pakistani
Asian/
Asian
British:
Banglad
eshi
Asian/
Asian
British:
Chinese
Asian/
Asian
British:
Other
Asian
0.4
0.3
0.6
6.8
0.3
0.2
0.4
0.6
0.3
4.9
9.9
0.2
0.3
0.7
1.2
0
0.3
33.0
0.2
0.2
1.6
Respondents
%
Population
Black/African/
Caribbean/
Black British:
African
Black/African/
Caribbean/Black
British: Caribbean
Black/African/
Caribbean/
Black British:
Other Black
Other
ethnic
group:
Arab
Other
ethnic
group:
Any
other
ethnic
group
0.2
0.2
0.0
0.1
0.2
0.6
1.1
0.2
0.3
0.4
0.5
0.2
0
0.7
0.9
Calderdale
%
Kirklees
%
Respondents
%
Religion
Of those who stated they had a religion the data showed an over representation of Muslim
people 36% compared to 7.3% (Calderdale) and 14.5% (Kirklees), Buddhists and ‘other’
were also over represented but to a much lesser extent. There was a significant gap in
respondents of a Christian faith 25% compared to 56% (Calderdale) and 53% (Kirklees).
Disability
There is limited data available about the local population of disabled people the census has
2 measures; ‘day to day activity limited a lot’ and ‘day to day activity limited a little’. The
survey respondents were asked ‘do you consider yourself to be disabled’ and 23%
responded yes. The data from the census recorded 17.9% (Calderdale) and 17.7%
(Kirklees). This was made up of people limited a lot, 8.2% (Calderdale) and 8.4 (Kirklees)
and limited a little 9.7 (Calderdale) and 9.3% (Kirklees).
In relation to the types of impairments; the majority of respondents had a long term
condition (42%) or mental health condition (29%).
Sexual orientation
Of the respondents only 2% identified as lesbian (0.8%), gay man (0.5%) or bisexual (0.8%)
(LGB). Sexual orientation is not included in the census so it is difficult to demonstrate a
37
local picture, but in the Integrated Household Survey, (Office of National Statistics), gave the
following figures for the period April 2011 to March 2012:
 1.1 per cent of the surveyed UK population, approximately 545,000 adults, identified
themselves as Gay or Lesbian.
 0.4 per cent of the surveyed UK population, approximately 220,000 adults, identified
themselves as Bisexual.
 0.3 per cent identified themselves as "Other".
 2.7 per cent of 16- to 24-year-olds in the UK identified themselves as Gay, Lesbian or
Bisexual compared with 0.4 per cent of 65-year-olds and over.
There is a perception that many people chose ‘prefer not to say’ to this question for a variety
of reasons reducing the number of respondents identifying as LGB. Of the people who
stated ‘other’, two described themselves as ‘past it’ and widow’.
Gender reassignment
One of the greatest difficulties in measuring or estimating the size of the Trans population is
that no systematic or reliable data has been collected through the Census or through other
Government-sponsored surveys. However in 2011 research by GIRES* concluded,
organisations should assume that 1% of their employees and service users may be
experiencing some degree of gender variance. At some stage, about 0.2% may undergo
transition. The number who have so far sought medical care is likely to be around 0.025%,
and about 0.015% are likely to have undergone transition. (*Gender Identity Research and
Education Society, 2011) of the respondents to the survey 0.2% said their gender identity
was different to the sex they were assumed to be at birth.
Pregnancy and maternity
Of the respondents 2% said they were pregnant or had given birth in the last 6 months.
Carers
Of the respondents 10.4 identified themselves as carers, the 2011 census found 10.5%
(Calderdale) and 10.4% (Kirklees).
Reponses to Question ‘what do you think of the ideas in this leaflet’
An analysis was undertaken comparing responses to the question ‘What do you think about
the ideas described in the leaflet’ to understand whether there were any different views
dependent on protected characteristics.
The responses were themed into positive, negative and neutral with 5 areas emerging
which capture the comments made. These are;




Hospital services
Travel and transport
Care and services in the community
Delivering the model
 Engagement process and information provided
Analysis of the themes has been undertaken compared to some of the protected
characteristics, where there was a sufficient sample. This will be detailed below.
38
Sex
There is no significant difference in responses from the sexes.
Women
Men
Positive
53%
53%
Negative
21%
17%
Neutral
24%
30%
When comments were broken down into the 5 themes and analysed (positive, negative,
neutral) it became apparent that there was very limited differences in the views of men and
women.
Women were more negative about the hospital services (women, 50.4% men, 41.5%) and
women were more positive about care and services in the community (women, 61.9%
men, 45.7%).
Quotes
Women care and services in the community – positive quotes
The idea that more services are nearer patients (providing the correct diagnoses and care
programmes are in place and regular visits happen, treating patients in their own home and friendly
surroundings would be ideal, particularly for the elderly.
realistic, easily understood putting needs at heart localizing service can understand need for
local hubs
I think the ideas are good, especially the specialist community centres, bring services more local for
people will help them access the healthcare they need easier and making these services accessible
seven days a week is good too
I feel community based services are an excellent idea however there must be the resources to
deliver them gender specific services should be offered at places like the well womans centre
Women and hospital services negative quotes
Some of the views I find contradictory. Outlining plans for more community based care and then
suggesting the relocation of hospital services to Huddersfield, Bradford and Leeds
There are a selection of options but they fail to address a and e issue. Emergency care needs to be
close to communities.
I am dubious as to whether or not the decision about the future of a and e services has already been
made. Halifax needs a and e department and gp surgeries should be open longer to alleviate the
pressure on hospitals
39
Age
The youngest group were the most positive, with the 46-65 coming next. In terms of
negativity the oldest group were the most negative, although this is based on a small
number of respondents (29).
Under 18
18-25
26-45
46-65
66-80
81+
Positive
73%
50%
53%
59%
42%
38%
Negative
14%
23%
20%
13%
21%
46%
Neutral
14%
26%
27%
28%
36%
15%
In terms of age groups analysed by theme the comments related to hospital services were
mostly negative (31.5-55.7%) and neutral with no group giving a majority of positive
comments. The most negative were the 26-45s (55.7%) with 18-25s (51.9%). In relation to
care and services in the community the majority of age groups were positive (50-60%)
however the 66-80s were much less positive (27.8%), similarly they had the most negative
comments (22.2%). For delivering the model the majority of comments were positive
(57.4-69.2%). Comments made by people over 81and under 18 have not been considered
as the sample size is too small.
Quotes
Age 66-80 care in community negative quotes
Supporting people to look after themselves at home. This hasn't worked the elderly who I have
worked with for thirty Years deteriorate quite quickly when in their own.
All ages positive care in community quotes
like the idea of more community services, its good to empower people to take greater
responsibility and their own health care. Agree with the specialist community centres and hubs.
(46-65)
Putting patients at the centre of services is an excellent idea and one that would definitely benefit
the community (26-45)
living out in Todmorden having services locally will be a huge benefit. i work in stroke early
supported discharge and so i have seen the benefits of supporting people as they leave hospital.
this could benefit other conditions especially orthopaedics/ surgery falls (26-45)
Age 26-45 hospital negative quotes
good ideas but not much attention paid to how deaf people can contact the NHS all based on
centred services or telephone - needs rethinking.
not good people will die if services are moved
40
Ethnic Group
Only two ethnic groups have sufficient respondents to consider the themes raised by the
data, these are the White British and Pakistani groups. The numbers for other groups
would be too low to present an accurate picture. There is no significant difference in the
opinions of these two groups.
White
British
Asian
Pakistani
Positive
Negative
Neutral
53%
18%
29%
59%
17%
23%
When the comments were analysed in relation to theme (comparing only White British and
Pakistani groups) there were no significant differences, however Pakistani groups
commented more positively on care and services in the community (Pakistani, 67.9%
White 48.2%) and the engagement process and information provided (Pakistani, 72.5%
White 63.6%).
Quotes
Pakistani – care in community positive quotes
like ideas for community services and care and specialist centres positive ideas for older people for
dementia
Its making services less complicated its giving people choice and capabilities to have services
nearer to home
I think the ideas will help members of the community feel more confident in using the services by
having local easy to access walk in centres and ability to get advice when needed.
Disabled
There does not seem to be a significant difference in views from disabled people to people
without impairments.
Yes
No
Positive
55%
53%
Negative
19%
20%
Neutral
26%
27%
In considering the themes disabled people made more negative comments on hospital
services (yes, 70.9% no, 43.0%) and less positive ones (yes, 6.4% no, 15.2%). When
commenting on care and services in the community the differences were much less
pronounced negative (yes, 9.7% no, 10.5%) but in contrast disabled people were more
positive (yes, 64.5% no, 52.6%)
41
Religion
Given the sample size it is only reasonable to consider Christianity and Islam for potential
difference in opinion.
Islam
Christianity
Positive
57%
47%
Negative
18%
21%
Neutral
25%
32%
While Muslims are more positive about the ideas in the leaflet, Christians are more neutral.
Carers
Carers are more negative about the ideas within the leaflet.
Yes
No
Positive
47%
55%
Negative
27%
18%
Neutral
26%
27%
Other groups
There are insufficient respondents to consider themes for sexual orientation, pregnancy and
maternity and gender reassignment, although the participation is not considerably different
than what would be expected compared to national demographics.
8 Findings from the Commissioners’ engagement process
The focus of the Commissioners’ engagement was to gather views on the commissioning
intentions as part of the five year plan. NHS Calderdale and Greater Huddersfield CCGs
each have their own strategy these documents including a questionnaire were circulated to
existing networks for comment and views gathered at the local drop in sessions for each
CCG. A summary and easy read version of the commissioning intentions, were developed
to ensure information was accessible (see appendix 6 and 7).
8.1
Findings
The commissioners asked: Q1. Do you understand what we plan to do?
42
From the responses we received on this question 65% understood the plans definitely or to
some extent and 16% thought they did. This left 19% who did not understand what the
plans were describing which may have some bearing on the responses that follow.
The commissioners asked: Q2.Do you agree with our plans?
From those responding 59% did agree with our plans and those responding no or not really
came in at 31% those who were unsure formed 10% or respondents. The questionnaire
asked those responding to no or don’t know to describe their response and the following
themes were identified:
Those responding with no or don’t know (31%) told us:








The plans were too vague or abstract and there was not enough detail to allow for
comment
The information was complex and hard for some people to understand
The plans need to be better communicated to local people
People want to know what it all means for them
Some people wanted us to describe what we mean by planned and unplanned care
and community care and what this means for A&E
There were concerns that the plans are to reduce cost
There were comments that we needed more focus on current appointment and waiting
times
More focus on keeping people healthy
43
Quotes
You state, in effect, a member of deliverable objectives, but given no indication of priorities or how
any of these objectives may either be obtained or delivered, or that they can’.
‘Plans as set out are very vague - just a wish list’.
‘Of the people who said not really and no not really the reasons were that the document does not
offer enough information for anyone to make a decision. Writing a document can look good on
paper, but it does not explain how and where the proposed changes would take place. Also when it
talks about community services, what does this mean? These decisions will make a massive impact
on people’s lives, their health and that of their families. Instead of writing flashy documents, GPs
and these commissioners should hold public events regularly across Calderdale to explain and face
up to people and take the real questions not hide behind websites and emails’.
‘Because your documents do not state clearly what may happen. Referring to planned and
unplanned care means nothing to much of the population. We only know that a&e dept. is likely to
close because others have translated for us. It looks like using jargon is a way to hide the facts’
Could be rationalised -Travel is big issue - people who need care are older/disabled - less likely to
be able to travel visiting more difficult, agree with development of local services, increased
availability of GPs
It sounds as if you are piously relying on unpaid workers rushing in to replace paid ones but there is
nothing to say that this must happen.
‘I don’t know if these plans cover enough of teaching us how to be healthy’
Not really/ no not at all - the plans look good on paper and if they are plans it suggests you have
already made a decision.
The commissioners asked: Q3. Is there anything missing in our plans that you think we
should be doing to help improve the health of people living in Calderdale and Greater
Huddersfield?
44
The feedback received was grouped into positive (green), negative (red) and neutral
comments (amber). The chart above shows that the majority of comments received were
neutral and negative, there were some positive comments and the feedback received
formed the following categories:
Those responding told us:





There needs to be more engagement on the CCGs plans
Better communication and more information
Focus on diet and health
That the CCG need to be able to adapt as local needs change
More plans on dementia and dementia care
Quotes
Lack of consultation - limited events, poorly publicised Todmorden representation on CCG board
and broader engagement Better more robust consultation on proposals
‘diet so very important but you know all this’
‘Other health problems - you seem to have the right priorities here but we can only say be aware
things change so how will you adapt and include any future health problems as they arise? Where
care is provided this is not a good idea. If care is changed and moved to other providers who will
monitor and check these. there are plenty of examples over the past few years of bad practice and
as people who already suffer poor health and poor services this will only get worse with cuts kicking
in’.
‘Dementia is a pressing problem and not specifically mentioned’.
Yes. Why is there a "no change" option? We pay our taxes and so we should be able to say "no" to
any changes. If you want to make change, start by providing proper service rather than sending
people all over the place over and over again and then back to square one. Agree
with more care in the community, but what do you mean by that? You don't say what they are. Can
you provide services in the Youth Club? (Group of 15 young people)
The Commissioners asked: Q4. Is there anything else you would like to tell us?
Those responding told us:





They want more plans to be publicised and more about the CCG and who you are
They want to see a reduction in paperwork for GP’s but an improvement in GP opening
times and appointments
When dealing with people who are unwell we need to ensure the appropriate amount of
time and care is given
That they want to help find solutions and spend resources together
Work more with young people and educate them at a young age
45


Use community groups to deliver plans
Find more innovative solutions to delivering services like exercise classes and
incentives to lose weight, relaxation classes etc.
Quotes
Publicise more with plans and meetings. Does not feel closing A&E is acceptable. We want to be
informed of future consultation meetings. Good experience of ambulance treatment’
‘Yes improve GP appointments times longer opening times, open a GP practice 24/7 to reduce
minor injuries to a&e’.
‘I am a teenager with psoriasis and apart from creams I have not been given help with stress relief
or relaxation though these have all been proven to help my condition why do I get creams’
8.2
Findings from the Calderdale community assets not included in the analysis.
The findings were a late submission so all the data captured is reported separately.
8.2.1 Responses from Mixenden, Illingworth and Ovenden area in Calderdale
We received 44 responses from residents living in this area.
Residents comments about the plans: 36 people understood the plan, 3 thought
they did and 4 did not, we had 1 no response. From this 31 agreed with the plans
with 10 not at all and 3 others stating they thought they did.









The respondents understood the ‘what’ but needed to know the ‘how’
There was not enough detail in the plans to make an informed decision about
what should be delivered
People wanted to know what was meant by local delivery for them, where
would it be centred and what do we mean by local, more things are needed in
the local community
More detail is needed about what services would like in this area. This needed
to describe so that people could understand
Concerns that one A&E would mean an overcrowded service
Tougher on those who do not look after themselves i.e. alcohol related
conditions
The plans read as a move towards privatisation, with the plans not being
workable
More say in these plans for local people, more help form local people to
design services
Be honest about what is driving the change, the media portray things
differently
What was missing from the plans, residents told us:

The areas described needed to be more specific in how they would support an
individual, what would it mean for me
46











Improved access to GP services, improved appointment system was needed
There were concerns about how services will be staffed
People wanted to know plans for things such as opening times
More focus on local communities and listen to local communities more
Look at longer investment in projects and provide adequate budgets to
community services such as Upbeat
More focus on incentives and preventative services than treatment
More services to support people with mental health problems, services like
CAMHS need more staff and funding
Need to consider transport and travel as part of your plans and improve
patient transport services which are often slow and running late and people
cannot travel to Huddersfield for services, concerns about ambulance transfer
times
More drop in services in other areas which can link to your GP practice for
people working away from home
More help for rough sleepers and the homeless who use A&E because they
have nowhere else to go
More services for people with a Learning Disability such as annual health
checks
Anything else people wanted to tell us:
















What is the case for moving A&E and what would replace it, keep the A&E as
it is
How will your plans affect me?
GP appointment systems need improving
Less focus on paperwork
Loneliness and isolation is a huge problem and small groups and informal
community activities can support this
Sessions to help people who are in debt, which can cause depression
Volunteer networks to support residents
Schemes to help people just out of hospital, gardening, shopping, cleaning
and people to have a chat
More choice of places to go when we need help other than healthcare settings
Local support for people with diabetes, groups that can advise on diet.
Lifestyle help people go the gym and back to work
More services that operate as a drop in – informal places for a coffee and chat
Concerns that older people may not receive the treatment they need to save
costs
More education in schools about health, first aid and managing minor health
issues
Better coordination of services from hospital to community i.e. physiotherapy
stopped on discharge from hospital and patients are often discharged too
soon without any help or support
All the care has gone out of the NHS
Look at funding play therapy
47
8.2.2
Cornhome and Walsden Residents, Calderdale
Residents in Cornholme and Walsden held a focus group with residents to discuss the
commissioning intentions and provide feedback. This document was received in the form of
a report and the following summarises the findings from this exercise. The full report can be
found in appendix 12.
The main themes emerging from conversations with residents in this area were the distance
from hospital and the lack of public transport at night, leaving costly transport such as a taxi
the only solution; most were unable to afford this option.
Residents stated they would like to see:










GP communication and information systems need to be improved, more facilities
such as Skype and use of email for the deaf
Patient information shared between hospitals and GPs needed to be handled more
effectively
Enough GPs to cover the work described in the plan and to play a stronger role they
need to sort out their own services
A better transport system to get people back home if they are transferred to a
hospital far away
More community services in Cornholme including more GP nurse services, a baby
clinic and other services closer to home
More investment in preventative medicine particularly massage and physiotherapists.
More emphasis on a good diet with the healthcare system leading by example
More information and involvement for families and carers if a patient has a sensory
disability so they can support communication and care of the patient
Early detection of mental health and better care and treatment, more information in
schools
People with mental health problems and dementia treated better as currently they are
treated as second class citizens and the care they receive is not appropriate
8.2.3 Calderdale Basement Project:
Calderdale Basement project provided 24 responses to the CCG plans. The project
supports people with substance misuse and is a third sector organisation based in Halifax
town centre.
Respondents comments about the plans: 10 people understand the plan, 11 thought they
did and 5 did not. From this 9 agreed with the plans with 7 not at all and 10 others stating
they thought they did.






Services should be left alone
There is not enough information about what you do and why
Why change something that works? Why do it now?
I don’t understand the plans
As long as it improves things I agree
You will do what you want anyway why ask our opinion
48
What was missing from the plans, respondents told us:




More home care from CPNs and more CPNs
More medication reviews, reviews completed more often
More home help and less focus on services in health settings or hospitals
Access to better psychiatrists
Anything else people wanted to tell us:









8.3
No one will listen to what I say anyway or we can’t influence anything
Stop messing with systems that are in place
We should know about your plans sooner, more information, more often
Listen to our suggestions
Decisions should be well thought out if money is an issue
More help and training for those carers who care at home
Keep the things that work that we have now and create more accessible services.
More holistic therapy on offer
Employ Doctors who care about us
Findings from Greater Huddersfield ‘Care Close to Home’ engagement activity
In January 2014, Greater Huddersfield CCG engaged with the public, key stakeholders,
providers and voluntary and community sector organisations in Kirklees to gain views and
ideas on their intentions to deliver care as part of Right Care, Right Time, Right Place.
The views of 202 people were gathered over this period including 60 people who attended
a stakeholder event, 112 people completing a survey and 30 people attending a Primary
Care event, all activity took place between January and February 2014. The main themes
taken from the engagement and the key points are highlighted below:
Supported self-care and prevention
 To be supported in being healthy and to be encouraged to self-care by providing access
to information, advice and support with regards to diet, exercise, support groups /
networks and who to contact for on-going support
 Individuals supported to take responsibility for their own health and wellbeing
 Provision of local, affordable gym and exercise / sport
 Early intervention through better identification of patients at risk and targeted support
Diagnosis and care planning specific themes
 Individualised care plan held electronically that can be accessed by patient and
professionals – plan needs to be outcome focused not just based on medical needs,
refreshed regularly and with a holistic approach to care while improving safety and
quality
49
Preventing admission to hospital specific themes
 Ensuring patients are fully involved in the development of their care plan and informed,
so they know what to expect, who to contact, provision of ongoing care / support and
regular reviews to help reduce the chance of a crisis occurring.
 Improve staffing at Care homes – increase staffing, ensure staff receive appropriate
training and support to improve care and prevent high turnover of staff. Consider an
increase in bed provision.
 Greater innovation and use of technology to improve outcomes and transformation
Discharge planning specific themes
 To involve patients and their families throughout the planning of their discharge. To
enable them to make an informed choice, they should be advised on what services are
available and what their options are. The approach needs to be holistic and flexible to
meet the individual needs of the patient. This should be done early enough, to ensure
that the appropriate services can be put in place. Upon discharge, patients need to know
what to expect and who to contact should they require any further advice or support.
 Greater integration of care across pathways which break down traditional barriers in
primary, community, secondary and social care
 Terminology needs to change from discharge to transfer of care. It was felt that
discharge implies that no longer receiving care; however, in most cases the care
transfers to another provider, this transfer needs to be seamless.
Overarching themes that emerged across more than one area








Regular reviews, follow ups and ongoing support and for this to be provided at home or
closer to home.
Ongoing involvement of patients and their families / carers throughout their care.
Enabling them to make informed choices and ensuring that they are provided with
information that they are able to understand. Patients need to know about their
diagnosis, what to expect, how to manage their condition, what their treatment options
are, what ongoing support or care is available and who to contact for further support.
Doing the right thing for patients and their families
Provision of care navigators
To be able to access the right services at the right time and for more services to be
available in the evening and at the weekend.
Ability for services and patients to access their patient record
Provision of a seamless / integrated service staffed by a skilled and flexible workforce
that wraps around the needs of the patient.
Improve and increase the use of technology, such as telemedicine, self-care hub,
assistive technology
50
In May 2014, a follow up event was held which further focussed on the development of an
integrated community-based service model (Care closer to home), which had been
developed using the feedback from the engagement undertaken in January 2014. 32
people attended the stakeholder event and the key themes are listed below:







The need for care and support that is co-ordinated and planned
What is needed to regain independence
Core Community Team Functions and stakeholder views on what this could look like
Ongoing Care and what this means for patients
Specialist in-reach / Out-reach and the functions of this service
Rapid response
And how to support discharge
Some of the general comments were:














Where is prevention and self-care in the model?
Care co-ordinator needs skills and experience to direct patients – anti natal, post natal,
children, and older patients – when they need it
A Single point of access needs to have access to a wide range of information (using
integrated systems) to ensure appropriate next steps/onward referral.
Specialist functions should be part of this. For example, a lot of antenatal care should
lead to higher need around postnatal depression – need access to specialist services
Need to take into account the needs of the population and the localities – it may differ
between areas as there will be pockets of various needs
Referral to be changed to access.
Role of pharmacy in prevention. How do they interact with social services care needs
based on patient feedback
Concerns – follow up appointments for procedures need to be adhered to as sometimes
they are lost in the system and forgotten about e.g. bone density scans, MRI scans
How are services going to join and be accessible 24/7 across health & social care?
There are gaps at the moment
Sharing information across agencies is key to ensuring the care navigator and anyone
else involved in the care/support of an individual
Concerns: how will Joe Public without up to date technology know where to go for help
in the first place? And get through the maze of info available?
Concerns: timetable for e.g. Occupational therapies, physiotherapy appointments, pain
management – at present this is inadequate
ALL services should be available via Choose & Book / NHS E-referral
Need to speak to deaf people/hard of hearing people/blind & visually impaired people
who all have different needs and will have some suggestions
51
8.4
Equality Monitoring
126 people partially or fully completed the equality monitoring form (see appendix 13). The
equality monitoring form was not attached to the questionnaire so unfortunately it has not
been possible to compare views held by particular protected groups.
To initially understand the validity of the data a comparison was undertaken with the local
demographics of the population.
As Calderdale CCG is co-located with the local authority the data is accurate to the 2011
census. For Greater Huddersfield CCG the data (in the most part) comes from the census
2011 which covers the Kirklees local authority area. This mean the data cannot be a direct
comparison. Any notable or expected variations will be noted.
For some equality groups we do not have local data available for comparison so national
data will be referred to.
Sex
Of the respondents 65% were women and 28% men, this means many more women
responded compared to the population locally.
%
Calderdale
Kirklees
Respondents
Men
48.9
49.4
28.0
Women
51.1
50.6
65.0
Age groups
The data for age was sourced from the mid 2011 population estimates for CCGs based on
the 2011 census, so reflects the most accurate picture for Greater Huddersfield.
There is significant difference in the under 18’s category with only 9.4% of survey
respondents compared to a population of 22-23%. This is to be expected as the under 13s
were not specifically targeted in this exercise.
There was a slight over-representation of 18-25s, 26-45 and 46-65, with reduced numbers
of the 66-80 and no over 81 year olds.
52
Age
Place
%
0-17
Calderdale
Greater
Huddersfield
Calderdale
Greater
Huddersfield
Calderdale
Greater
Huddersfield
Calderdale
Greater
Huddersfield
Calderdale
Greater
Huddersfield
Calderdale
Greater
Huddersfield
22%
18-25
26-45
46-65
66-80
81+
Respondents
No
%
22%
12
9.4
18
14
40
31.4
40
31.4
9
7
0
0
9%
11%
27%
27%
27%
26%
11%
11%
4%
4%
Ethnicity
There is a significant over representation of Pakistani populations at 19.7% compared to 7%
(Calderdale) and at 10% (Kirklees). There is a commensurate under representation of White
British at 41% compared to local populations of 87% (Calderdale) and 78% (Kirklees).
The other groups with less prominent over representation are; white other, mixed, white and
Black African and mixed, white and Asian. All other groups are under-represented. The
sample size, however was quite small at 127 people so this could be expected to some
extent, with the most notable under representation is that of Indian people.
Calderdale %
Kirklees
%
Respondents%
White:
English/
Welsh/
Scottish/
Northern
Irish/British
White:
Irish
White:
Gypsy
or Irish
Traveller
White:
Other
White
Mixed/
multiple ethnic
group: White
and Black
Caribbean
Mixed/multiple
ethnic group:
White and Black
African
86.7
0.9
0.0
2.1
0.5
0.1
76.7
0.6
0.0
1.8
1.2
0.2
41.0
0
0
4.7
0
0.78
53
Mixed/
multiple
ethnic
group:
White and
Asian
Mixed/
multiple
ethnic
group:
Other
Mixed
Asian/
Asian
British:
Indian
Asian/
Asian
British:
Pakistani
Asian/
Asian
British:
Banglad
eshi
Asian/
Asian
British:
Chinese
Asian/
Asian
British:
Other Asian
Calderdale
%
0.4
0.3
0.6
6.8
0.3
0.2
0.4
Kirklees %
0.6
0.3
4.9
9.9
0.2
0.3
0.7
0.78
0
0
19.7
0
0
0
Other
ethnic
group:
Arab
Other
ethnic
group:
Any other
ethnic
group
Respondents
%
Calderdale
%
Kirklees
%
Respondents
%
Black/
African/
Caribbean/
Black
British:
African
Black/African/
Caribbean/Black
British: Caribbean
Black/
African/
Caribbean/
Black British:
Other Black
0.2
0.2
0.0
0.1
0.2
0.6
1.1
0.2
0.3
0.4
2.4
0
0.78
0.78
0
Religion
Of those who stated they had a religion the data showed an over representation of Muslim
people 23.6% compared to 7.3% (Calderdale) and 14.5% (Kirklees), Buddhists were also
over represented but to a much lesser extent. There was a significant gap in respondents
of a Christian faith 25% compared to 56% (Calderdale) and 53% (Kirklees).
Christianity Islam Buddhist
0.3
Calderdale %
56.3
7.3
Kirklees
0.2
53.4
14.5
%
Respondents
0.78
25
23.6
%
Disability
There is limited data available about the local population of disabled people the census has
2 measures; ‘day to day activity limited a lot’ and ‘day to day activity limited a little’. The
survey respondents were asked ‘do you consider yourself to be disabled’ and 21.3%
responded yes. The data from the census recorded 17.9% (Calderdale) and 17.7%
54
(Kirklees). This was made up of people limited a lot, 8.2% (Calderdale) and 8.4 (Kirklees)
and limited a little 9.7 (Calderdale) and 9.3% (Kirklees).
In relation to the types of impairments; of those defining an impairment the majority of
respondents had a mental health condition (40%).
Calderdale
Kirklees
Day-to-day Day-to-day Respondents
activities
activities
‘do you
limited a
limited a
consider
lot
little
yourself to
be disabled’
21.3
8.2
9.7
8.4
9.3
Sexual orientation
Of the respondents 7.9% identified as lesbian (3.1%), gay man (3.93%) or bisexual (0.8%)
(LGB), this could be an over representation, however sexual orientation is not included in
the census so it is difficult to demonstrate a local picture, but in the Integrated Household
Survey, (Office of National Statistics), gave the following figures for the period April 2011 to
March 2012:

1.1 per cent of the surveyed UK population, approximately 545,000 adults, identified
themselves as Gay or Lesbian.

0.4 per cent of the surveyed UK population, approximately 220,000 adults, identified
themselves as Bisexual.

0.3 per cent identified themselves as "Other".

2.7 per cent of 16- to 24-year-olds in the UK identified themselves as Gay, Lesbian or
Bisexual compared with 0.4 per cent of 65-year-olds and over.
Gender reassignment
One of the greatest difficulties in measuring or estimating the size of the Trans population is
that no systematic or reliable data has been collected through the Census or through other
Government-sponsored surveys. However in 2011 research by GIRES concluded,
organisations should assume that 1% of their employees and service users may be
experiencing some degree of gender variance. At some stage, about 0.2% may undergo
transition. The number who have so far sought medical care is likely to be around 0.025%,
and about 0.015% are likely to have undergone transition. (Gender Identity Research and
Education Society, 2011) of the respondents to the survey none said their gender identity
was different to the sex they were assumed to be at birth.
Pregnancy and maternity
Of the respondents 0.78% said they were pregnant or had given birth in the last 6 months.
55
Carers
Of the respondents 18.1% identified themselves as carers, the 2011 census found 10.5%
(Calderdale) and 10.4% (Kirklees).
9.
Equality and diversity
The majority of the engagement activity has been equality monitored to assess the
representativeness of the communities reached during the engagement process.
The monitoring is optional and some people chose not to participate, other methods of
engagement such as the comments cards did not include equality monitoring.
Once data had been gathered it was analysed, this allowed for comparison with the local
demographic data and where possible trends in responses identified. This information is
presented in this report and will be used to contribute to the equality impact assessment for
the Right Care, Right Time, Right Place programme.
Equality monitoring is an essential part of our legal requirement to ensure we have given
due consideration to protected groups. However, as they are optional, not all equality forms
are completed fully and some not at all.
Overall through the various engagement activities 1306 equality forms were gathered. The
majority of these were through the 2 questionnaires that considered the SOC and the 5 year
strategy. The results of these is described earlier in this report.
The drop in sessions utilised a shorter equality monitoring form to understand who had
attended. This gave us the following data from the attendees who completed the form.
89 people completed the form, of which;
 55% women, 43% men
 91% White British, 3.4 % Asian
 18% were disabled
In terms of ages;
Under 18
18-45
46-65
66-75
75+
%
1
16
39
31
8
In terms of a comparison to local demographics the drop in sessions were not well attended
by people from Black and Minority Ethnic communities or by younger people.
56
Considering the reach of the engagement activity there are a number of themes;
 There was no significant difference in views on the ideas in the SOC leaflet for
different equality groups
 Most protected groups were represented; where there was over representation this
was of a group who usually have less of a voice so it benefited the programme to
hear them; where there was under representation this was of young people under 18
and some ethnicities (see recommendations)
 Drop in sessions did not attract a diverse population, possibly due to the appeal of
such activities, venue choice, timing or a perception that it does not affect them
9.1
Equality recommendations
The engagement activity has mostly met a representative sample of the majority of the local
population. It would not seem necessary to repeat the exercise to target any particular
communities to address the gaps that have emerged through the analysis. There would
however be learning for future activity;



10.
reaching the Indian population and other ethnic groups
reaching young people
considering the methodologies utilised to attract different groups
Overall findings and common themes
The engagement process carried out on behalf of the Providers and Commissioners in the
response to the case for change jointly produced findings which highlighted some common
themes. It is clear that the public see one health system and views relating to primary and
secondary care were contained in each of the engagement exercises.
The areas or aspects of care which were highlighted as being of highest importance to the
public when redesigning a health care system are as follows (these are not cited in any
order of importance):






People wanted to see more care closer to home and in a variety of community
settings
The public in Calderdale do not want to lose their A&E as part of services changing
Travel and transport needed further consideration as people could neither afford the
time to travel; the cost, or find suitable parking on premises. People want services to
be based locally
Access to services in the community needed to be 24/7 including bank holidays and
there was a strong message that GP access in particular needed to be addressed if
the system was to change. People also wanted services they could drop in to
People wanted more focus on prevention and innovative opportunities to keep
themselves well or be educated, particularly at a young age
Appropriate staff are needed in the community and this included more GP’s, district
nursing staff and those with a particular focus on a specialism or to meet the needs
of diverse communities
57






There were concerns that the model looked good on paper but would it work in
practice, this included comments relating to capacity to deliver including social care,
how information is shared and how services are coordinated
People did not understand the detail of any of the plans and wanted to understand
this further
People wanted the community to be part of the solution including design, delivery
and estates with greater community participation being the key to delivering services
for each community
Mental health services were not working and there was a need to look at services
further in both primary and community care
Hospital services were poor on waiting times and needed to improve in addition there
were a number of comments that people are discharged too early
There needs to be more consideration for vulnerable groups, protected groups,
carers and those with a disability
These themes reflect on the whole the things that people have already told us they would
like to see in the planning of future health and social care services.
Whilst staff training had been mentioned previously it was not reflected as a priority in these
engagement findings although people did want to see the right staff with the right skills in
the community model. Education and information was not described as a theme on this
occasion although the details regarding ideas for supported self-care included these areas.
Technology was cited as telephone access and sharing information in this instance and
managing risk and safeguarding were reflected in people’s experiences which varied.
11.
How the findings will be used to inform our plans
With the information we already have, the findings from the recent engagement activity and
the information we gather at the stakeholder event we will:



Further develop a ‘Community Model’ for Calderdale.
Further develop a ‘Community Model’ for Greater Huddersfield.
Inform the specification we have developed for the ‘In Hospital Model’
In addition:


The CCG governing bodies will make a decision about the next steps.
NHS England will look at our plans along with the ‘Yorkshire and Humber Clinical
Senate’ as part of the NHS England ‘Strategic Change Assurance Process’.
We will provide a full document containing all our findings and the feedback from the
engagement activity on the Right Care, Right Time, Right Place website. In addition we will
inform people of any further decisions or updates on the website. The website address is.
http://www.rightcaretimeplace.co.uk/
58
Appendix 1: CCG, Communication and Engagement Strategy
‘Right Care, Right Time, Right Place’
Communication, Engagement and
Equality Strategy and Action Plan
Commissioners’
NHS Calderdale and Greater Huddersfield
Clinical Commissioning Groups
59
1. Introduction
The purpose of the Communication, Engagement and Equality Strategy and Action Plan is
to describe our proposals for engaging with staff, the public, patients and carers on the
commissioning intentions for Calderdale and Greater Huddersfield service reconfiguration
as part of our response to the Calderdale and Huddersfield Health and Social Care
Strategic Review, ‘Right Care, Right Time, Right Place’.
The plan does this by describing the background to the review and the ‘Case for Change’, a
brief introduction to the Providers’ response to ‘Right Care, Right Time, Right Place’,
Calderdale and Greater Huddersfield commissioning intentions and our plans for delivering
engagement activity; this includes what we already know.
2. The Case for Change
The way we deliver health and social care services needs to change to make sure it can
meet current and future needs. Huge advances in medicine have changed the way we treat
illness and injury; we have a growing and an aging population; our illnesses are different
and people’s expectations of health care are growing. We know people want care closer to,
or at, home and a choice about how, when and where they’re treated.
The cost of health and social care across Calderdale and Huddersfield is now more than
£600 million a year. Growing demand, price inflation and the costs of new drugs and
treatments mean we need to look at how we spend budgets to get maximum benefit for
everyone. We need to ask some serious questions;
 Can we do things differently but maintain high quality services?
 Can we keep people out of hospital for everything but the most serious illness by
improving the way we care for them at home?
All seven organisations involved in health and social care in Calderdale and Huddersfield
are working together on the review, ‘Right Care, Right Time, Right Place’:

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
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


Calderdale and Huddersfield NHS Foundation Trust (CHFT)
Calderdale Clinical Commissioning Group (CCCG)
Calderdale Metropolitan Borough Council
Greater Huddersfield Clinical Commissioning Group (GHCCG)
Kirklees Metropolitan Borough Council
Locala Community Partnerships
South West Yorkshire Partnership Foundation Trust (SWYPT)
The review consists of four working groups attended by staff, managers and clinicians from
each of the partner organisations; each group has been tasked with identifying proposals
which will ensure we can meet the future needs of our population. The four working groups
are:
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 Integration and Personalisation - ‘Integrating services delivered in the community
and integrated commissioning and personalisation’. The vision is to improve
efficiency by removing duplication, streamlining management of services and
providing specialist care in community settings where appropriate. Working together
to change the health and care system by shifting resources towards early
intervention and prevention of health conditions while reducing duplication.
 Children - ‘Taking forward the proposals from the Children’s Care Stream’
The Children’s Care Stream has developed a 10 year vision for the transformation of
children's services: every child will have a healthy start and continue to lead a safe,
happy life with every opportunity to achieve their potential within their families and
communities.
 Capacity and Capability - ‘To deliver best in class care and support through existing
capability and capacity ‘ The working group wants to enable individuals and their
families to make informed choices about their lifestyle and management of health
conditions and improve the effectiveness and responsiveness of services so that care
providers ‘do it once’ and ‘do it well’.
 Digitisation - ‘To digitise the health and social care economy’
The working group wants to improve efficiency and to support people to live
independent lives for longer but making best use of information technology, changing
the way services are delivered and driving additional efficiency by joining up IT
systems across the health and social care economy.
3. The Providers’ response to ‘Right Care, Right Time, Right
Place’
Alongside the work taking place within the review, a Strategic Outline Case (SOC) has been
prepared in collaboration by three provider partner organisations; Calderdale and
Huddersfield Foundation Trust, Locala Community Partnerships and South West Yorkshire
Partnership NHS Foundation Trust (SWYPFT). This outline case is a response to ‘Right
Care, Right Time, Right Place’ and a review by the National Clinical Advisory Team (NCAT)
in spring 2013.
The Providers’ response describes a new model for the provision of hospital and community
services across Calderdale and Greater Huddersfield. Under this model, the three
providers would work together and closely with general practice, social care and voluntary
organisations (the third sector) to deliver integrated care and support services in the
community. This will include including moving current hospital-based services closer to
where people live.
The response states that: integrated community services would work seamlessly with
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acute and emergency services that would be based on one specialist hospital site and with
planned and elective care on a second specialist planned care hospital site. It also identifies
significant benefits to patients, services users, local people and service providers and
commissioners.
The scenarios included in the document have been drawn from a significant local, national
and international evidence base and are recommended and supported by senior doctors
and other health and social care professionals from all three providers.
It is important to recognise that the response is underpinned by a strong patient, service
user, public and stakeholder voice which will be refined and change following further
discussions and deliberations amongst the seven Strategic Review partners and the public.
The response will be subject to a separate engagement process which will be published on
the Right Care, Right Time, Right Place website. This process will describe how the
Providers’ will engage with staff, key stakeholders, public, patients and their representatives
to strengthen their proposal.
Once the findings from the Providers’ engagement have been evaluated, a report of findings
will be produced and this will further inform our commissioning intentions. We will use the
information to enable us to assess the extent to which the Providers’ response is in line with
staff, key stakeholders, public, patients and their representatives’ views and how we deliver
future services.
Until this process is complete, no decision can be taken about significant changes to the
future of services in Calderdale and Greater Huddersfield. Any decision of this significance
will be made by the commissioning organisation and not the provider and can only be made
after a period of formal consultation.
4. NHS Calderdale and Greater Huddersfield CCG
Commissioning Intentions – the Commissioners’ response
NHS Calderdale and Greater Huddersfield Clinical Commissioning Groups (CCG’s) are
responsible for commissioning a range of services in Calderdale and Greater Huddersfield.
Using the information already held on the local areas using the JSNA and working with
partners in the Health and Well Being Board, CCG’s need to ensure that their
commissioning intentions meet the needs of the local community. In order to deliver these
intentions each CCG has a five year strategy based on what they already know about the
community and the health needs in the local area.
NHS Calderdale CCG – five year strategic plan
We have developed a plan for Calderdale which sets out our five year ambition. This
ambition includes a vision for the future, which is the Commissioners’ contribution to the
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delivery of change as a partner in the Calderdale and Huddersfield Strategic Review, ‘Right
Care, Right Time, Right place’.
Our system has recognised that significant change is essential in order to ensure that
everyone gets the right care at the right time and in the right place, whilst responding to the
challenges it faces. The plan builds on our organisational aims, which are:

To Commission high quality services that are evidence based and make the most of
available resources

Seek to ensure that all Calderdale residents have access to appropriate clinical care at all
times
Encourage and enable the development of care closer to home
Continue to tackle variation in the quality of services provided to ensure improved experience
and outcomes
Improve access to and choice of services
Enhance integration and collaboration for service delivery
Improve infrastructure to support delivery
Encourage the development of supportive learning environments






In developing this plan we have maintained the integrity of our aspirations for Calderdale,
whilst ensuring we respond to the need to change the system around us. We have
developed our plans using information from The Joint Strategic Needs Assessment (JSNA)
and the Health and Well-Being Strategy for Calderdale together with information and
intelligence gathered from previous engagement and patient experience activity. In addition
we have used clinical insights and refreshed our outcomes and design principles to ensure
we will make the changes needed to deliver the outcomes for local people, ensuring
services are safe and of high quality.
The focus of our change programme over the next 5 years is to continue the shift of
services and resources from unplanned hospital care to integrated health and social care delivered in community and primary care settings. The first 3 years of our plan will be
heavily focused on work already started to create and deliver new models of unplanned and
urgent care.
We have developed a number of improvement programmes which will drive the delivery of
our ambition over the next 3-5 years. These programmes are:

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

Cardiovascular
Diabetes
Respiratory
Alcohol conditions
Musculoskeletal
Cancer & tumours
Mental health
Strategic Review
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
Better Care Fund
Each programme is described in more detail and we want to ensure that our plans reflect
the needs of our local community. The engagement activity will enable us to have more
detailed conversations on our plans and help us to understand how we can deliver these
over the next five years.
NHS Greater Huddersfield CCG – two year operational plan and five year strategic plan
NHS Greater Huddersfield CCG has developed a two year operational plan and a five year
strategic plan.
The Vision for our larger health and social care system in the next five years has been
developed in partnership with NHS North Kirklees CCG and Kirklees local authority. The
strategic planning footprint has a pivotal role in bringing together the partners to develop
proposals for transformational change. The development of the vision for our larger health
and social care system in the next five years has also been greatly influenced by our
proactive collaboration in the Calderdale and Huddersfield Strategic Review, Right Care,
right time, right Place. As a CCG, our two year strategic plan is based on our contribution to
delivery of this change.
Our system has recognised that significant change is essential because we want to ensure
that everyone gets the right care at the right time and in the right place, whilst responding to
the challenges it faces. We know that to meet current challenges, service delivery will need
to change on an unprecedented scale. Delivering care across existing systems will be a key
development for the future of service delivery and evidence suggests that a “systems
thinking approach” will be required to understand the environment and the complex
interactions within it.
NHS Greater Huddersfield Clinical Commissioning Groups (GHCCG) operational plan sets
out a unique and innovative vision of health and social care service delivery for the next two
years in this locality. GHCCG has set the development of its two year plan within the context
of the footprints in which we plan and deliver services. In developing this Plan we have
maintained the integrity of our aspirations for GHCCG. We have aligned ambitions across
our units of planning (particularly those of our economy-wide change programme) to ensure
synergy in delivery and maximise the opportunities to make large scale, sustainable
change:
The focus of our change programme over the next two years is to continue the shift of
services and resources from unplanned hospital care to integrated health and social care delivered in community and primary care settings. The first two years of our plan will be
heavily focused on work already started to create and deliver new models of unplanned and
urgent care and on our intention to provide a new model to deliver high quality, safe care
out of hospital.
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GHCCG recognise that transformational change is most likely to be achieved through the
implementation of this medium term plan and our whole system long-term commissioning
plans. Taking this longer-term perspective is crucial, as commissioners we need to develop
bold and ambitious strategies for future service delivery.
Benefits and Outcomes
The outcomes delivered by these aspirations can be characterised into a number of themes:

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
Increasing opportunities for self care
Making best use of technology and innovation
Optimising delivery in primary care
Optimising delivery in secondary care
Building community capacity to deliver better health and wellbeing
The direction of commissioning for the CCG is fully contextualised within the local area and
takes account of the holistic landscape of public sector service provision across the patch.
The innovative approaches to community engagement and involvement developed in
Greater Huddersfield provide a unique platform upon which to build locally steered and
designed services, based on the real input from local people.
As a result of this, local people can expect:

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Services delivered as close to home as possible
Improved health and wellbeing
Opportunities to have a say in the design of health and social care provision
Accessible, non-discriminatory service provision
Integrated services
Services that maximise dignity and respect for vulnerable groups
The plan sets out the pathway for the organisation to navigate a course through external
change and uncertainty towards stable, responsive and sustainable health and social care
services for Greater Huddersfield now and in the future.
What will GHCCG health economy look like in two years’ time?
In line with the strategic vision and the priorities arising from the needs assessment, the
GHCCG health and social care economy in two years’ time will have the following
characteristics:


Improved outcomes and performance
Improved safety and quality
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
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Greater integration of care across pathways in primary, community, secondary and
social care
Clinical leadership at all levels
Financial stability for all organisations, across the commissioning and provider health
and social care economy
Individuals supported to take responsibility for their own health care, through an
integrated self-care programme
Meaningful engagement of patients and communities in decision making and active
use of patient experience to improve care
Greater innovation and use of technology to drive improved outcomes and further
support transformation
Earlier intervention through better identification of patients at risk and targeted
support (Risk stratification)
Innovative forms of contracting which incentivise integration and joint delivery of
better outcomes and quality
The CCG recognises the importance of ensuring a good quality of care; this is reflected in
both the approach to quality, with a focus on clinical leadership and embedding quality
from strategic objectives to the point of care delivery. We understand that each of our
residents within Greater Huddersfield will have different health needs now and in the future
and so each and every patient journey through our services will be different. We have
created a number of models for each of these areas;




Self-management
Primary Care
Hospital Care
Community and Mental Health
Each model is described in more detail in the plan and we want to ensure that our plans
reflect the needs of our local community. The engagement activity will enable us to have
more detailed conversations on our plans and help us to understand how we can deliver
these over the next five years.
5. The purpose of the strategy and action plan
The purpose of the strategy and action plan is to provide information on our intention to
engage with the following target audiences:



Public, patients, carers and their representatives
Local Councillors and MP’s
Member practices and staff
The strategy sets out why we need to engage with the target audience on our plans – this
includes the legislation each CCG has to work from and our local approach to engagement.
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The action plan sets out the activity people can expect to take place as part of our delivery
of the engagement, the timelines involved and who will be leading on the work. This will
help people to understand what to expect from an engagement exercise, how they can be
involved and how long the process will take.
6. What have public, patients and carers already told us?
Engagement activity delivered as part of ‘Right Care, Right Time, Right place’ took place
from October 2012 to February 2013. This activity provided us with insight on a number of
key themes. The insights were supported by from three years of data collection using
information stored in PALS (Patient Advice and Liaison Service), Complaints, Patient
Opinion, NHS Choices, local and national surveys and dedicated engagement events.
During this time and to date we have been able to reach;


44 members of the public through planned care focus groups
1, 653 people via a survey about unplanned care – this included 97 web based
responses, 247 location interviews and 1,313 hard copy survey returns
 50 members of the public participated in a long term care event, and
 254 children and young people were directly engaged on unplanned care
The total number of people directly engaged in conversations was 2,002 people and we
have an engagement reach using the Clinical Commissioning Group (CCGs) relationship
matrix. The relationship matrix is a list of organisations that are willing to circulate
information to their own members. We have a profile of each organisation on the matrix
which means we can reach of 24,440 people from various localities and protected
characteristics.
In addition we combined all the data held by all seven partners’ organisations using Patient
Advice and Liaison Service (PALS), complaints, local and national surveys over the past
three years. This intelligence captured an estimated combined reach of approximately
12,000 people. This year (2013/2014) we have directly engaged with approximately 5,000
people on a variety of service areas.
All this information has been combined together to provide the programme office for the
Calderdale and Huddersfield Strategic Review, Right Care, Right Time, Right Place with
some common themes and has provided us with real insight into how services should be
provided in the future. The common themes were:





Timely and consistent access to services
Coordinated and integrated care
Services closer to home
Involve us in decisions about our care and in planning care
Better use of technology.
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In addition we have delivered the NHS national “Call to Action’ and received the views of
487 people who told us what was important to them. The public identified 13 themes, in
order of importance the themes were:

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Education and information
Invest in the community
National solutions and campaigns
Self Care
Improve access to health services
Staff and training
Working together
Regular check ups
Discharge planning and better
hospitals
Manage risk and safeguarding
More services in the community
Invest in technology
Accountability
Each of themes has been presented to the Strategic Review Programme Board in more
detail.
The commissioners have captured all this feedback and have used it as a basis for
describing their commissioning intentions.
7. Aim and objectives of the engagement activity
The aim of the engagement exercise will be to talk to key stakeholders, which includes staff,
public, patients, carers and their representatives using a series of activities to ensure our
commissioning intentions have been properly discussed and considered, and any additional
views are taken into account. This information will help us to understand our approach to
delivering the commissioning intentions and inform any future plans.
In addition, we will use the information to further inform the providers response to the way
services can be provided in the future and ensure as CCG’s we have considered the needs
of our local population from a commissioner’s perspective.
We want to describe our commissioning intentions to local people by making sure our two
strategies are available for people to read, by producing a summary document, which
includes a version in an accessible format.
Using these aims, the objectives will be:

To ensure any engagement activity is delivered in line with current legislation
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
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
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
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

To listen to a representative sample of public views on the proposals using a variety
of mechanisms to engage with people and capture views
To communicate clearly and simply the messages in an accessible format, how we
intend to commission services in the future and receive feedback on these should be
delivered
To use the information from the engagement exercise to assess the extent to which
the Providers response will deliver services in line with your views
To ensure we meet with a representative sample of the population to understand if
there are any particular impacts on the nine protected groups as defined by the
Equality Act 2010
To analyse results and identify potential trends – including those relevant to
protected groups
To provide a report of findings on the engagement process. This report will be used
to inform our plans to deliver services in the future
To provide feedback to staff, public, patients and carers on the findings of the
engagement activity
To ensure that adequate engagement has been undertaken
The engagement activity taking place to inform our plans will be delivered in conjunction
with the commissioners.
Diagram below describes the process we will use:
Case For Change
Providers’ Strategic Outline
Case
Commissioning
Intentions
Existing
Mechanisms
Drop in Sessions
Asset Based
Approach
Stakeholder Events
Development of Joint Report of findings
Stakeholder Event
Commissioners’ Service Change
Proposals
Stakeholder Event
CCGs’ Governing Body Decision
on Proposals
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8. Principles for Engagement
NHS Calderdale and Greater Huddersfield CCGs both have ‘Patient and Public
Engagement and Experience Strategies’. These strategies have been developed alongside
key stakeholders. The strategies set out the approach to engagement and what the public
can expect when we deliver any engagement activity. The principles in both strategies state
that we will;






Ensure that we engage with our public, patients and carers early enough throughout
any process
Be inclusive in our engagement activity and consider the needs of our local
population
Ensure that engagement is based on the right information and good communication
so people feel fully informed
Ensure that we are transparent in our dealings with the public and discuss things
openly and honestly
Provide a platform for people to influence our thinking and challenge our decisions
Ensure that any engagement activity is proportionate to the issue and that we provide
feedback to those who have been involved in that activity
The strategy sets out what the public can reasonably expect us to do as part of any
engagement activity and the process we need to deliver needs to preserve these principles
to ensure public expectations are preserved.
9. Legislation
Health and Social Care Act 2012
The Health and Social Care Act 2012 makes provision for Clinical Commissioning Groups
(CCGs) to establish appropriate collaborative arrangements with other CCGs, local
authorities and other partners. It also places a specific duty on CCGs to ensure that health
services are provided in a way which promotes the NHS Constitution – and to promote
awareness of the NHS Constitution.
Specifically, CCGs must involve and consult patients and the public:
 in their planning of commissioning arrangements
 in the development and consideration of proposals for changes in the commissioning
arrangements where the implementation of the proposals would have an impact on
the manner in which the services are delivered to the individuals or the range of
health services available to them, and
 In decisions affecting the operation of the commissioning arrangements where the
implementation of the decisions would (if made) have such an impact.
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The Act also updates Section 244 of the consolidated NHS Act 2006 which requires NHS
organisations to consult relevant Overview and Scrutiny Committees (OSCs) on any
proposals for a substantial development of the health service in the area of the local
authority, or a substantial variation in the provision of services.
The Equality Act 2010
The Equality Act 2010 unifies and extends previous equality legislation. Nine characteristics
are protected by the Act, age, disability, gender reassignment, marriage and civil
partnership, pregnancy and maternity, race, religion and belief, sex and sexual orientation.
Section 149 of the Equality Act 2010 states that all public authorities must have due regard
to the need to a) eliminate discrimination, harassment and victimisation, b) advance
‘equality of opportunity’, and c) foster good relations. All public authorities have this duty so
the partners will need to be assured that “due regard” has been paid through the delivery of
this strategy and in the review as a whole.
The NHS Constitution
The NHS Constitution came into force in January 2010 following the Health Act 2009. The
constitution places a statutory duty on NHS bodies and explains a number of patient rights
which are a legal entitlement protected by law. One of these rights is the right to be
involved directly or through representatives:



In the planning of healthcare services
The development and consideration of proposals for changes in the way those
services are provided, and
In the decisions to be made affecting the operation of those services
10.
Engagement
The engagement activity will be planned to capture views of local people with a specific
focus on patients currently using services, protected groups and carers. A plan proposing
the engagement activity is attached as an action plan (appendix 1).
What we already have in place
We currently have a number of mechanisms in place to capture the views of the public.
These mechanisms have already informed our commissioning intentions and will
continue to be utilised throughout this process. The current engagement mechanisms we
have in place are:

A dedicated website which will contain information on how to contact us and also
opportunities to post comments. This includes the use of social media such as
Twitter and Facebook.
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
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

PALS and complaints services who regularly capture public views as part of their
customer facing role.
We work closely with Healthwatch colleagues to ensure we listen to people’s views.
We work closely with our staff and member practices, including Patient Reference
Groups.
We review existing consumer websites including those attached to the local media,
patient opinion and NHS Choices to gather feedback.
We gather the views and opinions through national and local surveys on specific
service areas or topics.
We have a ‘Relationship Matrix’ which enables to engage with a number of key
organisations. These organisations are mapped by the target audience they reach
and the protected characteristics we cover.
In Calderdale we work closely with the third sector and have invested in ‘Health
Connections’ a third sector hub which ensures we can engage with third sector
colleagues providing support to health. Greater Huddersfield work with third Sector
leaders.
In addition Calderdale use an ‘Asset Based Approach’ to engaging our local
population, this means we train and fund local groups to talk to the public on our
behalf using the methods and approaches appropriate to that community. We work
with 44 groups in varying localities representing some of the most seldom heard
residents in our area. Greater Huddersfield work closely with local authority
colleagues to deliver similar activities.
What else do we need to do?
In order to enable the public to engage on our commissioning priorities we will need to
provide further platforms for discussion, offer stakeholders the chance to host conversations
and directly target those groups who we need specific feedback from. This will include any
groups who may have been underrepresented in any previous engagement activity.
The engagement activity will be delivered using a number of mechanisms; these are:
Drop in sessions - To ensure all members of the community we serve have an opportunity
to have their say, we will need to deliver drop in sessions in each local area. Each session
will be on different days to give as many people as possible the chance to attend. The drop
in sessions will provide a platform for the public to talk to us about our commissioning
intentions, the provider response and ‘Right Care, Right Time, Right place’. There will also
be an information stand displayed about the ideas we have in easy to understand and
accessible formats.
We recommend that we deliver 12 drop in sessions across
Calderdale and Greater Huddersfield.
Comments cards – Comments cards will be available at the drop in sessions and in other
service areas for people to write down any comments, issues or concerns they may have.
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A comments box will also be made available for the comments cards to be posted to
provide anonymity.
Media and communications - The communication channels identified in section 10 will be
used to disseminate information about the drop in sessions and will describe any other
opportunities for involvement. In addition a contact name and number will be provided for
members of the public to contact should they need more information. The media support
required includes:




Sign-post people to websites where they can receive more information and
provide comment
Provide a contact point for anyone requesting a presentation or discussion on our
commissioning intentions
Social media feeds
Media releases and liaison
Existing networks - In addition we need to capture people’s view through engagement and
conversation and we can use our networks and existing platforms to host conversations and
ensure comments and views are captured on the proposals by circulating a summary
document and attaching a short questionnaire. We can use third sector organisations and
membership networks to deliver this.
Stakeholder events – Two joint stakeholder events will be organised following the
engagement with wider target audiences. These events are displayed in the diagram on
page 12. The events will form part of the engagement process and ensure that key
stakeholders are engaged in the development of any proposals. The first stakeholder event
will be set up to consider the information we have collected jointly, the second event will be
to present the proposals we have developed following the first event.
To ensure we capture a representative sample of community views we will equality monitor
at all engagement activity intervention. This will enable us to reach protected groups who
may have different experiences of health and social care services, where we do not reach
those protected groups we will specifically target engagement to reach them.
11.
Communication
Communication channels identified in this section will be used to disseminate information
and will provide opportunities for patients and the public to provide their views.
The methods below will also be supported by the communication leads for each
organisation using a central team within the Programme Management Office to produce
press releases, content for social media, intranet and internet sites and staff engagement.
We will use the following delivery methods to reach each of the named target audiences:
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Target Audience
Service users, general public, third
sector
OSC/Health and Wellbeing boards
Staff
Healthwatch
Elected members / Councillors

Partners’ intranets, websites and social
media platforms
 Relationship matrix
 Patient Reference Groups
 Third Sector umbrella organisations.
 Patient groups
 Carers groups
Meetings/ briefings
 Internal bulletins
 Staff Intranets
 Cascades at meetings through managers.

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

Media
12.
Delivery Method
Email and personal discussions
Newsletter articles
Information to be circulated electronically –
explanatory email with a link to web survey
Proactive media releases
briefings
Social media
Equality
All engagement activity will be equality monitored to assess the representativeness of the
views gathered during the engagement process. Where there are gaps in gathering the
views of specific groups relating to the protected characteristics, this will need to be
addressed.
The engagement activity is required to identify trends in opinion and these will form part of
the engagement process with findings feeding directly into the Equality Impact Assessment.
To ensure we have given due consideration to equality issues we will undertake a full
Equality Impact Assessment (EQIA) on the results of our engagement and detail the
process we have undertaken to ensure we are full informed about any adverse impact or
consequence for any group. This will ensure we have the potential to improve equality
outcomes.
13.
Non pay budget required
We have already identified a budget, which will deliver the engagement on the Providers’
response. We will work together on the drop in sessions and these have already been
accounted for in the Providers’ engagement plan. The budget set out below highlights the
additional costs required.
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Engagement Phase Budget
Commissioning Intentions
Summary document to be developed and accessible formats created
£2,000.00
Events display materials and presentations
Maximum additional total budget required
£2,000.00
£4,000.00
14.
Analysis of data and presentation of findings
We will fully utilise all existing engagement intelligence and ensure that we have gathered
and considered previous information to inform the process.
Once the proposed engagement activity has taken place we will ensure that all recent and
existing intelligence is captured into one report, this will include engagement activity
delivered as part of the Providers’ response. This report will provide an overview of the
views of staff, public, patients and carers.
This report will be received through internal reporting mechanisms and a decision will be
made on the next steps. The report and decision will be shared with providers.
15.
How the findings will be used to inform our plans
With the information we already have, the findings from the recent engagement activity and
the information we gather at the stakeholder event we will:
 Further develop a ‘Community Model’ for Calderdale.
 Further develop a ‘Community Model’ for Greater Huddersfield.
 Inform the specification we have developed for the ‘In Hospital Model’
In addition:


The CCG governing bodies will make a decision about the next steps.
NHS England will look at our plans along with the ‘Yorkshire and Humber Clinical
Senate’ as part of the NHS England ‘Strategic Change Assurance Process’.
We will provide a full document containing all our findings and the feedback from the
engagement activity on the Right Care, Right Time, Right Place website. In addition we will
inform people of any further decisions or updates on the website. The website address is.
http://www.rightcaretimeplace.co.uk/
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Appendix 2: Provider, Communications and Engagement Strategy
Right Care, Right Time, Right Place
Communication, Engagement and
Equality Strategy and Action Plan
Providers’
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Introduction
The purpose of the Communication, Engagement and Equality Strategy and Action Plan is
to describe our proposals for engaging with staff, the public, patients and carers on the
Providers’ response to ‘Right Care, Right Time, Right Place’.
The strategy does this by describing the background to the Strategic Review through the
Case for Change, The Strategic Outline Case and the CCG’s intentions. The document
tells you about our plans for delivering engagement activity which includes a brief summary
of what people have already told us.
The Case for Change
The way we deliver health and social care services needs to change to make sure it can
meet current and future needs. Huge advances in medicine have changed the way we treat
illness and injury; we have a growing and an aging population; our illnesses are different
and people’s expectations of health care are growing. We know people want care closer to,
or at, home and a choice about how, when and where they’re treated.
The cost of health and social care across Calderdale and Huddersfield is now more than
£600 million a year. Growing demand, price inflation and the costs of new drugs and
treatments mean we need to look at how we spend budgets to get maximum benefit for
everyone. We need to ask some serious questions;


Can we do things differently but maintain high quality services?
Can we keep people out of hospital for everything but the most serious illness by
improving the way we care for them at home?
All seven organisations involved in health and social care in Calderdale and Huddersfield
are working together on the review, ‘Right Care, Right Time, Right Place’:

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



Calderdale and Huddersfield NHS Foundation Trust (CHFT)
Calderdale Clinical Commissioning Group (CCCG)
Calderdale Metropolitan Borough Council
Greater Huddersfield Clinical Commissioning Group (GHCCG)
Kirklees Council
Locala Community Partnerships
South West Yorkshire Partnership Foundation Trust (SWYPT).
The review consists of four working groups attended by staff, managers and clinicians from
each of the partner organisations; each group has been tasked with identifying proposals
which will ensure we can meet the future needs of our population. The four working groups
are:
 Integration and Personalisation - ‘Integrating services delivered in the community
and integrated commissioning and personalisation’. The vision is to improve
efficiency by removing duplication, streamlining management of services and
providing specialist care in community settings where appropriate. Working together
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to change the health and care system by shifting resources towards early
intervention and prevention of health conditions while reducing duplication.
 Children - ‘Taking forward the proposals from the Children’s Care Stream’
The Children’s Care Stream has developed a 10 year vision for the transformation of
children's services: every child will have a healthy start and continue to lead a safe,
happy life with every opportunity to achieve their potential within their families and
communities.
 Capacity and Capability - ‘To deliver best in class care and support through existing
capability and capacity ‘ The working group wants to enable individuals and their
families to make informed choices about their lifestyle and management of health
conditions and improve the effectiveness and responsiveness of services so that care
providers ‘do it once’ and ‘do it well’.
 Digitisation - ‘To digitise the health and social care economy’
The working group wants to improve efficiency and to support people to live
independent lives for longer but making best use of information technology, changing
the way services are delivered and driving additional efficiency by joining up IT
systems across the health and social care economy.
Calderdale and Greater Huddersfield Commissioning Intentions
– The Commissioners’ response
Calderdale and Greater Huddersfield CCG are the commissioners for the local area. The
commissioners buy services on behalf of the local population of Calderdale and Greater
Huddersfield from providers. Providers include Calderdale and Huddersfield Foundation
Trust, Locala and South West Yorkshire Foundation Trust. The CCG also work with the
local authority to ensure services are provided in partnership.
Each CCG has a five year strategy in place, this strategy takes into account national and
local priorities. These priorities need to be delivered using the finances allocated whilst
achieving the necessary outcomes and improvements. The strategic review takes account
of these priorities and supports delivery in a partnership approach.
The CCG are responsible for engagement on their commissioning intentions and this
activity will also take place at the same time as the provider engagement on ‘Right Care,
Right Time, Right Place’.
The Providers’ response to ‘Right Care, Right Time, Right Place’
Alongside the work taking place within the review, as Providers’ we have prepared a
Strategic Outline Case (SOC) in collaboration with our three provider partner organisations;
Calderdale and Huddersfield Foundation Trust, Locala Community Partnerships and South
West Yorkshire Partnership NHS Foundation Trust (SWYPFT). This outline case is a
response to ‘Right Care, Right Time, Right Place’ and a review by the National Clinical
Advisory Team (NCAT) in spring 2013.
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The Providers’ response describes a new model for the provision of hospital and community
services across Calderdale and Greater Huddersfield. Under this model, the three
providers would work together and closely with general practice, social care and voluntary
organisations (the third sector) to deliver integrated care and support services in the
community. This will include including moving current hospital-based services closer to
where people live.
The response states that: integrated community services would work seamlessly with
acute and emergency services that would be based on one specialist hospital site and with
planned and elective care on a second specialist planned care hospital site. It also identifies
significant benefits to patients, services users, local people and service providers and
commissioners.
The scenarios included in the document have been drawn from a significant local, national
and international evidence base and are recommended and supported by senior doctors
and other health and social care professionals from all three providers.
It is important to recognise that the response is underpinned by a strong patient, service
user, public and stakeholder voice which will be refined and change following further
discussions and deliberations amongst the seven Strategic Review partners and the public.
The response will be subject to a separate engagement process which will be published on
the Strategic Review website. This process will describe how the Providers’ will engage
with staff, key stakeholders, public, patients and their representatives to strengthen their
proposal.
Once the findings from the Providers’ engagement have been evaluated, a report of findings
will be produced and this will further inform our commissioning intentions. We will use the
information to enable us to assess the extent to which the Providers’ response is in line with
staff, key stakeholders, public, patients and their representatives’ views and how we deliver
future services.
Until this process is complete, no decision can be taken about significant changes to the
future of services in Calderdale and Greater Huddersfield. Any decision of this significance
will be made by the commissioning organisation and not the provider and can only be made
after a period of formal consultation.
The purpose of the Strategy and Action Plan
The purpose of the Communication, Engagement and Equality strategy and action plan is to
provide information on our intention to engage with the following target audiences:

Key stakeholders including partner organisations
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


Staff
Public, patients, carers and their representatives
Local Councillors and MP’s
The strategy sets out why we need to engage with the public on our plans - which includes
the legislation we need to work within. We want to involve as many people as possible to
strengthen our plans.
The action plan sets out the activity people can expect to take place as part of our delivery
of the strategy, the timelines involved and who will be leading on the work. This will help
people to understand what to expect from an engagement exercise, how they can be
involved and how long the process will take.
What have public, patients and carers already told us?
We have used information already gathered from staff, public, patient’s carers and their
representatives from the last 18 months. This engagement activity delivered as part of the
‘Right Care, Right Time, Right Place’ took place from October 2012 to February 2013 and
has been used to inform our response.
This activity reports provided us with insight on a number of key themes. These insights
were supported by from three years of data collection using information stored in PALS
(Patient Advice and Liaison Service), Complaints, Patient Opinion, NHS Choices, local and
national surveys and dedicated engagement events. During this time and to date the review
reached;




44 members of the public through planned care focus groups.
1, 653 people via a survey about unplanned care – this included 97 web based
responses, 247 location interviews and 1,313 hard copy survey returns.
50 members of the public participated in a long term care event, and
254 children and young people were directly engaged on unplanned care.
The total number of people directly engaged in conversations was 2,002 people and an
engagement reach using the Clinical Commissioning Group (CCGs) relationship matrix.
The Relationship Matrix is a list of organisations that are willing to circulate information to
their own members. The matrix has a profile of each organisation on the which means we
can reach of 24,440 people from various localities and protected characteristics.
In addition we combined all the data held by all seven partner organisations using Patient
Advice and Liaison Service (PALS), complaints, local and national surveys over the past
three years. This intelligence captured an estimated combined reach of approximately
12,000 people. This year (2013/2014) we have directly engaged with approximately 5,000
people on a variety of service areas.
All this information has been combined together to provide us with some common themes
and real insight into how services should be provided in the future. The common themes
were:
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




Timely and consistent access to services
Coordinated and integrated care
Services closer to home
Involve us in decisions about our care and in planning care
Better use of technology.
In addition the local NHS national “Call to Action’ engagement activity received the views of
487 people across Calderdale and Greater Huddersfield. The public identified 13 themes,
in order of importance the themes were:
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Education and information
Invest in the community
National solutions and campaigns
Self Care
Improve access to health services
Staff and training
Working together
Regular check ups
Discharge planning and better
hospitals
Manage risk and safeguarding
More services in the community
Invest in technology
Accountability
We have captured all this feedback and it has been used as a basis for describing the
landscape of health and social care services in the future from a provider perspective.
Aim and objectives of the engagement activity
The aim of the engagement exercise will be to communicate and engage with key
stakeholders on our response to ‘Right Care, Right Time, Right Place’.
The target audiences will include professionals, clinicians, staff, public, patients, carers and
their representatives and we will use a number of mechanisms and key activities to deliver
this. We want to share what people have already told us and listen to people’s views so we
can ensure we have captured as many views as possible.
By engaging in this way we can ensure any plans have been properly discussed and
everyone’s views have been considered. We need to ensure that we give ‘intelligent
consideration’ to our findings to ensure we can evidence how the intelligence has informed
our plans.
Using these aims, the objectives will be:
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




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


To communicate clearly and simply the messages in an accessible format, how our
plans will deliver services for residents, staff and service users living in both
Calderdale and Greater Huddersfield.
To listen to public views on the plans using a variety of mechanisms to engage with
people and capture views.
To actively engage with current service users and staff to understand in more detail
their views and the direct impact they may have on those currently working for, and
using a service.
To ensure we meet with a representative sample of the population to understand if
there are any particular impacts on the nine protected groups as defined by the
Equality Act 2010.
To analyse and identify key themes from what residents, staff and service users have
told us so - including those relevant to protected groups.
To provide a report of findings on the engagement process, which will help inform the
development of proposals, which will be subject to a formal consultation.
To provide feedback to staff, public, patients and carers on the findings of the
engagement activity.
To ensure any engagement activity is delivered in line with current legislation.
To ensure that adequate engagement has been undertaken .
The engagement activity taking place to inform our plans will be delivered in conjunction
with the commissioners. The diagram describes the process we will use:
Case For Change
Providers’ Strategic Outline
Case
Commissioning
Intentions
Existing
Mechanisms
Drop in Sessions
Asset Based
Approach
Stakeholder
Events
Development of Joint Report of
findings
Stakeholder Event
Commissioners’ Service Change
Proposals
Stakeholder Event
CCGs’ Governing Body Decision
on Proposals
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Legislation
Health and Social Care Act 2012
The Health and Social Care Act 2012 makes provision for Clinical Commissioning Groups
(CCGs) to establish appropriate collaborative arrangements with other CCGs, local
authorities and other partners. It also places a specific duty on CCGs to ensure that health
services are provided in a way which promotes the NHS Constitution – and to promote
awareness of the NHS Constitution.
Specifically, CCGs must involve and consult patients and the public:
 in their planning of commissioning arrangements
 in the development and consideration of proposals for changes in the commissioning
arrangements where the implementation of the proposals would have an impact on
the manner in which the services are delivered to the individuals or the range of
health services available to them, and
 in decisions affecting the operation of the commissioning arrangements where the
implementation of the decisions would (if made) have such an impact.
The Act also updates Section 244 of the consolidated NHS Act 2006 which requires NHS
organisations to consult relevant Overview and Scrutiny Committees (OSCs) on any
proposals for a substantial development of the health service in the area of the local
authority, or a substantial variation in the provision of services.
The Equality Act 2010
The Equality Act 2010 unifies and extends previous equality legislation. Nine characteristics
are protected by the Act, age, disability, gender reassignment, marriage and civil
partnership, pregnancy and maternity, race, religion and belief, sex and sexual orientation.
Section 149 of the Equality Act 2010 states that all public authorities must have due regard
to the need to a) eliminate discrimination, harassment and victimisation, b) advance
‘equality of opportunity’, and c) foster good relations. All public authorities have this duty so
the partners will need to be assured that “due regard” has been paid through the delivery of
this strategy and in the review as a whole.
The NHS Constitution
The NHS Constitution came into force in January 2010 following the Health Act 2009. The
constitution places a statutory duty on NHS bodies and explains a number of patient rights
which are a legal entitlement protected by law. One of these rights is the right to be
involved directly or through representatives:
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

In the planning of healthcare services
The development and consideration of proposals for changes in the way those
services are provided, and
In the decisions to be made affecting the operation of those services.
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Engagement
The engagement activity will be planned to capture views of staff and local people with a
specific focus on protected groups and carers. A plan proposing the engagement activity is
attached as an action plan (appendix 1).
What we already have in place
We currently have a number of mechanisms in place to capture the views of the public.
These mechanisms will continue to be utilised throughout this process. The current
engagement mechanisms are:
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Local councillors and MP’s have been kept up to date with briefings and a log of all
conversations and contact has been established.
Overview and Scrutiny Committees and Health and Well Being Boards are
being kept up to date with our plans through presentations and briefings.
PALS and complaints services have been fully briefed and they will capture public
views as part of their customer facing role.
We are working closely with Healthwatch colleagues to ensure we provide
consistent messages to the public and capture views on a day to day basis.
We will trawl existing consumer websites including those attached to the local
media, patient opinion and NHS Choices to gather feedback.
What else do we need to do?
In order to enable the public to engage with us we will need to provide further platforms for
discussion, offer stakeholders the chance to host conversations and directly target those
groups who we need specific feedback from. This will include any groups who may have
been underrepresented in any previous engagement activity.
The engagement activity will be delivered using a number of mechanisms and will need full
commitment from all partners to providing staffing and appropriate key speakers as
required. The engagement mechanisms will be:
Drop in sessions - To ensure all members of the community we serve have an opportunity
to have their say, we will need to deliver drop in sessions in each local area. Each session
will be on different days and dates to give as many people as possible the chance to attend.
The drop in sessions will provide a platform for the public to talk to us about the proposals
and for staff to listen to peoples’ views. There will also be an information stand displayed in
easy to understand and accessible formats. We recommend that we deliver 12 drop in
sessions across Calderdale and Greater Huddersfield to cover a number of geographical
locations.
Comments cards – comments cards will be available at the drop in sessions and in other
service areas for people to write down any comments, issues or concerns they may have.
A comments box will also be made available for the comments cards to be posted to
provide anonymity.
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Media and communications - The communication channels identified in section 10 will be
used to disseminate information about the drop in sessions and will describe any other
opportunities for involvement. In addition a contact name and number will be provided for
members of the public to contact should they need more information. The media support
required includes:
 Posters in key locations to promote the engagement and advertise the drop in
sessions
 Sign-post people to websites where they can receive more information and provide
comment
 Social media feeds
 Media releases and liaison
Existing networks - In addition we need to capture people’s view through engagement and
conversation and we can use our networks and existing platforms to host conversations and
ensure comments and views are captured on the proposals by circulating a summary
document and attaching a short questionnaire. We can use third sector organisations and
membership networks to deliver this. To be able to ensure we capture a representative
sample of community views we will equality monitor at each engagement activity
intervention. This will enable us to ensure we reach protected groups who may have
different experiences of health and social care services, and where we do not we will
specifically target engagement to reach them.
Staff engagement – we will be using the same material to engage staff. We will build on
existing platforms in organisations and utilise notice boards, websites, staff briefings, local
intranets through partner organisations.
Political stakeholders – We will write to core MPs to offer monthly informal briefings to
keep them abreast of progress with the strategic review and address any specific questions
they may have. In this letter we will also inform them in advance of any new material being
posted on our website. In addition we will write to the elected members of each council via
the appropriate officers offering a similar approach. This will be in addition to reacting as
appropriate to any suggestions for alternative approaches the MPs and/or elected members
may suggest.
Staff, clinicians and professionals – We will engage with key stakeholders through a
number of key stakeholder events which will focus on key themes. The key themes will be:
 Locality and community model
 Specialist hospital sites
 How will self-care work
 Emergency and urgent care
 Community hubs
 Non-financial appraisal criteria
Stakeholder events – Two joint stakeholder events will be organised following the
engagement with wider target audiences. These events are displayed in the diagram on
page 12. The events will form part of the engagement process and ensure that key
stakeholders are engaged in the development of any proposals. The first stakeholder event
85
will be set up to consider the information we have collected jointly, the second event will be
to present the proposals we have developed following the first event.
To ensure we capture a representative sample of community views we will equality monitor
at all engagement activity intervention. This will enable us to reach protected groups who
may have different experiences of health and social care services, where we do not reach
those protected groups we will specifically target engagement to reach them.
Communication
Current communication channels will be utilised to reach service users, the public and
stakeholders to distribute information and to raise awareness of the activity taking place so
this will support the engagement process. In addition a communication plan will be
developed which supports future communications with key stakeholders. This will include a
number of activities including:

Development of a media release to let people know how we intend to engage with
patients, public and other stakeholders. Build messaging about our approach to
engagement into on-going media liaison opportunities

Supporting the production and distribution of the engagement document for use in
engagement meetings and events including any supporting media like Q&A
documents.

Work with communications colleagues to develop further collateral to explain the
Providers’ response.
The methods below will also be supported by the communication leads for each
organisation that will collectively agree content for social media, intranet and internet sites
and staff engagement. In summary we will use the following delivery methods to reach
each of the named target audiences; these will be described in more detail in the
communication plan:
Target Audience
Service users, general public, third
sector
OSC/Health and Wellbeing boards
Staff
Healthwatch
Delivery Method

Partners’ intranets, websites and social
media platforms
 Partners’ membership forums
 Relationship matrix
 Patient Reference Groups
 Third Sector umbrella organisations.
 Patient groups
 Carers groups
Meetings/ briefings
 Internal bulletins
 Staff Intranets
 Cascades at meetings through managers.
Briefing meeting
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Elected members / Councillors
Local Professional Committees
Media
Email and personal discussions
Newsletter articles
Information to be circulated electronically –
explanatory email with a link to web survey
Information to be circulated electronically. Face to
face discussions to be offered to LMCs etc.
Proactive media releases
briefings
Social media
Equality
All engagement activity will be equality monitored to assess the representativeness of the
views gathered during the engagement process. Where there are gaps in gathering the
views of specific groups relating to the protected characteristics, this will need to be
addressed prior to any formal consultation.
The engagement activity is required to identify trends in opinion and these will form part of
the engagement process with findings feeding directly into the Equality Impact Assessment
for the Full Business Case.
To ensure we have given due consideration to equality issues we will undertake a full
Equality Impact Assessment (EQIA) on the results of our engagement and detail the
process we have undertaken to ensure we are full informed about any adverse impact or
consequence for any group. This will ensure we have the potential to improve equality
outcomes.
Non pay budget required
Engagement Phase Budget
Providers’ response to ‘Right Care, Right Time. Right Place’
Item
Community Champions/Community Assets - KMBC
Community assets – Calderdale CCG
Children and Young People specific engagement - KMBC
Children and Young People specific engagement - Calderdale
Venue Hire – 4 for Calderdale (upper and lower valley, central and
north) – 5 for Greater Huddersfield (town centre, Denby Dale, Holmfirth,
Slaithwaite, Salendine Nook) including refreshments
Interpreters
Engagement document (low key) – Leaflet, summary document,
questionnaire, design, printing, electronic format.
Accessible formats – language, large print, Braille and easy read
Posters in GP practices and localities
Events display materials and presentations
Estimated
Cost
£10,000.00
£7,500.00
£ 2,000.00
Funded
£5,000.00
£500.00
£4,000.00
£500.00
£1,000.00
£2,000.00
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Press adverts
Radio Phoenix
£2,000.00
Free
Maximum total budget required
34,500.00
Analysis of data and presentation of findings
We will fully utilise all existing engagement intelligence and ensure that we have gathered
and considered previous information to inform the process.
Once the proposed engagement activity has taken place we will ensure that all recent and
existing intelligence is captured into one report. This report will provide an overview of the
views of staff, public, patients and carers on the proposals.
This report will be received through internal reporting mechanisms and a decision will be
made on the next steps which may include a formal consultation process. A
Communications, ‘Engagement and Equality Formal Consultation Plan’ will then be
developed to accompany this process.
How the findings will be used to inform our plans
We have already used the views of the staff, public, patients, carers and stakeholders to
inform our plans. This information is identified in section 6, ‘What have staff, the public,
patients and carers already told us?’
The next stage of engagement will be to help us to understand if what people have already
told us is all we need to consider when developing further plans. We need to ensure that
we provide platforms for engagement to test out our thinking and identify if there is anything
else we should consider. This information will be used to further inform the development of
future proposals. The process for ensuring we intelligently consider views is highlighted in
the stages listed below:

Stage 1 – (Autumn 2013) Develop scenarios based on what we already know and
what staff, public, patient’s carers and stakeholders have already told us. This will be
achieved through analysing the information we already have.

Stage 2 – (April – June 2014) Engage further with staff, the public, patients, carers
and stakeholders to understand if we have considered everything.

Stage 3 – (June –July 2014) Test our proposals using two stakeholder events and
assurance from the Consultation Institute.
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Appendix 3
Calderdale and Huddersfield Strategic Review - Engagement Stage April, May and June 2014.
Drop in sessions – Calderdale and Greater Huddersfield
Catchment Area
Drop in Location
Date of meeting
Time of meeting
North Halifax
New Beginnings @Threeways
Thursday 10th April 2014
2pm - 7pm
Fartown
Fartown Village Hall
Tuesday 8th April 2014
2pm – 7pm
Catchment Area
Drop in Location
Date of meeting
Time of meeting
Salendine Nook
Salendine Nook YMCA
Wednesday 28th May
2pm - 7pm
Slaithwaite
Slaithwaite Civic Hall
Friday 30th May
2pm -7pm
Upper Valley
Mytholmroyd Community Centre
Monday 2nd June 2014
2pm – 7pm
Fartown
Fartown Village Hall
Tuesday 3rd June 2014
2pm – 7pm
Lower Valley
Brighouse Civic Hall
Wednesday 4th June 2014
2pm-7pm
Denby
Kirkburton “The Hub”
Thursday 5th June 2014
2pm – 7pm
Central Halifax
Hanson Lane Enterprise Centre
Monday 9th June 2014
2pm – 7pm
North Halifax
New Beginnings @Threeways
Tuesday 10th June
2pm – 7pm
Holmfirth
Holmfirth Civic Hall
Wednesday 11th June
2pm-7pm
Todmorden
Todmorden Health Centre
Thursday 12th June
2pm – 7pm
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Asset Based Approach – Planned Activities - Greater Huddersfield from 1st April – 31st May
Group / Forum
Contact Existing /
New
Description
Location
Protected
Characteristics
Engagement Officer
Best Time To
Engage
Estimated
numbers
Sister Shout
Existing
Lesbian Support Group
Town Centre
Yes
Carmen-
Tuesday Eve
10
HUGG
Existing
Huddersfield Gay Group
Town Centre
Yes
Carmen
Wednesday Eve
22
Chinese Community
Centre
Existing
Social Hub for Chinese
Community in South Kirklees
Town Centre
Yes
Carmen
Awaiting response
10
APNA Health
Existing
South Asian community
Health Support Group
Springwood Temple
Yes
Carmen with Sally
Awaiting date
50
Kurdish School
Existing
Women and children
South Kirklees
Yes
Carmen
9th April – 12 noon
10
Huddersfield Deaf
Community
Existing
Huddersfield Centre for the
Deaf
Huddersfield Town
Centre
Yes
Carmen with Sally
1st May at 6pm
20
Huddersfield African
Caribbean Cultural
Trust
Existing
Huddersfield Caribbean
Carnival/promotion of
Caribbean culture in schools
and amongst young people
and the community.
Huddersfield Town
Centre
Yes
Rebecca
Evening
7
Ahmadiyya Muslim
Association
Existing
Faith Group and Health
Focus
Birkby
Yes
Both male and female
groups
Rebecca and Laila
Friday Daytime
70
REACH project
Existing
Support for Asylum Seekers
and Refugees
New North Baptist
Church
New North Parade
Huddersfield
Sarli
15 April 2014
11.30am
15-20
Moldgreen United
Reformed Church
Yes
Jeremy
Tuesday morning end
April/Early May 2014
10
Kirklees Volunteer
Centre
Huddersfield town
centre
Yes
Rebecca
Flexible
Huddersfield town
centre Pack Horse
Centre
Polish Parish
Huddersfield
Thornton Lodge
Yes
Rebecca and Carmen
Once a month on a
Thursday evening
Up to 70
Yes
Rebecca and Sally
Up to 20
Yes
Sarli
Tues lunch time every
fortnight
Monday Lunchtime
Crosland Moor
Yes
Sarli
To be confirmed
15
Yes
Sarli
Tbc
12
Moldgreen United
Reformed Church
Friendship Centre
Existing
Kirklees Visually
impaired network
Existing
Womens Institute
Central Huddersfield
Existing
Polish Elderly group
Existing
Huddersfield Pakistani
Association
Friends of Beaumont
Park
Existing
Friendship and Support
group for individuals and
family with mental health
issues
KVIN is run by and for
visually impaired people. To
improve the health and well
being of blind and partially
sighted people
Membership organisation for
womens involvement and
learning
Luncheon group and support
group
Older people luncheon group
Existing
Park Support
Volunteers Together
Existing
Asylum support group
Kirklees-wide
Yes
10-20
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Group / Forum
Contact Existing /
New
Description
Location
Protected
Characteristics
Engagement Officer
Best Time To
Engage
Estimated
numbers
Agewell
Existing
Fartown
Yes
Jeremy and Nisar
Existing
Birkby
Yes
Jeremy and Habi
April
8th May 2014
April
th
7 May 2014
25
Birkby Croft
Older peoples support group
mixed ethnicity
Sikh and South Asian
Women support group
Jigsaw / Young Adults
with Physical
Disabilities
Hillhouse Gurdwara
Existing
Employment support for
people with disabilities
South Kirklees
Yes
Jeremy
7th may 1.30pm
hudds mission
15
Existing
Sikh Temple involved in T.B
focus group. Interest in health
work identified
Hillhouse
Yes
Jeremy and Sarli
Women’s Sewing
Group – South Asian
Women
Existing
Sewing – Peer support
emotional health and
wellbeing
Birkby
Yes
Linda
Monday a.m
April/May 2014
10
One stop shop, Birkby
Existing
South Asian Women
attending one stop shop
Birkby
Yes
Linda
Thursday PM
April/May 2014
10
Birkby/Paddock Family
Forum
Existing
Birkby/Paddock
Yes
Linda
Wednesday AM
April/May 2014
12
Sahaylees Netball
Existing
Diverse group of parents
wishing develop activities for
the community
Sport Fitness. South Asian
Women
Birkby
Yes
Linda
Flexible
April/May 2014
10
35
25
15
91
Asset Based Approach Planned Activities – Calderdale from 1ST April – May 2014
Group / Forum
Contact Existing / New
Description
Location
Forum 50+
Northowram over
50’s
Southowram over
50’s
WAC
Women’s Centre
Crisis Pregnancy
Care
British Muslim
Association
Integrate
Interfaith Council
C COM
Carers project
Existing
Existing
Network of older people
Group meeting
Existing
St Augustines Centre
Existing
Pennine Magpie
Existing
Disability Partnership
Existing
Disability Support
Calderdale
Dialogue Groups
SWYFT
Existing
Ver di Gris
Engagement Officer
Best Time To Engage
Estimated numbers
Calderdale
Town ward
Protected
Characteristics
Age - older
Age – older
Soo
Hanif
Asset to decide
Tuesday Morning
tbc
tbc
Group meeting
Town Ward
Age-older
Hanif
Thursday afternoon
tbc
Existing
Existing
Existing
Day care centre
Drop in centre
Drop in centre
Central Halifax
Calderdale
Calderdale
Age- older/BME
Women/gender
Women/gender
Sajid
Helen
Val
Asset to decide
Asset to decide
Asset to decide
50
tbc
10
Existing
Day care centre
Central Halifax
Religion/ethnicity
Rahoof
Asset to decide
50
Existing
Existing
Existing
Existing
Group meeting
Network of faith groups
Network of mosques
Support groups for carers
in Calderdale
Central drop in facility with
community cafe.
Day care for young people
with a learning/physical
disability
Network of people with a
disability.
Support group for people
with a disability
Monthly meeting for mental
health service users and
carers.
Arts group for older people
with Dementia
Youth club for young
people
Todmorden
Calderdale
Calderdale
Calderdale
BME
Religion – all faiths
Religion – muslim faith
Carer
Nadeem
Hanif
Sail
Wendy
50
100
tbc
tbc
Calderdale
Asylum seekers &
refugees
Disability – Young
people
Laura
Asset to decide
Asset to decide
Asset to decide
Various support
groups in April
Cafe Wednesday – 12
noon
Asset to decide
Calderdale
Disability - all
Hanif
tbc
Calderdale
Disability - all
David
2nd Tuesday evening
in May
Asset to decide
Calderdale
Mental Health/carers
Aboo
Monthly – April/May
tbc
Calderdale
Mental Health/Age
Jeff
Asset to decide
tbc
Pye Nest / Sowerby
Bridge
Young People
Rod
Asset to decide
50
Calderdale
Young People
Asad
Asset to decide
50
North Halifax
Young People
Sarah
Asset to decide
tbc
Calderdale
Young people
Anne Gomersall
Asset to decide
tbc
Calderdale
Young People
Rahat
Asset to decide
tbc
Calderdale
Substance misuse
Mary
Asset to decide
30
Calderdale
Substance misuse
Hanif
Asset to decide
tbc
Existing
Existing
Pavilion in the Park
Existing
Calderdale Reds
Existing
St Georges Youth
Club
CY3P
Existing
Himmat
Existing
Project Colt
Existing
Basement Project
Existing
Existing
Youth club for young
people
Youth club for young
people
Engagement project for
young people
Youth provision for
excluded young people
Drop in support group for
people with substance
misuse.
Drop in support group for
people with substance
misuse.
Calderdale
Jill
tbc
tbc
60
92
Asset Based Approach Planned Activities – Calderdale from 1ST April – May 2014
Group / Forum
Contact Existing / New
Description
Location
Protected
Characteristics
Geographical
representation
Geographical
representation
Geographical
representation
Geographical
representation
Geographical
representation
Engagement Officer
Best Time To Engage
Estimated numbers
NBCC
Existing
Community Hub
Rastrick CC
Existing
Community Hub
North Halifax Ovenden
Lower Valley
Colin/Roy
Asset to decide
50
Jason
Asset to decide
50
Halifax Opportunities
Trust
Boothtown
Partnership
Mixenden Resource
Centre
Existing
Community Hub
Central Halifax
Abrar
Asset to decide
50
Existing
Community Hub
Town
Vicky
Asset to decide
tbc
Existing
Community Hub
North Halifax
Liz
Asset to decide
50
Old Library
Cornholme
BME Network
Existing
Cafe and community Hub
Upper Valley
Hanif
Asset to decide
tbc
Calderdale
Geographical
representation
BME/Geographical
Existing
Healthy Living
Partnership
Elland and District
Partnership
Halifax Central
Initiative
Advancement of
Community
Empowerment
Existing
Network of diverse
organisation and groups.
Community Hub
Rahoof
Asset to decide
100
Park Ward
BME/Geographical
Safdar
Asset to decide
30
Existing
Community Hub
Lower Valley
Geographical
Jo
Asset to decide
tbc
Existing
Community Hub
Central
Geographical
Hanif
Asset to decide
tbc
Existing
BME hub
Central
Geographical
BME
Riaz
Asset to decide
50
Chiraag People
Existing
BME hub
Central
Geographical
BME/All ages
Waseem
Asset to decide
50
93
Existing networks – Calderdale and Greater Huddersfield
Group / Forum
Contact Existing /
New
Description
Location
Mechanism
Engagement
Officer
Best Time To
Engage
Estimated
numbers
Membership - Locala
Existing
Locala have a
membership database of
x amount of people
Greater Huddersfield
wide
Sent out an engagement
document to each member
via the newsletter
Amanda Thomas
April 2014
tbc
Sent out an engagement
document to each member
via the newsletter
Bronwyn Gill
April 2014
tbc
Send out the engagement
document to each member
Sabrina Armstrong
April 2014
tbc
Send out an electronic
engagement document to
each member
Send out an electronic
engagement document to
each member
Send out an electronic
engagement document to
be included in the
newsletter.
Send out an electronic
engagement document to
be included in the
newsletter.
Send out an electronic
engagement document to
be used at focus groups.
Tracey Robson
April 2014
tbc
Emma Tasker
April 2014
tbc
Dawn Pearson
April 2014
700 groups
Dawn Pearson
April 2014
500 groups
Dawn Pearson
April 2014
tbc
Send out an electronic
engagement document to
be used at focus groups.
Richard Kennedy
April 2014
14,000 people
Membership - SWYFT
Existing
SWYFT have a
membership database of
x amount of people
Calderdale wide
Greater Huddersfield
wide
Calderdale wide
Membership CHFT
Existing
CHFT have a
membership database of
x amount of people
Patient Reference
Groups - calderdale
Existing
Patient Reference
Groups – Greater
Huddersfield
Third Sector Networks
- Calderdale
Existing
Most practices have
patient reference groups
and a central group.
Most practices have
patient reference groups
and a central group.
North Bank Forum
provide support to over
700 local groups
Third Sector Networks
– Greater
Huddersfield
Existing
Healthwatch
Existing
Relationship Matrix
Existing
Existing
Voluntary Action Kirklees
and Third Sector
Leaders provide support
to local VCS groups.
Calderdale and Greater
Huddersfield both have a
Healthwatch
Calderdale CCG and
Greater Huddersfield
CCG have a relationship
matrix of 60 groups
Greater Huddersfield
wide
Calderdale wide
Calderdale wide
Greater Huddersfield
wide
Calderdale wide
Greater Huddersfield
wide
Greater Huddersfield
wide
Calderdale wide
Greater Huddersfield
wide
Calderdale wide
94
Stakeholder Activities – clinicians, staff and
professionals
Event
1. Locality/community model
Julie Barlow
Bev Walker
2. Specialist hospital sites
Julie Barlow
Kathryn Aldous
Julie O’Riordan (TBC)
3. How will self-care work
Julie Barlow
Kathryn Aldous
Pravin (TBC)
4. Emergency & Urgent Care
Rachel and Mark D (TBC)
5. Community Hubs
Andrew and Simon Sturdee (TBC)
6. Non-financial appraisal criteria
Clare
Lead
Jim
Barwick
Jackie
Ramsey
Anna
Basford
Catherine
Riley
Alex
Farrell
James
Drury
Anna
Basford
Catherine
Riley
Alex
Farrell
James
Drury
Alex
Farrell
Anna
Basford
Date
(All sessions
take place 13.30pm)
th
11 April 2014
Venue
Parent craft room,
CRH
15th April 2014
Bankfield meeting room,
Dean Clough
17th April 2014
Medium training room, CRH
22nd April 2014
Board Room,
Broad Lea House
25th April 2014
Board Room,
Broad Lea House
28th April 2014
Large Training Room,
CRH
95
Appendix 4: Providers engagement document – SOC summary
http://www.rightcaretimeplace.co.uk/wp-content/uploads/2014/08/StrategicOutline-Case-summary.pdf
Appendix 5: Providers engagement document – SOC easy read
http://www.rightcaretimeplace.co.uk/wp-content/uploads/2014/08/StrategicOutline-Case-summary-easy-read-version.pdf
Appendix 6: CCG engagement document – 5 year plans
http://www.rightcaretimeplace.co.uk/wp-content/uploads/2014/08/GreaterHuddersfield-Plain-English-5yr-Strategy-.pdf
http://www.rightcaretimeplace.co.uk/wp-content/uploads/2014/08/CalderdaleCCG-Plain-English-Strategy-Calderdale.pdf
Appendix 7: CCG engagement document – easy read versions
http://www.rightcaretimeplace.co.uk/wp-content/uploads/2014/08/GreaterHuddersfield-CCG-Easy-Read-Strategy-Calderdale.pdf
http://www.rightcaretimeplace.co.uk/wp-content/uploads/2014/08/CalderdaleCCG-Easy-Read-Strategy-Calderdale.pdf
Appendix 8: comments cards
96
Appendix 9: Providers stakeholder engagement
-
SOC – ENGAGEMENT EVENTS – CHFT / LOCALA
Key CHFT Staff
Public
Key Stakeholders
Calderdale and Huddersfield NHS Foundation Trust
Calderdale Clinical Commissioning Group
Greater Huddersfield Clinical Commissioning Group
Event cancelled
South West Yorkshire Partnership NHS Foundation
Media Interviews
Trust
Locala
Key
Date
Time
Week commencing
Monday 3 February
(3 – 9 February)
7.2.14
Week commencing
Monday 17 February
(17-23 February)
20.2.14
Venue
Speakers
(Clinicians/
Directors/
ADD)
Briefing to Linda Riordan, MP
Owen
Williams
Briefing to Membership
Councillors
Andrew
Haigh
Owen
Williams
Nos
Attended
Date
Mtg
Reques
ted
(If
known)
Key Issues Raised




Information exchange
Discussion re the Trust’s
preferred option ‘2’
We need to demonstrate that
topic 2 has wider benefits for a
large scale geographic area, eg
M62 corridor and changes in
mid-Yorks
Developments at Todmorden
would be welcomed
97
Date
Time
Venue
21.2.14
Briefing to Craig Whittaker, MP
22.2.14
Written Staff Briefing - CHFT
Week commencing
Monday 24 February
(24 Feb -2 March)
24.2.14
24.2.14
25.2.14
1 pm
6 pm
Locala Executive Directors and Senior
Management Briefing - electronic
Locala staff - electronic
Kirklees HWB
Calderdale OSC
Speakers
(Clinicians/
Directors/
ADD)
Nos
Attended
 Good communications is key
 Information exchange
Owen
Williams/
Barbara
Crosse
Carol Hirst
Catherine
Riley
Jim Barwick
Jim Barwick
1300 Locala
staff



Anna Basford
Barbara
Crosse
Martin Carter

Briefing to Workforce and OD Directorate
25.2.14
Locala Partnership Forum (Unions)
27.2.14
Week commencing Monday 3 March
(3-9 March)
Kirklees OSC
4.3.14
Calderdale HWB
Locala Board
6.3.14
Date
Mtg
Reques
ted
(If
known)
Key Issues Raised
Julie Hull
Jim Barwick
Anna Basford
/Owen Williams
Robert Flack
Jim Barwick

60 staff

Presentation/
discussion of SOC
Need to clarify what ‘minor
injuries’ means
Concerns about loss of
beds at CRH
Staff information exchange
Presentation/discussion of
SOC
98
Date
Time
Venue
7.3.14
Briefing to Jason McCartney, MP
7.3.14
Briefing to Barry Sheerman, MP
Week commencing Monday 17 March
(17-23 March)
CHFT Staff Meetings
17/18/19
(x 2 sessions per day - 1 each at HRI and
March 2014
CRH)
17.3.14
17.3.14
Face-to-Face Interview – Halifax Courier
(Calderdale CCG)
Alan Brook, Steve Cleasby, Nigel Taylor
Briefing to CHFT Medical Division
Consultant Management Forum
Speakers
(Clinicians/
Directors/
ADD)
Nos
Attended
Owen
Williams/Helen
Thomson
Owen
Williams/David
Birkenhead
Catherine Riley,
CHFT
Barbara Crosse,
CHFT
Keith Griffiths,
CHFT
Martin Debono,
CHFT
Julie Hull, CHFT
150 staff
over 6
events
Date
Mtg
Reques
ted
(If
known)
Key Issues Raised





Information exchange

Information exchange
Generally, staff are supportive of
our preferred topic;
Staff recognise the longer-term
benefits of changing the way
services are delivered for both
patients and staff;
Staff want to work with us on the
design of new services;
Staff recognise that we are one
Trust with two hospitals – our
patients and staff are already
familiar with our two hospitals
“Response Time more vital than A
& E Department”
Saj Azeb
20 staff

Concerns over capacity and fit if
HRI is unplanned site
 Generally, positive and a good
understanding of the need to
change
99
Date
Time
19.3.14
10.00am
Venue
Speakers
(Clinicians/
Directors/
ADD)
Kirklees Healthwatch Board Meeting
Catherine Riley,
CHFT
Carol McKenna
Steve Ollerton
(GHCCG)
19.3.14
20.3.14
Locala Members’ Council
Lynn Galvin
Full-time Officer
Royal College of Midwives
20.3.14
Membership Council Development
Session
Robert Flack
Ann-Marie
Henderson,
CHFT
Jason
Eddlestone,
CHFT
Catherine Riley,
CHFT
Andrew Haigh
Ruth Mason
20.3.14
Good Shepherd Church
Mytholmroyd
“An Introduction to your local FT”
Ruth Mason
Nos
Attended
Date
Mtg
Reques
ted
(If
known)
Key Issues Raised
 Be honest about budget reductions
 What’s the cost of the PFI at
Calderdale
 If both A & Es close how will we
get home once treated
 How will we address gaps in
services, e.g. continence
 What will happen if the M62 is shut
 Is losing 100 beds safe
 Feeling from staff is “here we go
again”
 RCM seeing these changes up
and down country
 We would still be giving women the
choice of service model
 We need to look at the bigger
West Yorks pic in terms of
provision across the region
 There is a need to explain the
rationale for preferred scenario
 Priority need to be given to making
sure Todmorden is up and running
 Are you planning redundancies.
Have staff been consulted?
 Concerns about moving A & E,
e.g. Heptonstall, and distance to
100
Date
Time
Venue
Speakers
(Clinicians/
Directors/
ADD)
Nos
Attended
Date
Mtg
Reques
ted
(If
known)
Key Issues Raised
CRH
Trust News Article – front page
23.3.14
Week commencing Monday 24 March
(24-30 March)
Face-to-face Interview – (CHFT) Halifax
25.3.14
Courier (featured on 28 March)
Calderdale LMC
26.3.14
27.3.14
Week commencing
(31 March – 6 April)
31.3.14
8-9.30
Available
in paper
and
electronic
format –
6,000 staff
“Trust say changes will lead to
better level of care for all”
Owen Williams
Barbara Crosse
(supported by
Carol Hirst)
Catherine Riley,
CHFT
Barbara Crosse,
CHFT
Jim Drury,
SWYFT
Jim Barwick,
Locala
16



Positive about proposals;
Anxious about impact on primary
care
Factor in workforce issues
Locala Partnerhsip Forum (Unions)
Monday 31 March
CHFT – Estates Staff - HRI
Lesley Hill, CHFT
20 staff
 It’s good we’re spending capital
in a building we own (if HRI)
 A & E waiting times will get
worse if only one A & E
 Are our jobs secure?
101
Date
Time
Venue
Speakers
(Clinicians/
Directors/
ADD)
31.3.14
Peta Clarke – full-time RCN officer
31.3.14
Chairman’s Information Exchange
With Membership Councillors
Nos
Attended
Jason Eddlestone,
CHFT
Catherine Riley,
CHFT
Jackie Murphy, CHFT
Andrew Haigh
Membership
Councillors
 How does this fit in with retendering of Locala services
 Will skill-mix and staffing ratios
change
 People feel it’s a ‘done deal’
 MC’s feedback from discussions
at staff sessions
 Location of individual services
not important, but infrastructure
is
 Important to have assurances
that funding provided for
community services is used for
that service
 Very concerned about the
possibility of no A & E in
Calderdale
 Want to see more info re what a
Minor Injuries Unit would look
like – the conditions/injuries it
deals with
 We want to see more District
Nursing staff
 Will A & E times get worse if
there is only 1?
 Its good that we are spending
on a capital building we own (if
HRI)
 Briefing on process so far
1.4. 14
6.45
pm
start
Calderdale Healthwatch
Upper Valley – Ward Forum
Hebden Bridge Town Hall
Entrance via George Street Entrance from
6.15pm
Dawn Pearson,
wybscu
Lesley Hill, Director of
Planning,
Performance, Estates
& Facilities, CHFT
1.4.14
4-6pm
CHFT Staff Meetings – Nursing
Lecture Theatre - HRI
Jackie Murphy, CHFT
Ajay Sharma
Barbara Crosse,
1.4.14
)
Date
Mtg
Reques
ted
(If
known)
Key Issues Raised
102
31.3.14
26.3.14
Date
Time
Venue
Dil Ashraf
David Hughes
Speakers
(Clinicians/
Directors/
ADD)
) GPs
)
Nos
Attended

CHFT
Catherine Riley,
CHFT


CHFT Staff Side reps
3.4.14
Catherine Riley
(CHFT)
Julie Hull (CHFT)

Yorkshire Ambulance Service
Catherine Riley,
CHFT



3.4.14
3.4.14
Calderdale Ward Forum
Ripponden Junior and
Infant School
Halifax Road
Ripponden
evening Greater Huddersfield GPs
Broad Lea House
6.45
pm
They agreed our direction of
travel
How to involve primary care
contractors
Request for us to speak to
LMC
People less interested in big
strategic plan – but whether
they will have a job at the end!
It’s a fait a complait
/staff side concerned about the
connectivity in the community
Will our-patients services be on
both sites?
Moving services into the
community is great but we have
to ensure we have resources in
the community to manage them
How will cultural changes be
managed – previously clinics
held at Todmorden were never
that busy, and staff were bored,


3.4.14
Date
Mtg
Reques
ted
(If
known)
Key Issues Raised
Not yet
confirmed/provisional
Event cancelled by
CCG
-
Alex Farrell, SWYFT
Anna Basford, CHFT
 All GPs present supported
direction of travel
31.3.14
103
Date
Time
Venue
Speakers
(Clinicians/
Directors/
ADD)
Nos
Attended
Jim Barwick, Locala
Ashwin Verma, CHFT
4.4.14
8-9.30
CHFT ISS and Leaselend staff
CRH
Week commencing Monday 7 April
(7 – 13 April)
CHFT Staff Meetings – Nursing
7.4.14
2pm
Lecture Theatre - HRI
7.4.14
4 pm
CHFT Staff Meetings – Nursing
Parentcraft Room, CRH
Lesley Hill, CHFT
40 staff
Clare Brearley, CHFT
Catherine Riley,
CHFT
15 staff
Janet Powell, CHFT
Catherine Riley,
CHFT
23 staff
Date
Mtg
Reques
ted
(If
known)
Key Issues Raised
 Why has old primary care
models been dismantled and
cut?
 Concerns about Social Services
capacity
 Strong support for self-care
models
 Examples of poor service in
community (poor palliative care)
 We need more District Nurses
 What will happen to ISS staff if
HRI is the unplanned hospital.
Will they transfer?
 Will senior decision making be
24/7?
 Does the decision have to be a
unanimous vote?
 Do the CCGs have a preferred
option?
 Who will sit on the consultation
panel?
 What will be the impact on jobs
at CRH if HRI is main site?
 Conscious that more people will
choose to call 999 for an
ambulance due to distance to
travel from Calderdale(when
maternity services moved to
104
1.4.14
26.3.14
26.3.14
Date
Time
Venue
Speakers
(Clinicians/
Directors/
ADD)
Nos
Attended
Date
Mtg
Reques
ted
(If
known)
Key Issues Raised
Halifax there was a worry that
more women in labour would
call 999) but that has proved not
the be the case)
 What are GPs doing about
appts and increased number of
A & E attendances because
patients can’t get a GP
appointment?
7.4.14
8.4.14
6.30
pm
2-7pm
Calderdale Heathwatch
Lower Valley
Bailiff Bridge Community Centre
1 Victoria Road
Baliff Bridge
West Yorkshire
HD6 4DX
Drop-In Session
Fartown Village Hall
Ballroyd Road
Penny Woodhead
CCCG
David Birkenhead
CHFT
Alan Brook CCCG
Anna Basford CHFT
Jim Barwick Locala
Dawn Pearson
wybcsu
Alex Farrell, SWYFT
Amanda Thomas,
Locala
 Rationale for A & E changes
and the scope of minor injuries
 The importance of provision of
additional services out of
hospital
 Receiving the presentation
provided a more balanced
picture than current media
coverage
 Overall, constructive dialogue
which highlighted the
importance Healthwatch place
on providing care out of
hospital and reducing the need
for hospital admissions
 Members commented that they
found the presentation very
helpful.
 Praise about the Trust’s eye
dept at CRH, and the fact that
105
Date
Time
Venue
Fartown
HD2 1AN
Membership Council Development
Session
Written Staff Briefing - CHFT
8.4.14
8.4.14
8.4.14
11pm12am
CHFT Discussion – for Night Staff
Southside Restaurant, HRI
Speakers
(Clinicians/
Directors/
ADD)
Nos
Attended
Carol Hirst, CHFT
Date
Mtg
Reques
ted
(If
known)
Key Issues Raised
many patients already travel
from Huddersfield to Halifax
and vice-versa
 Need to clarify what a minor
injuries unit will be like
 Personal experience of a
patient requiring neuro surgery
travelling to Leeds for in-patient
care
Catherine Riley
Carol Hirst
Available
as a
written
briefing
and
electroni
cally for
6,000
staff
Owen Williams, CX,
CHFT
8 staff
 Staff understand the rationale
behind the proposed changes,
but want to know more about
how it might work in practice
 Staff wanted to better
understand the thinking behind
the Trust’s stated preference
 The services proposed would
need extensive new build on
the current HRI site
 Maintaining the status quo is not
an option (a point raised at both
106
Date
Time
Venue
Speakers
(Clinicians/
Directors/
ADD)
Nos
Attended
Date
Mtg
Reques
ted
(If
known)
Key Issues Raised
HRI and CRH meetings)
9.4.14
12.30
am1.30
am
2-7pm
10.4.14
10.4.14
3pm
 Clarity around rumours
circulating re A & E closure
 Staff wanted to better
understand the current PFI
arrangements
 Staff placed significant
emphasis of senior consultant
presence, particularly outside
daytime hours.
 Staff questioned finances and
savings of £50m and how this
might relate to job security.
 A belief from staff that if the
proposed changes in
community and close to home
do not materialise, the chance
of these proposals working
would be reduced
 (a point made at both CRH and
HRI meetings)
(Nothing to record due to low
footfall at session)
CHFT Discussion – for Night Staff
Ingleton Falls Restaurant, CRH
Owen Williams, CX,
CHFT
30 staff
Drop-In Session
New beginnings@ 3ways
Nursery Lane
Ovenden
Halifax
HX3 5 SX
CHFT – Staff Meeting - Nursing
Keith Griffiths, CHFT
Debbie Graham,
CCCG
Tracey Hollis. GHCG
2
Jackie Murphy, CHFT
24 staff 
26.3.14
Will the shuttle service
improve?
107
Date
Time
Venue
Speakers
(Clinicians/
Directors/
ADD)
Nos
Attended
Date
Mtg
Reques
ted
(If
known)
Key Issues Raised

Stroke services – would
acute care be on one site
and rehab on the other?
 Could we not have one big
new build hospital in Elland?
 Will there be a reduction in
bed capacity?
10.4.14
Greater Huddersfield GPs
Textile Centre of Excellence
Anna Basford, CHFT
Jim Barwick, Locala
James Drury, SWYFT
Barbara Crosse,
CHFT
10.4.14
Third Sector/Voluntary Organisations –
Greater Huddersfield
Anna Basford, Jim
Barwick,
Alex Farrell
15

Implications of National Policy
and Keogh report an recognition
that this is the way forward
across England

The need to understand and
factor in changes in in patient
flows as a result of changes e.g.
possible increased flow to
Barnsley

The importance of effective and
integrated IM and T to enable
new ways of working

The need for more community
beds as a result of changes in
hospital bed base
 The 3rd Sector are/can be the
‘champions of prevention. Need
to consider how this is made a
reality in the model
 Self-care model is understood
108
Date
Time
Venue
Speakers
(Clinicians/
Directors/
ADD)
Nos
Attended
Date
Mtg
Reques
ted
(If
known)
Key Issues Raised
by some, but not all – we need
to find ways of describing it
better
 Consider ‘digital inclusion’ so
that eole aren’t disadvantaged
by digital develoments
 Statutory partners need to be
more inclusive of third sector,
with the potential for
parterships
Locala Board briefing
10.4.14
11.4.14
1-3.30
Stakeholder Event
Locality/Community Services
Parent Craft Room, CRH
Week commencing Monday 14 April
(14-20 April
15.4.14
1-3.30 Stakeholder Event
Specialist Hospitals
Bankfield Meeting Room, Dean Clough
discuss planned and unplanned sites
17.4.14
1-3.30
Robert Flack
Jim Barwick
Helen Frain, Peter
Horner, Carol Atkin,
Jill Adams, Melanie
Giles, Caroline Mullins
(Locala)
(panel complete)
Stakeholder Event
Self-Care
Medium Training Room
CRH
to
Anna Basford,
Catherine Riley,
(CHFT)
Jackie Ramsay, Peter
Horner, Carol Atkin,
Jill Adams (Locala)
(panel complete)
Alex Farrell, James
Drury
(panel complete)
27



22
Single Info system or shared
record essential
Single assessment – build on
through shared record
Is it affordable?
 Sufficient capacity on
unplanned site for all demand
 Public education in revised
health and social care system
 Ensure proposals fit with a
wider West Yorkshire plan
 Change of culture for staff and
patients
 Not enough sharing of best
practice currently
109
Date
Time
Venue
Week commencing Monday 21 April
(21-27 April)
Rowen Health Federation (GP Federation
22.4.14
in Greater Huddersfield)
22.4.14
1-3.30
24.4.14
25.4.14
10-
Speakers
(Clinicians/
Directors/
ADD)
Barbara Crosse
Anna Basford
Catherine Riley
Stakeholder Event
Emergency and Urgent Care
Board Room, Broad Lea House
Anna Basford,
Catherine Riley,
CHFT
(panel complete)
CHFT Staff Meeting - Community
Mandy GibbsonsPhelan CHFT,
Lesley Hill, CHFT
CHFT Staff Meeting – Estates
Nos
Attended
23
Date
Mtg
Reques
ted
(If
known)
Key Issues Raised
 Opportunities of provider
collaboration across primary
and secondary care
 Support for the strategic
direction of travel an scope for
providers to offer integrated
care
 Mutual benefits for working
together was recognised and
agreed as essential to deliver
more effective models of care
 Explore opportunities for
provider collaboration re minor
injuries/illnesses in OBC
 Explore opportunities around
specific LTCs
 The possibility of GPs having
remote access to SKYPE to
access advice of senior
physicians
 Attendees generally supportive
of service models described in
SOC
 An opportunity to share views
and ideas

-
110
Date
Time
Venue
11.30
1-3.30
Stakeholder Event
The Community Hubs
Board Room, Broad Lea House
Week Commencing Monday 28 April
(28 April-4 May)
28.4.14
1-3.30 Stakeholder Event
Prioritisation of Criteria
Large Training Room, CRH
25.4.14
Speakers
(Clinicians/
Directors/
ADD)
Alex Farrell, SWYFT
Anna
Basford, CHFT
(panel complete)
30.4.14
Jim Barwick
Catherine Riley
Jim Barwick
Jackie Ramsey
Kirstie Scott
30.4.14
Calderdale LMC
Barbara Crosse
Mags Barnaby
Date
Mtg
Reques
ted
(If
known)
Key Issues Raised
 General support for service
models described in SOC
Alex Farrell, James
Drury
(panel complete)
Locala Executive Directors
Meeting with Social Care Provider Staff Huddersfield
28.4.14
Nos
Attended
19
 Public education/marketing
“where we go for? Needed
 Recognise ‘home’ as the default
– ensure hubs don’t absorb
community resources
 Need social care presence,
access and phone numbers
 Ambulance access required at
all levels in building
 * A detailed report of 6
Stakeholders Events has
been produced
8 social
care
represe
ntatives
 7-Day provision of Social
Services is implicit in new Care
Bill and Urgent Care Agenda
 All agreed it is a shared
direction of travel
 Concerns from Council we are
focussed on adult services
 OBC Briefing – well received
 Need to clarify Trust and CCG
boundaries re proposed visits
to practices
111
Date
Time
Venue
Speakers
(Clinicians/
Directors/
ADD)
30.4.14
Locala Members’ Newsletter - update
Amanda Thomas
(Locala)
30.4.14
Locala Integrated Children’s Service
Team Leaders briefing
CHFT Staff Meeting Intermediate Care
and Community Directorate
Jim Barwick
1.5.14
CR
Nos
Attended
1500
Membe
rs
20 staff




Week commencing Monday 5 May
(5 May-11 May) (Bank Holiday 5th May)
Meeting with Leader/CX of Calderdale
8.5.14
Council
Written Staff Briefing - CHFT
8.5.14
9.5.14
Halifax Courier -
Owen Williams
Andrew Haigh
Carol Hirst
Catherine Riley
Date
Mtg
Reques
ted
(If
known)
Key Issues Raised
Community resources
governed and managed by us,
but not owned by us
GPs in Calderdale were
engaged in the process
Learn from Locala example.
Staff want to come back into
Hospital setting as they feel
isolated
Significant Consultant presence
in the Community needed to
show investment of the current
model
 Information Exchange
Available
as a
written
briefing
and
electronic
ally for
6,000
staff

Article following Calderdale H
112
Date
Time
Venue
Speakers
(Clinicians/
Directors/
ADD)
“Bust up at A & E” –
Halifax Courier –
9.5.14
“Message is Clear – Hands Off our A &
E”
Week commencing Monday 12 May
(12 May-18 May)
13.5.14
14.5.14
14.5.14
14.5.14
15.5.14
Locala Health Visitor Team
Leaders Briefing
Community Pharmacy West
Yorkshire Staff
Jim Barwick
Workshop to understand the
Clinical Voice – Dean Clough
Locala Members’ Council briefing
Meeting with Calderdale
Healthwatch
Jackie Murphy
Karen Taylor (SWYMHT)
Jim Barwick
OOwen Williams
Anna Basford
Catherine Riley
Catherine Riley
James Drury
John Yorke
Bash Fazlee
Nos
Attended
Date
Mtg
Reques
ted
(If
known)
Key Issues Raised
& WB Board Meeting on 8.5.14
Article following march through
Halifax Town Centre
20
community
pharmacy
staff
 Role of Community
Pharmacy in helping to
build confidence in selfcare and prevention
 Push boundaries on
dealing with complex
patients
 Pharmacy could be
developed into an
intermediate service



People accept the
views outlined in the
SOC when it is
explained
The SOC doc isn’t
easy to find, easy to
read, or easy to follow
Perception that the
113
Date
Time
Venue
Speakers
(Clinicians/
Directors/
ADD)
Nos
Attended
Date
Mtg
Reques
ted
(If
known)
Key Issues Raised
Acre Mill development
means that the
decision has already
been made
Specific questions raised
at the meeting and
responses – see central
SOC file
(date to be
confirmed)
Meeting with Kirklees
Healthwatch
16.5.14
Briefing to Linda Riordan, MP
16.5.14
Briefing to Craig Whittaker,MP
16.5.14
Briefing to Jason McCartney, MP
16.5.14
Briefing to Barry Sheerman, MP
--
 Update/Information
Exchange
 Update/Information
Exchange
 Update/Information
Exchange
 Update/Information
Exchange
Owen Williams
James Drury
Owen Williams
James Drury
Owen Williams
Barbara Crosse
Owen Williams
Barbara Crosse
Week commencing Monday 19 May
(19 May-25 May)
CHFT Staff – Estates
20.5.14
2.30
Lecture Theatre, HRI
Face-to-face interview (CHFT) with Nick
22.5.14
Lavigueur, Huddersfield Examiner
(Featured on 26th and 27th May 2014)
Face-to-Face Interview (Matt Walsh 23.5.14
CCCG)
Lesley Hill
Barbara Crosse
(supported by Caroline
Wright)
Interview with Matt
Walsh – Supported by
Rosemary Cook
40
New Twist : Threat to both
A & E Units – but health plan
will lead to better care
Health Chief joins call to
save NHS
114
Date
Time
Venue
Locala Exec Directors and Senior
Management Team Briefing
Week commencing 26 May
(26 May-1 June)
5.30
Voluntary Action Calderdale
27.5.14
pm
Calderdale Disability Centre
Kings Centre
Park Road
Halifax
23.5.14
Speakers
(Clinicians/
Directors/
ADD)
Nos
Attended
Jim Barwick
Jim Barwick
(Locala)
James Drury
(SWYFT)
Janet Powell
(CHFT)

20


27.5.14
27.5.14
27.5.14
28.5.14
28.5.14
10-12
2-7 pm
Date
Mtg
Reques
ted
(If
known)
Key Issues Raised
Locala OBC Action Team Lync
debrief/update
Locala Health Visitor Team Leader
Briefing
Locala District Nursing/Community
Matrons Intermediate Care – South
Operational Meeting
Voluntary Action Calderdale
Resource Centre
Hall Street (on corner of Lister Lane)
Halifax
HX1 5AY
All/Jim Barwick
Anna Basford
Allan Hart-Thomas
Clare Brearley
17
Drop-In Session
YMCA
Salendine Nook
Steve Ollerton
David Birkenhead
Carol Hirst
Janet Powell
James Drury
20
(approx.)
Attendees generally
supported the proposals in
the SOC document
Discussion about a “super
ambulance/ mobile
hospital”
Consider wheelchair/guide
dog access to ambulances
Jim Barwick
Caroline Mullins
individuals
representing
17 groups
 High quality care is key
 Transport issues
 Strong emphasis to Improve
communications across
voluntary sector and hospital
boundaries
 Concerns expressed by one
gentleman re how/where
drop-in sessions had been
advertised/timing and
location of meetings
115
Date
Time
29.5.14
29.5.14
30.5.14
28.5.14
2-7pm
Venue
Speakers
(Clinicians/
Directors/
ADD)
Locala District Nursing North
Operational Mtg
Locala Partnership Forum (Unions)
Drop In Session
Slaithwaite Village Hall
Slaithwaite
Huddersfield
Caroline Mullins
Calderdale LMC
Rob Aitchison
Jim Barwick
Barbara Crosse
Jackie Murphy
Nos
Attended
Date
Mtg
Reques
ted
(If
known)
Key Issues Raised
 Praise re food provided by
CHFT
 Concerns by a number of
people following “New Twist”
headline by the Huddersfield
Examiner
 The majority of people
supportive of the need to
change how some services
are to be delivered
 Some concern whether
community services can
support the proposals
(Locala)

TBC
 Implications of YAS issues –
and the fact that they are
downgrading some services
 Most people only recognise
CHT as a provider and A &
E seems to be the biggest
concern
 More information/
 communications needed – on
GP screens and door
knocking
 LMC value being kept
informed and involved in the
116
Date
Time
Venue
Speakers
(Clinicians/
Directors/
ADD)
Nos
Attended
Date
Mtg
Reques
ted
(If
known)
Key Issues Raised
process
Week commencing 2 June
(2-6 June)
Meeting with Leader/CX of Kirklees
2.6.14
Council
2-7pm Drop-in Session
2.6.14
Mytholmroyd Community Centre
3.6.14
7-8pm
GP Federation PHH (Huddersfield)
Broad Lea House
Owen Williams
Andrew Haigh
Juliet Cosgrove
(2-7)
Clare Brearley (24)
Julie O’Riordan
(3.30 – 6pm)
Ashwin Verma
Julie O’Riordan
Martin Debono
David Birkenhead
Catherine Riley
Anna Basford
Mark Davies
Jim Barwick
25
30 GPs
 Update/
 Information Exchange
 Visiting patients at HRI will
be difficult and costly
 This is politically motivated
with no real evidence base
behind it
 Concerns at the prospect of
closing A & E and “running
down” the Calderdale site
 A plea for wider/improved
communications (events and
developments/issues)
 Support for improving
community services – but
this needs to be in place
before making changes to
the hospitals
 Agreed the system would
benefit from some re-design
 Pressures in both primary
and secondary care
 Keen to bring primary and
secondary care clinicians
together to have
conversations
 How do we convince
117
Date
Time
Venue
Speakers
(Clinicians/
Directors/
ADD)
Nos
Attended

3.6.14
2-7pm
Drop-in-session
Fartown Village Hall
Catherine Riley
(2-4pm)
Heather
McClelland (2-4
pm)
Juliette Cosgrove
(4-7pm)
Janet Powell
(5.30-7pm)
TBC
Date
Mtg
Reques
ted
(If
known)
Key Issues Raised



decision makers of the
clinical evidence base?
Could PHH become a 4th
partner in the process?
Some cynicism about
proposed changes
Some support of proposed
changes and offer of
involvement
Don’t want A & E to go to
Leeds
Emma Gothard
and Melanie Giles
(LOCALA)
4.6.14
2-7 pm
Drop-in Session
Brighouse Civic Hall
Brighouse
Emma Livesley
(2-7)
Colin Welsh
(3pm)
Barbara Schofield
(4-7 pm)
TBC
 Travel issues for people
travelling from remote areas
of Calderdale to HRI without
a car
 Need to explain more about
Minor Injuries Unit in
community locations
 Other ‘not SOC related’
issues – Parking/disability
access at CRH
Issues raised/ addressed
within division by EL
118
Date
5.6.14
Time
2-7 pm
Venue
Drop-in session
The Hub
Kirkburton
Speakers
(Clinicians/
Directors/
ADD)
Catherine Riley
(2-5)
Lesley Hill (2-6)
Carol Hirst (5-7)
Nos
Attended
TBC


Jim Barwick Carol
Atkin and Kirsty
Shepherd
(LOCALA)


5.6.14
8.6.14
Locala Board Briefing
Written Staff Briefing - CHFT
Week commencing 9 June
(9-15 June)
2-7pm
Drop-in session
9.6.14
Hanson Lane Enterprise
Jim Barwick
Catherine Riley
Caroline Wright
Rob Aitchison (27pm)
Catherine Riley
(2-3.30pm)
Colin Welsh (27pm)
Date
Mtg
Reques
ted
(If
known)
Key Issues Raised
Transport Concerns,
particularly for elderly
Practice based
anticoagulation is very
good. High praise re
services provided from
Kirkburton Health Centre.
Agree with topics in
principle, but not sure care
in the community is
feasible due to lack of
money and staff
“Very informative day” –
awoken my thought
processes
Available as a
written briefing
and
electronically
for 6,000 staff
 Public feel we need to get
the message across – they
want to understand the
evidence base
 Some worried about
emergency care
 Travel concerns, especially
the elderly
119
Date
Time
Venue
Speakers
(Clinicians/
Directors/
ADD)
Nos
Attended
Date
Mtg
Reques
ted
(If
known)
Key Issues Raised
 People keen to understand
proposal in more detail and
engage in a constructive
way
 We need to explain where
plans like ours have
worked and benefitted the
public, eg Torbay
 Public sceptical about
planned improvements to
community services
9.6.14
10.30am
9.6.14
10.6.14
2-7pm
DATS Staff Engagement session
Discussion Room 1, HRI
Intermediate Care Team
St John’s, Halifax
Drop-in session
New Beginnings (Halifax)
26 staff
Catherine Riley
Mandy Gibbons
Phelan
30 staff
Catherine Riley
(2-5pm)
Lindsay Rudge
TBC (2-5pm)
David Birkenhead
(4.30-7pm)
Lesley Hill (4-
TBC
 Have you factored
Dewsbury A&E demand?
 Following the presentation,
staff feel excited about the
future and about the Trust
as a whole
 Staff feel able to discuss
the proposals with their
patients, families, relatives
 “It all makes sense really”
 Don’t close our
 A & E! – strong
feelings/passion from 3
people
 “If” we go ahead the MI
Unit should have the ability
to stabilise critically ill pts
120
Date
Time
Venue
Speakers
(Clinicians/
Directors/
ADD)
Nos
Attended
7pm)
Melanie Giles
(Locala)
Jim Barwick
(Locala)
10.6.14
10.6.14
11.6.14
11.6.14
2-7pm
12.6.14
2-7pm
Locala OBC Action Team Lync
debrief/update
Locala Health Visitors Team Leaders
Children’s Business Unit Professional
Forum Briefing
Drop-in session
Holmfirth Civic Hall
All/Jim Barwick
Drop-in session
Todmorden Health Centre
Rob Aitchison (27)
Vicky Pickles (2-
Emma Gothard
Richard
Palfreeman
Jan Giles
David Hughes,
GP
Janet Youd (2-5)
David Birkenhead
(2.30-7)
Date
Mtg
Reques
ted
(If
known)
Key Issues Raised
prior to transfer
 Event poorly attended – but
no suggestions as to how
this could be improved
 Poor experience of end of
life care (hospital) (15
years ago and 3 years ago)
 More/improved community
support needed
TBC
?80 (tbc)
 Generally supportive of
proposals
 Some concerns about A&E
topics
 Transport concerns –
particularly for elderly
visitors
 Support for specialist
paediatrics
 Support for a MI Unit at
HVMH
 Concerns re ambulance
response times
 Events not well
advertised.
 Need to get the clinical
121
Date
Time
Venue
Speakers
(Clinicians/
Directors/
ADD)
Nos
Attended
6)
Lesley Hill (3.305.30)
Sal Uka (3.30
pm)
Janet Powell
(3.30-7)
12.6.14
8pm
Meeting for the Deaf Community
Locala Transformation Team - briefing
DATS Staff Engagement Session
Medium Training Room, CRH
Week commencing 16 June
(16-22 June)
Locala Quality/Governance Team
16.6.14
Meeting
District Nurse/Team Leader Cabinet
18.6.14
12.6.14
13.6.14
19.6.14
11am
20.6.14
12 –
1pm
DATS Staff Engagement Session
Board Room, HRI
Local Care Direct
Bradley, Huddersfield
benefits across to the
public with case studies,
eg the role of paramedics
in assessing where a
patient should be treated
 Improve pharmacy
access out of hours in
Todmorden
 People interested in
having a community hub
at Todmorden, and
having a say in future
developments
-
Community
Health Workers
(on behalf of the
CCGs/WSYCSU)
Jackie Ramsay
11.00am
Date
Mtg
Reques
ted
(If
known)
Key Issues Raised
20
Jim Barwick
Carol Atkin
Kirsty Shepherd
18
Catherine Riley
Jim Barwick

LCD want to be part of our
conversations – frustrated
122
Date
Time
Venue
Speakers
(Clinicians/
Directors/
ADD)
Nos
Attended

Week commencing 23 June
(23-29 June)
26 June
11am DATS Staff Engagement Session
Week commencing 30 June
(30 June-6 July)
Waterhouse McIntosh Homes
2.7.14
Halifax
Contact: George Pickles
01422 831878
Date
Mtg
Reques
ted
(If
known)
Key Issues Raised
that they weren’t involved
earlier in the engagement
process.
Further session to be
arranged for clinical
teams
10 staff
Clare Brearley
Catherine Riley




The group provides
warden supported homes
They are strongly
supportive of locality
model, and feel they could
work better with NHS, on
admission and discharge
planning
Communications could be
better managed
The group are keen to
become more involved in
engagement/service
model planning
/CH/Y: ENGAGEMENT EVENTS – 21 JULY 2014
123
Appendix 10: Letter from Barry Sheerman
Barry Sheerman MP, sent in a letter and a petition containing over 1,000 signatures
opposing plans to the closure of the A and E department in either Calderdale or
Huddersfield (see appendix - ?). The petition also came with 141 public comments relating
to A and E services. The comments covered the following key themes:











Keep A and E services in both Calderdale and Huddersfield, both local areas are
large enough to require their own services.
One A and E service will become overcrowded, services are already overcrowded.
Travel and transport for people particularly in rural areas will not be possible because
of the cost, time to travel and parking, if they have their own transport, will not be
sufficient to cope with demand.
The Elland by pass is gridlocked and will cause problems for emergency vehicles.
Ambulance response times were a concern, including the time it would take to reach
the hospital destination.
There were a number of concerns that lives would be lost.
Services were being cut as part of a cost cutting exercise.
Current services were valued and there were lots of examples to support this.
Local people want easy access to local facilities and there were a number of
comments that services may go to Leeds.
People want a say on what happens to ‘their’ services.
Services work perfectly well as they are and people do not want them to change.
124
Appendix 11: Equality monitoring of respondents on SOC
1091 completed whole or part, of whom;
Sex
Women
590 Men
478 Prefer not to say/blank
23
Under 18
36
129 26-45
414
46-65
334 66-80
117 81-100
28
100+
1
Blank
32
Afghanistan
3
Austria
1
Bangladesh
6
Britain
28
Canada
1
China
2
Czech Republic
3
D R Congo
1
England
411
Germany
3
Hong Kong
2
India 4
4
Iran
6
Iraq
7
Ireland
6
Israel
1
Kuwait
1
Northern Ireland
2
Pakistan
126 Poland
1
Romania
1
Scotland
5
Singapore
1
Slovakia
1
South Africa
2
Turkey
1
UK
270
Yemen
1
Vietnam
2
Wales
5
Zaire
1
Zimbabwe
1
Blank
167
Age
18-25
Country of birth
125
Ethnic group
Arab
8
Chinese
2
Indian
3
Pakistani
360 African
5
Caribbean
3
Mixed white and Asian
13
0
Mixed white and black
Caribbean
1
White British
614 White Gypsy
3
White Irish
9
Other mixed
2
Prefer not to say/blank
30
Other white
7
Other Asian
20
Other
10
Polish
1
Bangladeshi
2
Vietnam
2
Bengali
1
D.R.Congo
1
Vietnam
2
Iraqi
2
Afghan
3
Bangladesh
3
Bengali
1
Jewish
1
Mixed white and black
African
Disability
No
778 Yes
261 Prefer not to say/blank
28
Hearing
19
18
Physical or mobility
44
Long standing illness
110 Mental health
75
Learning Disability
29
Prefer not to say
22
Other
11
MS
1
Diabetes
1
Stroke - COPD
1
Over active thyroid
1
Addiction
2
Stroke - Slight mobility
problem
1
Type of impairment
Visual
126
Addict on recovery
1
Parkinson's
1
Epilepsy
1
Spinal stenosis
1
Sexual orientation
Bisexual
8
Gay Man
5
Heterosexual
888
Lesbian
9
Prefer not to say/blank
93
Other
2
Past it
1
Widow
1
Religion and belief
No religion
317 Yes
676 Prefer not to say/blank
46
Buddhism
9
Christianity
276 Islam
397
Hinduism
1
Judaism
1
Other
16
Roman Catholic
8
If yes, which religion?
Non declared
1
Sunni Muslim
1
Atheist
1
Rastafarian
1
Agnostic
1
Church of England
1
Other
1
Gender reassignment
Transgender
2
Pregnant/Had a baby within the last 6 months
Yes
26
Are you a carer?
Yes
114
Open minded (awaiting
1
proof)
127
Appendix 12: Cornholme and Portsmouth Old library focus
Group
128
129
130
131
Appendix 13: Equality monitoring on Commissioners 5 year strategy leaflet
127 completed whole or part, of whom;
Sex
Women
83
Men
36
Prefer not to say/blank
6
Under 18
12
18-25
18
26-45
40
46-65
40
66-80
9
Blank
8
England
34
Iraq
1
Kenya
1
New Zealand
1
Nigeria
2
Pakistan
8
Poland
5
Scotland
1
Somalia
1
UK
45
Unknown/blank
23
Age
Country of birth
Ethnic group
Asian/Asian British
Pakistani
25
White
Black and Black British
Mixed
African
3
White and Asian
1
Other
1
White and Black
African
1
Other
White British –
Scottish/Welsh/NI/England
53
Arab
1
White other
6
Prefer not to
say/blank
34
132
Disability
No
94
Yes
27
Prefer not to say/blank
8
Hearing
2
Visual
1
Physical or mobility
5
Long standing illness
7
Mental health
10
Other
0
Autism spectrum
0
Heterosexual
10
7
Type of impairment
Sexual orientation
Bisexual
1
Gay Man
5
Lesbian
4
Prefer not to
say/blank
13
34
Yes
65
Prefer not to say/blank
26
1
Christianity
32
Islam
30
Gender reassignment
Transgender
0
Pregnant/Had a baby within the last 6 months
Yes
1
Are you a carer?
Yes
23
Religion and belief
No religion
If yes, which religion?
Buddhism
133