“Why we oppose these cuts” – our official response to the public consultation

THIS is the Save Trafford General community campaign’s official response to the public consultation over the NEW HEALTH DEAL FOR TRAFFORD.

Background

The Save Trafford General Campaign is a community based campaign established to enable local people in Trafford to have their say on the proposed changes at Trafford General Hospital.

The campaign was launched in June 2011 when it was first announced that Trafford Healthcare Hospital Trust was no longer viable as a hospital trust because it could not achieve Foundation Trust status by April 2014 – the date laid down by the Department of Health for all Hospital Trusts to achieve this new status.

As a result, it was decided Trafford Healthcare Hospital Trust would seek an ‘acquisition partner’ and effectively be incorporated into the core business of the acquisition partner.

By September 2012, having completed what was described as ‘an open and transparent’ acquisition process, a decision was made that the Central Manchester University Hospital Trust had been successful in acquiring Trafford Healthcare Hospital Trust. It would become part of Central Manchester on the 1^st April 2012.

As the acquisition was taking place Trafford PCT in consultation with the Shadow Clinical Commissioning Group launched the pre-consultation phase of the New Health Deal for Trafford.

Throughout the acquisition process and the pre-consultation phase, members of the Save Trafford General Campaign raised questions around the future of:

• accident and emergency services
• acute surgery
• the pediatric observation and assessment unit
• intensive care services.

These questions were raised both in private meetings with the commissioners and in public at the ‘pre- consultation meetings’.

Each time, we received reassurances from commissioners that no decisions had been made about the shape of these services for the future. There were further reassurances that the acquisition of Trafford Healthcare Hospital Trust was an ‘as is acquisition’ and that no changes were planned for the future.

Despite these reassurances, we were not convinced. We continued to air our concerns in public and in private with the specific aim of encouraging greater awareness of the threat to their local NHS services amongst the people of Trafford. We were also keen to ensure that local people had the opportunity to make their voice heard and be fully involved in shaping the New Health Deal for Trafford.

Since the announcement of the proposed changes in April 2012, the Save Trafford General community campaign group has:

• held regular campaign meetings open to all members of the public
• conducted face to face discussions with the public at a regular series of street stalls in Urmston, Stretford, Old Trafford and Sale and at public events all over the borough
• gained press coverage for the campaign to save services at Trafford General in the local, specialist, regional and national print and broadcast media
• used social media, specifically Twitter and our facebook pages to further engage members of the public (see https://www.facebook.com/saveTraffordNHS – 624 members and  http://www.facebook.com/groups/SaveTraffordNHS/  98 members
• produced and distributed more than 10,000 posters and leaflets about the threat to Trafford General in and around Trafford
• had representatives attend all of the consultation meetings
• regular discussions with and provided intelligence and feedback to local politicians, including councilors in both Trafford and Manchester, the leader of Trafford Council, Cllr Matt Colledge; the chair of Manchester’s Health Scrutiny Committee , Cllr Eddy Newman; Wythenshawe and Sale East MP Paul Goggins and other MP’s involved in similar campaigns to save local NHS services. The relationships we have developed with the above named elected representatives have been open, respectful and supportive. It will be noted that this support has been cross party.

The public have responded to the campaign to the SaveTraffordGeneral campaign and to the SaveA&E campaign with passion, commitment and unswerving loyalty to their local hospital and NHS services.

They have made it clear in countless ways and on numerous occasions that they vehemently oppose the plans to close A&E and ICU, end children’s services and stop all acute and emergency surgery at the birthplace of the NHS.

The clearest expression of opposition came at the march and rally that took place on 7^th July 2012 – around the 68^th birthday of Trafford General as the first NHS hospital in the country, when more than 1,000 people came out on to the streets of Urmston to show their opposition to the commissioners plans. History was made as local people filed past Trafford General in the biggest public demonstration ever seen in Trafford.

The campaign has enjoyed widespread support from the public ever since. More than 12,500 people from across Trafford have signed our protest petition which has been presented to the Prime Minister. Again this is the largest expression of public opposition and demands ever seen in Trafford.

More than 900 have signed our online petition at 38degrees

http://you,38degrees.org.uk/petitions/save-a-e

And more than 900 people (93 per cent) have voted “Yes” to the question:

Do you support the campaign to save A&E, ICU, children’s services and acute surgery at Trafford General Hospital? on our website www.savetraffordgeneral.com

Public opposition to the New Health Deal for Trafford is clear, unequivocal and overwhelming.

But we have little confidence that health commissioners will listen to the people of Trafford. Throughout the public consultation; which has been characterized by incompetence, repeated failures and broken promises; they have shown an arrogant contempt for the views of local people. Commissioners appear to come from the ‘we know best‘ school of management and have been consistently unwilling to answer legitimate questions openly and honestly or to properly address the concerns of local people. They are supposedly servants of the public, but appear to take the public for fools. The people of Trafford have shown they won’t be fooled.

 It is against this background that our response to the New Health Deal for Trafford is made. The proposals to downgrade and remove services from Trafford General Hospital are overwhelmingly opposed by local people. Their views must be listened to very seriously and given fundamental priority by health commissioners. Our submission reflects the views of the overwhelming majority of Trafford residents.

 Our response to the New Deal for Trafford Consultation document:

 1. Vision for integrated care.

We have extremely serious reservations about the vision for Integrated Care.

Within the consultation document and in the presentations outlined at the consultation meetings, no examples have been provided for what Integrated Care would look like in the Trafford of the future.

Before anyone can have an informed view of Integrated Care people want to know:

• what services will be available
• when these services will be available
• where these services will be located
• the cost of these services and the funding available
• the scope of these services
• the impact of the Integrated Care model on current GP and community services, and on the terms and conditions of existing staff
• the impact on Trafford General Hospital
• how and when people will be able to access these services
• how these services compare with what is currently available.

Without this clear, concrete, factual, information, the vision for Integrated Care is just words on the page. It bears no relationship to reality.

Given the significance attributed to Integrated Care for the future health and well being of Trafford residents, commissioners have signally failed in their duty to ‘inform and engage’ people in the development and delivery of ‘The New Deal for Healthcare’ in Trafford.

To suggest that people can make a decision about potential changes and the removal of vital services at Trafford General Hospital on the basis of the mythical ‘vision for integrated care’ indicates a serious lack of respect for the people of Trafford. Moreover, it underlines serious professional failings on the part of Trafford’s Healthcare commissioners. They have simply failed to do their job properly.

The ‘vision’ and the consequent impact on, and relationship with, hospital services at TGH are also based on a ‘pick and mix’ analysis of the available research. The most authoritative research on Integrated Care clearly indicates a successful integrated care service must be carefully introduced as part of a transitional approach to health service delivery. It also relies on a fully functioning locally based, single site accident and emergency service – see the Kings Fund review of Torbay Integrated Care Services.

This was obviously such an inconvenient truth for Trafford’s health commissioners that they have consistently chosen to ignore this valuable and authoritative piece of research. This comes as no surprise to those who have dealt with health commissioners over the last six months – they have consistently relied on assertion rather than evidence.

2. The reason for change.

We have serious reservations about the case for change.

The idea that the downgrading and removal of services at Trafford General Hospital will make any significant impact on the apparent £19 million deficit is now patently ludicrous.

Commissioners began the public consultation holding to this line; these measures needed to be taken to reduce the deficit.

But as this argument began to unravel, they shifted their position in the latter stages of the consultation process.

They acknowledged that any substantial savings would be found within the Central Manchester Foundation Trust colossal £750 million annual budget and that the A&E related changes were “peripheral” to the TGH financials.

At the same time, a detailed analysis of the NHS Trafford budget indicated that the £19 million was more a symptom of what we believe to be ‘spread-sheet-itis’. Budgets are shifted around to present financial evidence for whatever ‘case’ or ‘vision’ commissioners want to pursue.

Neither the campaign team, nor even the Council’s executive has received satisfactory explanations to legitimate and detailed questions concerning the financial claims and transactions.

The ‘deficit’ also appears to be a direct result of payments made to CMFT by Trafford PCT since the acquisition.

The second part of the case for change seems to rest on arguments around numbers, patient safety and recruitment.

Commissioners again appear to take a selective ‘pick and mix’ approach to available evidence from the National Clinical Advisory Team.

Commissioners failed to report that the same National Clinical Advisory Team also reported ‘good team working practices and a robust system of rotation for clinical specialists was more important than numbers to ensure clinical safety within a hospital environment’.

Rather than the public being provided with clear, transparent and robust evidence and options, they have been force-fed a single plan with one-sided arguments that do not even stand up to basic, let alone forensic, scrutiny.

We believe that an alternative case for change can be made: to retain and develop the services at Trafford General as part of Central Manchester Hospital Foundation Trust.

This approach would:

• increase the number of patients using Trafford General Hospital
• maintain and improve the current safety record at Trafford General Hospital
• reduce pressure on the accident and emergency service at other hospitals in the area
• ensure a more balanced budget
• ensure the recruitment of appropriate skilled and qualified clinicians
• support the development and introduction of a fully integrated care service for Trafford.

3. The proposal

a. Orthopaedics

We support the proposal to improve orthopaedic services at Trafford, with reservations.

Throughout the consultation there was;

• a failure to present any  robust evidence to justify  it has the full support of the public
• a failure to present any specific evidence from clinicians or the public to support the establishment of an orthopaedic centre of excellence at Trafford General
• a failure to provide proper projected costings or projected income streams
• a failure to properly identify patient numbers, resource implications or the likely impact on other services at Trafford General
• a failure to present the financial risks linked to the development of an orthopedic centre of excellence
• a failure to acknowledge, and minimise the increased transport/travel costs to people who may use the new facility in the future
• a failure to acknowledge the lack of public transport links in some areas of the borough, notably  Broadheath and Partington.

Again, patients don’t appear to be at the heart of these proposals, which appear to be constructed for the benefit of clinicians. Where is the evidence otherwise?

b. Outpatients

We fully support this element of the proposal.

c. Day case surgery

We support this element of the proposal with reservations.

In addition, we believe that a fully functioning Intensive Care Service must be retained to fully support the potential risks associated with any surgery.

To omit this we fear puts patients’ lives in potential danger.

We also have concerns that an increase in capacity for day case surgery could be used as a means of reducing the current waiting lists at other CMFT sites. With an estimated 1,500 people on the waiting list at CMFT this could increase, rather than reduce waiting times for Trafford residents.

How this is managed needs explaining to the public, so that it is understood to be ‘fair’ to all.

d. Intensive care and emergency surgery.

We do not support the proposed changes to intensive care and emergency surgery.

The rationale appears to be that with the removal of intensive care and emergency surgery it is not possible to deliver a full accident and emergency service.

This is flawed logic. Colloquially, it puts the cart before the horse. Turn it around and logic tells us that if we retain Accident and Emergency services we automatically need to retain intensive care and emergency surgery services.

Trafford ICU only very recently benefitted from significant investment of more than £1,million – the justification for this recent investment still applies.

 Accident and emergency

We do not support the proposed changes to accident and emergency services.

This is wrong. The lack of facilities to carry out emergency surgery and provide an intensive care service will mean that people who require these services will need to be transferred to other hospitals in the area. These will result in unnecessary risks to patient safety and increased delays in receiving appropriate treatment.

Similarly the removal of the Paediatric Observation and Assessment Unit means that children who require this service will need to be transferred to other hospitals in the area. This will also result in unnecessary risks and delays in treatment to children in our area.  This is unforgivable risk-taking with the health and welfare of our children.

These proposed changes to Accident and Emergency services have not been fully explained to people as part of the consultation process.

At no stage of the consultation has the case been made to downgrade accident and emergency services.

As indicated above the case for downgrading accident and emergency services is based:

• a flawed logic
• a selective ‘pick and mix’ approach to available research
•  prejudicial single-site accounting.

There has been a lamentable failure to explore a least one alternative option – increase the numbers of people using the service to enhance the delivery of services to local people.

There has been a failure to take into account the serious concerns of the public outlined below. There has been a real failure to engage the public in an open and honest consultation.

The focus of clinicians and commissioners has been on their single-minded belief that super-size hospitals will deliver better outcomes for A&E patients.  There has been a fundamental failure to comprehend that this dogmatic obsession is not a universal truth per-se and not universally accepted or guaranteed.

There has been an institutional preoccupation with the preferences of clinicians and familiar hospital structures, whereby there has been no attempt whatsoever to explore multi-site network services capacity and delivery models.

There has been a noticeable reluctance or refusal to view and assess the changes from the perspective of the patient, as they affect the complete patient experience and journey from incident through to treatment and eventual recovery.  The public are rightly very concerned about the impact of changes on:

• increasing ambulance/paramedic demand and worsening incident capacity & response times;
• increasing travel times – by ambulance or public/private transport;
• increasing travel costs – for patients and families and friends;
• increasing treatment waiting times at already over-capacity super-size hospitals’ A&E units;
• the seriously adverse individual and combined effect of the above (and other unintended consequences) – on lives lost, health compromised and inequalities increased.

4. Are there any aspects you feel have not been considered?

It is reasonable to expect that broader regional changes may have significant domino effects on Trafford patients and the broader network of health services provision.

It would be perverse in the extreme to be seeking to permanently remove services at TGH now which may in fact have a very important role in the context of the regional service developments and multi-site capacity, flexibility and options.

5. Any other comments

Public engagement efforts have been poor. Many people are still unaware of the proposals for the future of Trafford General, which represent the biggest changes to the local NHS since it was founded 68 years ago. By any judgment, the public consultation has repeatedly failed to consult the public of Trafford.

The SaveTraffordGeneral community campaign petition with over 12,500 signatures was delivered in person by a small delegation to the Prime Minister’s office at Number 10 Downing Street on Thursday 18^th October 2012, with a letter to the Prime Minister requesting that he forward the petition to Trafford’s health commissioners as a matter of urgency before 31^stOctober 2012, for inclusion in the consultation.

6. The consultation

We fully support the view of Trafford Health Scrutiny Committee in their description of the consultation as being flawed and their recommendation that the consultation should have been postponed and delayed until 2013 and considered as part of the Greater Manchester review of accident and emergency services.

We are also very concerned that despite a number of promises that all households in Trafford would receive a copy of the consultation document before the consultation started; significant numbers of Trafford residents failed to receive this document at any stage of the consultation process.

Having attended all of the consultation meetings,  it is clear to us that not enough time and effort has been put into informing and encouraging local residents to attend the consultation meetings with a significant number of the meetings having less than 15 local residents attending.

We made a number of suggestions on how the consultation team could engage with local people but none of these suggestions were taken up as part of the consultation process. Promises that ‘bespoke’ meetings would be held have not been kept. To provide just one example, SaveTraffordGeneral invited health commissioners to a public Question Time event, with an independent chair. They refused our request. So much for public engagement.

It was clear from the presentations made by the Commissioners that the consultation was at best a deeply flawed PR exercise designed solely to inform local people about why changes had to be made (from the point of view of the commissioners). There was no attempt at genuine dialogue or exploration of the issues.

The question and answer elements of these meetings failed to properly answer any challenging questions asked by the public or to provide any real solutions to any of the serious concerns people raised. It was the worst kind of ‘box ticking exercise, revealing a deep contempt for the views and concerns of local people. In passing we would observe that this culture of arrogance, complacency and ‘we know best’ has no place in public service, least of all our National Health Service, which is beloved by so many.

The main concern raised at these consultation meetings was the risk to the health and well-being of local people from the loss of a fully-functioning 24/7 Accident and Emergency Service.

People at these meetings continually drew on their own personal and family experiences, to express their fears and concerns for the future. Their concerns about the lack of facilities at other hospitals to deal with accidents, injuries and illnesses were constantly raised. The problems of capacity at MRI, Wythenshawe and Salford Royal and the consequent delays in receiving appropriate treatment were constantly repeated. In response, commissioners sought to minimise and downplay these concerns.

The only response from both clinicians and commissioners was that while they understood the difficulties people faced and ‘were sorry’ about the lack of facilities, they ‘were confident’ that the proposed changes would result in better healthcare provision across Trafford as a whole. But no evidence was adduced to support this claim.

Other concerns raised by the public included:

• the likely increase in waiting times at alternative hospitals following the changes to accident and emergency services at Trafford General
• the increased time it will take from accident occurring to treatment time at alternative hospitals following the changes to accident and emergency
• the increased cost and time taken for family and friends to visit following the changes to accident and emergency services at Trafford General Hospital
• the increased time it would take to diagnose and treat children following the loss of the Pediatric Observation and Assessment Unit
• the lack of evidence to support the belief that Integrated Care will reduce admissions to A&E services.

Commissioners duly acknowledged these issues were problematic but failed to offer any plans, resources or actions to properly address them prior to the changes taking place.

The consultation also failed to take any real account of people with different needs or to engage with people and groups who can be described as ‘hard to reach’.

This area must be seen as a significant failure of the consultation. There is a clear legal requirement to meet the needs of different groups of people within the consultation process. Many of the groups who can be described as hard to reach are people who are likely to be most affected by the proposed changes.

A clear example of the failure to meet the need of people with different needs can be seen in the failure to provide copies of the consultation document in a range of versions.

For example one community group who contacted the consultation team to request the document in languages for people from South Asian communities were informed it would take some time and that the only language available was Urdu.

When asked what people with mental health needs should do in the future following the closure of A&E between 12 midnight and 8am, we were told ‘they will need to go elsewhere’. We find this a shocking abrogation of responsibility by a public service. There was no acknowledgment or acceptance of the difficulties this would  raise for an extremely vulnerable group of people, nor were any proposals put forward to minimize the risk to people in this situation.

Throughout the consultation, members of the Save Trafford General community campaign made repeated requests for information on a variety of these issues.

Dutiful assurances were given in public. But, away from the public gaze, there has been a spectacular and repeated failure to provide this information in a genuine, timely, open and honest fashion. This shows a remarkable and breathtaking lack of both professional integrity and respect for the local community which highly-paid commissioners are supposed to serve.

To date we have yet to receive responses on the following issues;

• the scale, scope and outcomes of activities to engage with ‘hard to reach groups’
• the usage of accident and emergency services by people with mental health needs
• details of the number of A&E attendances from 1^st April to 30^th September 2012
• reasons for presentation at A&E from 1^st April to 30^th September 2012
• times of presentations to A&E from 1^st April to 30^th September 2012
• details of numbers of people admitted for treatment from the 1^st April to the 30^th September 2012
• details and numbers of people transferred to other hospitals following admissions through A&E from 1^st April to 30^th September 2012
• the business case for developing Integrated Care services
• the financial case for the New Deal for Health in Trafford.
• The financial justification

To date, we have been informed that a total of 330 people have attended the public meetings held as part of the consultation process and the 1,316 completed response forms have been received.

The population of Trafford is approximately 225,000 – these response figures therefore represent c.0.15% and c.0.58% of the population of Trafford.

Hardly a ringing endorsement of the consultation process.

This needs to be set against 1,000 people who marched through the streets of Urmston on the 7^th July 2012 to protest against the downgrading or removal of services from Trafford General Hospital, and the 12,500 people who signed the petition to retain the services at Trafford General Hospital.

The consultation figures reported by the commissioners clearly illustrate a spectacular failure to effectively engage with the population of Trafford throughout the consultation.

Whilst it might be wrong to anticipate the reported outcomes of the consultation, the figures clearly illustrate that any analysis of the consultation response forms will at best be potentially misleading and at worst completely inaccurate.

Given the clear view of the local community that current service delivery at Trafford General should be improved rather than downgraded or removed, it is incumbent on the commissioners to now properly explore with the public the alternative options retaining its 24/7 A&E, ICU, POAU and appropriate surgery and increasing the numbers of people using Trafford General Hospital, as part of a multi site network, rather than driving through a fundamentally flawed ‘plan’ which does not enjoy any public support and which puts the health and well-being of many Trafford residents at risk.

It is not too late. This public consultation should be shelved and the future of the services at Trafford General considered as part of the forthcoming Greater Manchester review. To do otherwise would be both wrong and wholly inconsistent with the need for comprehensive, joined up health care fit for the 21^st century.

It would illustrate corporate contempt for the views, concerns and needs of local people whom the NHS is meant to serve.

It would put the lives and health of local people at risk and it would sound the death knell for Trafford General, the birthplace of the NHS.