Looking to The Future – Analysing Consultation Responses

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					                CALDERDALE PRIMARY CARE TRUST
              HUDDERSFIELD CENTRAL PRIMARY CARE TRUST
             SOUTH HUDDERSFIELD PRIMARY CARE TRUST




                       LOOKING TO THE FUTURE –

                 ANALYSING CONSULTATION RESPONSES

                             Agenda Item 04/06

Purpose of paper

1. There are two sections to this paper, one covering Looking to the Future
   and the other Moving Forward. The purpose of these papers are to:

         Provide information on the approach to analysing the responses to
          the consultation.

         Report on the responses and views gathered to the consultation
          proposals and, highlight the key themes in each area.

         Continue our commitment to involving public and patients by
          providing information at each stage of the consultation process.


Action Required

2. Board members are asked to note the approach analysing the
   consultation responses and the key issues raised by the public and
   stakeholders.



Paper Author:

Looking to the Future: Dawn Gaukroger, PPI lead, Calderdale PCT

Moving Forward: Steve Pashley, Independent Healthcare Management
Consultant

Lead Director:

Jo Bibby, Project Director, Looking to the Future
LOOKING TO THE FUTURE – ANALYSING CONSULTATION
RESPONSES


1. Purpose of the Report

1.1       The purpose of the paper is to:

             Provide information on the approach to analysing the responses to
              the consultation.

             Report on the responses and views gathered to the consultation
              proposals and, highlight the key themes in each area.

             Continue our commitment to involving public and patients by
              providing information at each stage of the consultation process.


2. Background Summary

2.1 Following a period of engagement with stakeholders and people who use
    services (see Engagement Annexe – www.calderdale-pct.nhs.uk „Looking
    to the Future‟) the consultation stage was aimed at the wider public and
    sought their views on a range of options for future services. A consultation
    document was published as a full report and in summary form. It
    presented options for each of the key service areas:

         Community services
         Surgical services
         Children‟s services
         Women‟s services
         Estates and St Lukes

2.2 The consultation commenced on 6th October 2005 and initially was
    planned to end on 16th January 2006. However, following a request by the
    Calderdale & Huddersfield Joint Overview and Scrutiny Committee, the
    consultation was extended by a further two weeks to 30th January 2006.
    Wide ranges of consultation activities were undertaken during the 17
    weeks (see paper 03/06). The activities sought to reach four groups:

         The general public
         Representatives from voluntary and community groups
         Key stakeholders and service users
         Staff and health care professionals.

2.3 The approach to consultation was discussed and agreed with the local
    Overview and Scrutiny Committees (OSC), the Patient and Public
    Involvement Forums (PPIF) and the Strategic Health Authority (SHA).




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3. Data Capture

3.1   The process to capture the data was as follows:

         All letters, emails and freepost responses from members of the
          public and key stakeholder were recorded and referenced.

         Petition responses and standard letters were also recorded under
          the proposal area and the number of signatories noted.

         Data captured through stakeholder events such as meetings,
          workshops and discussions were recorded by the staff that
          attended or supported discussions.

         A media review of all coverage of Looking to the Future and the
          issues raised.

3.2   All correspondence either verbal or written has been read,
      acknowledgements where appropriate have been sent and all
      comments have been noted. A full audit trail has been compiled and
      comments used in reports and feedback can be traced back to source.


4. Analysing responses

4.1   The approach to analysing and reviewing the responses for
      consultation was developed with advice from Strategic Positioning- a
      management consultancy with a track record of working with Boards
      through complex decision making processes.

4.2   In order to ensure full and fair examination of all the responses, all the
      data gathered from letters, emails, feedback forms, and notes of
      meetings was reviewed. Independent advice was taken on handling
      issues that fell outwith the consultation proposals.

4.3   Strategic Positioning facilitated a workshop, running over 2 days, with
      the three PCT Boards to ensure that there was a structured, balanced
      and thorough investigation of the concerns raised through consultation.

4.4   In order to analyse the responses a database was established to
      capture all the comments made. The database registered individual
      issues under the following headings:

         Community services
         Surgical services
         Children‟s services
         Women‟s services


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             St Luke‟s Hospital and Estates
             Transport and Other
             Ambulance service

4.1       Within each section of the database the following categories were set
          up to identify themes, which were emerging from the responses:

         Access
         Clinical issues/safety
         Patient/Family experience
         Health inequalities
         Workforce
         Capacity
         Finance
         Process of consultation
         A question or clarification

4.2       Once all the data had been captured it was possible to analyse the
          responses in a systematic way. The process also supported the
          identification of any possible new approaches to the issue consulted
          on, any impact of the proposals to patients and the public, and the
          levels of support among particular groups on the proposed areas for
          change.


4.3       Some 250 separate themes were identified through this analysis. For
          each issue an explanation or response was commissioned from the
          relevant service improvement group. A Panel of PEC members and
          Directors from the PCTs reviewed this information in order to prioritise
          themes for consideration at the joint PCT Board workshop. Boards
          were provided with a full set of all the themes raised and the responses
          provided. They also received copies of all the stakeholder letters,
          standard letters and petitions.




5. Quality Assuring the Process

5.1 The approach taken to analyse and consider responses was Quality
    Assured by a subcommittee of the Primary Care Trusts and Calderdale
    and Huddersfield NHS Trust (membership is listed at Annex 1).

5.2 In quality assuring the analysis of consultation responses, the
    subcommittee followed the Cabinet Office guidance on consultation. As
    stated below:




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Extract from Cabinet Office Guidance on consultation

       Responses were carefully and open-mindedly analysed, and results
        made widely available. An account of the views expressed and the
        rationale for decisions finally taken should be given.

       All responses to the consultation were acknowledged.

       Responses were carefully analysed for:
           o Possible new approaches to the issue consulted on
           o Further evidence of the impact of the proposals
           o Levels of support among particular groups

       Attention was paid to:
               o Single issue groups monopolising the debate
               o The views of representative bodies, voluntary organisations,
                  user groups and other groups that are especially affected by
                  the issues

   As full account as is possible was kept of both formal and informal
    responses and everyone‟s views are considered fairly.




5.3 The subcommittee developed a checklist to assess whether all information
    was analysed in a „quality controlled‟ manner.

5.4 In conclusion, the subcommittee agreed that the process offered a robust
    and transparent approach to dealing with consultation responses.




6. Meetings held and Responses made

6.1 The following meetings were held during the consultation period across
Calderdale and Huddersfield. Patient views were recorded at all meetings.

Number of Meetings with general            13
public
Number of meetings held with key           53
stakeholders and service users




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6.2 In addition, a total of 1477 individual responses were received:

                  Method of Feedback                              Number
                                                                  received
Feedback forms received                                      89
E-mail via the Looking to the Future website or PALS         287
Telephone calls                                              46
Faxes                                                        0
Letters (including stakeholder responses)                    1055
Huddersfield Examiner – Maternity response                   1450
Huddersfield Examiner – Gynaecology and Surgery              2133
response
Object to all proposals form                                 723
Petitions                                                    9 (45,446
                                                             signatures))


6.3 There was a spectrum of views expressed in the consultation.
    Responses from members of the local community overwhelmingly
    expressed concerns about the proposal. Many of the letters from
    individuals did not agree with any of the proposals put forward, some
    focused specifically on concerns about the proposals for maternity
    services. All the reasons given for these concerns were considered in
    the analysis put to the Board Workshop.

6.4 Views on the proposals for community services tended to be expressed
    through the stakeholder meetings and feedback forms rather than in
    letters from members of the local community.

6.5 Views expressed at stakeholder meetings tended to demonstrate an
    understanding of the factors driving the need to change and raised many
    valuable and significant comments about factors that would need to be
    addressed if proposals were implemented.

6.6 The responses from professional groups tended to be supportive of the
    proposals, indicating recognition that the proposals addressed issues of
    national standards.

6.7 A number of responses were received from local councillors and councils
    setting out concerns on behalf of their constituents. Full copies of these
    were made available to Board members.




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7. Issues raised during the consultation

7.1 This section sets out a summary of the key issues raised repeatedly
    throughout the consultation process. Although the list is not exhaustive, it
    emphasises the prominent areas of concern in each of the proposal areas.

7.2 Direct quotes from written responses from the general public and
    stakeholder groups have been used in and amongst the text as examples.
    These comments have been picked to support key issues and are not
    intended to reflect the wider view but more an individual patient experience
    of a service. Again the comments are not exhaustive.

7.3 The responses from the Calderdale and Huddersfield Public and Patient
    Involvement (PPI) Forums have been included in full at annex one. The
    Joint Health Scrutiny Committee summary of „Conclusions and
    Recommendations‟ is also attached at annex two.




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A.     Community Services

Comments from the general public: Community Services

Are these community services going to be properly resourced? Will there be extra
staff? Are staff going to be trained appropriately – if its all down to GPs – surely this
is going to add to their workload and patient waiting times and in turn cause patients
difficulties when they want to see them. At the GPs I attend I frequently find it difficult
trying to get an appointment with my GP when I want it and the practice nurse is not
easily accessible.

Will GP’s be sufficiently trained in screening and diagnosis at the moment this is
done in hospital?

If services are devolved to GP practices, how do you ensure this doesn’t increase
risk?




7.4 The proposals for community services set out in Looking to the Future
    elicited the following views from the public and stakeholders:

7.4.1 People welcomed the idea of more services provided more locally but
      wanted assurances that these developments will materialise

7.4.2 There were concerns expressed as to whether there was the capacity
      and capability within primary care to take on additional workload that
      would be associated with these developments

7.4.3 People wanted the assurance that services moved from hospital
      settings into the community would be safe and of as high quality

7.4.4 It was also felt to be important that developments in community service
      would not be at the expense of hospital services.

7.4.5 There was support expressed for more support for people with long
      term conditions to „self-manage‟. There were a range of views
      expressed on how this could be best achieved.

7.4.6 The needs for carers to be recognised and supported was raised .




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Key stakeholder Comments: Community Services

‘The committee is supportive of the move to increase investment in community-based
healthcare and to provide some services in local communities which have previously
only been available in hospital settings’ -Joint Health Scrutiny Committee
(Calderdale and Kirklees).

‘ In general, we welcome those moves designed to provide services local at sites
more readily accessible to patients, so long as robust controls are in place to ensure
that such services are of equal or better quality to those currently provided’ -
Calderdale PPI Forum.


‘The forum believe that there is a definite need to develop services in the community
but are concerned how this could be most effectively carried out without a major
increase in staffing and funding without diminishing hospital services in both
Calderdale and Huddersfield’ – Calderdale and Huddersfield PPI Forum.

‘The Forums seek assurance on the provision of services within the community to
ensure that the proposed service delivery plans are adequately supported’ -
Huddersfield Central and South Huddersfield PPI Forum.




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B.     Surgical Services


Comments from the general public: Surgical Services

‘I agree in principal to elective surgery having one base. There must be a facility for
emergency surgery to occur on all sites’- comment from a member of the public.

‘A few years ago, we actually experience a transfer to Halifax. A family member had
emergency surgery in Huddersfield where there were no spare intensive care beds.
The move an our subsequent visits to that foreign place added dreadfully to the
trauma for the whole family.’

‘I feel planned surgery should take place at whichever hospital is most local to
patients depending on where they live. In my case it would be HRI. Facing the
trauma of surgery is hard and having family and friends visit is a crucial role to play to
play in giving people the strength to cope’.

Should we have a group that looks at discharge requirements?




7.5 The general public‟s views on the surgical proposals, including breast
    surgery and gynaecology, were predominantly concerned with the
    implications of services being further away.

7.5.1 Some people expressed concern that with services for emergency
      surgery being further area this could lead to increased risk.

7.5.2 It was felt that emergency surgery was something that should be
      available on both hospital sites

7.5.3 The distance people would need to travel for planned surgery was also
      a concern.

7.5.4 People wanted greater clarity on how people would be supported to
      access services

7.5.5 The implications for friends and relatives was also a particular concern.
      It was felt that the additional distance would make visiting difficult,
      particularly during winter months.


7.6 In addition to these general issues there were specific concerns raised
    about the loss of breast surgery from the HRI site.




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  Key Stakeholder Comments: Surgery

  „The committee is supportive of the proposals to separate planned and
  unplanned surgery onto different hospital sites, which evidence suggests will
  have clear benefits to the quality of care and patients‟ clinical outcomes, including
  less likelihood of planned operations being cancelled‟ - Joint Health Scrutiny
  Committee (Calderdale and Kirklees).

  „ Whilst the Forum can accept the need to concentrate specialist services such as
  oncology and urology it cannot support the proposal to allocate emergency and
  elective surgery to different hospitals. The Forum does not believe that there
  should be any reduction to emergency facilities at either hospital‟ – Calderdale
  and Huddersfield PPI Forum.

  „The Forums on the grounds of clinical logic, support the proposed transfer of all
  emergency orthopaedics, emergency general surgery and the complex planned
  surgery to the Huddersfield Royal site and the provision of all planned inpatient
  general and orthopaedic surgery at the Calderdale Royal site‟ - Huddersfield
  Central and South Huddersfield PPI Forum.

  „We accept the benefits of a proposed combined unit, but feel that given the
  considerable history of service and support in Huddersfield, this is where any
  such unit should be sited. We urge those who have the difficult job of deciding
  the shape of services to seriously consider our submission when reaching that
  decision‟ - The Huddersfield Royal Infirmary Breast Clinic Appeal

  „ The Forum‟s support the proposal to centralise the treatment of breast disease
  on clinical grounds‟- Huddersfield Central and South Huddersfield PPI Forum.

  „The concept of concentrating all in-patient gynaecology at the Calderdale Royal
  site is supported, as it will not only improve training for junior doctors but will also
  allow the consultant to develop special interest teams to enhance clinical care of
  women„ – Royal College of Obstetrics

  „The committee supports the proposals to provide all acute inpatient gynaecology
  services from the Calderdale site, as this will ensure that women requiring an
  inpatient stay can be looked after in an environment dedicated to their needs‟-
  Joint Health Scrutiny Committee (Calderdale and Kirklees).

  The specialist centralisation of specialist services such as gynaecology and
  breast cancer, providing that adequate pre-operative and post-operative care is
  provided and supported in both Calderdale and Huddersfield, is a proposal the
  forum would support‟ – Calderdale and Huddersfield PPI Forum.




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C.     Children’s Services

Comments from the general public: Children’s Services

„Some neonatal studies underline the fact that premature babies do better if their
parents are involved in their care as much as possible. How will the extra distance
on a single congested route help parents – especially for those residents of South
Huddersfield – in carrying out this important role?’

‘A sick child needs to know parents are close at hand or visiting regularly. It’s a
worrying time. What about the single parents of this world having to trek backwards
and forwards on public transport and of course the added financial costs of having
longer distances to travel’

‘Very sick children need very prompt treatment. A trip from south Huddersfield to
Halifax could cost a child its life.’




7.7 Similar to the surgical services, the main issues raised by the general
    public were concerned with the implications on the additional travelling.
    There was a particular emphasis on how this would impact on families.

7.7.1 Many people felt that paediatric services is a core service and that it
      should be possible to provide them in a hospital serving the population
      the size of Huddersfield

7.7.2 People who had used the service felt that the current services were
      good and didn‟t feel they needed to change

7.7.3 There was concern expressed that the additional journey distance from
      Huddersfield to Calderdale could present risks for sick children

7.7.4 The experience of families was an issue of particular concern. It was
      generally felt that the additional journey time and the complications that
      this will involve would be stressful for parents and could affect their
      child‟s recovery.

7.7.5 It was felt that the needs of single parents required specific
      consideration.




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Key stakeholder comments: Children’s Services

„The Committee is supportive of the provision of more services for children in
community and non-hospital settings. Members also believe the proposals to
centralise inpatient paediatric services at Calderdale Royal and emergency surgery
at Huddersfield Royal to be in the best interest of Patients‟- Joint Health Scrutiny
Committee (Calderdale and Kirklees)

„We welcome the proposal that hospital doctors should provide children‟s clinics in
the community but question whether this will provide cost effective utilisation of
expensive professional staff resources‟ – Calderdale PPI Forum

„In the interest of the health of children in both areas the forum would be in support of
concentrating inpatient services at Calderdale providing there is an increase in staff
and equipment…The forum would suggest that the Trust when making decisions
involving children take into account the difficulties that families face when a child is
an inpatient‟- Calderdale and Huddersfield PPI Forum.

„The Forums are supportive of the provision of inpatient children‟s services at the
Calderdale Royal site augmented by a 24 hour paediatric Assessment and
Observation unit at the Huddersfield Royal site‟ - Huddersfield Central and South
Huddersfield PPI Forum.

„The centralisation of Neonatal and General Paediatric inpatient beds on the Halifax
site should be strongly recommended‟ – Royal College of Paediatrics and Child
Health.

„We would support the establishment of an assessment unit at the Huddersfield site
and would recommend that there is a consultant who has responsibility each day for
that site and this could be linked into the clinics in Huddersfield hospital. It will be
important to develop clear protocols for the assessment and management of children
with, for example, abdominal pain‟ - Royal College of Paediatrics and Child
Health.

„The neonatal network supports the proposed model of service as set out in the
consultation document, specifically the centralisation of neonatal intensive care
provision onto one site‟- Yorkshire Neonatal Network Partners In Care.




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D.     Maternity services


Comments from the general public: Maternity Services

‘As for the midwife led unit proposed for HRI, I do not believe this will be suitable for
the majority of births. First time births, C-sections, high blood pressure, etc. In fact
anything but very straightforward pregnancies would be excluded from a midwife led
unit’

‘The distance I have to travel from Meltham to Calderdale is of great concern. In
terms of having a baby this can be a very rapid and sudden event and there may be
little enough time to get to HRI and at rush hour having to get to Calderdale could
endanger the child. It would probably be quicker and more convenient for me to
travel to Oldham or Tameside instead.’

‘Surely the town the size of Huddersfield and the areas covered should warrant
keeping our own full maternity services at the Huddersfield Royal Infirmary. Having
to travel an extra five miles form my area adds extra anguish all for mothers to be
feel’

I feel very strongly that these proposals do not have our best interest at heart and will
increase pressure on midwives and are purely being made for financial reasons.




7.8 The proposals for maternity services attracted by far the greatest amount
    of comment. The overriding concerns were about potential risks of the
    preferred option.

Obstetrics

7.8.1 There was a very strong feeling that a population the size of
      Huddersfield should be able to support a full obstetric service. Some
      people felt that women should be able to have the choice to have their
      baby in Huddersfield if they wish to.

7.8.2 People also felt that even if there was a case for centralising the
      obstetric service is should be centralised in Huddersfield rather than
      Calderdale.

7.8.3 The question of how the additional deliveries could be accommodated
      at the Calderdale Royal was raised in a number of the stakeholder
      meetings.

7.8.4 There was also some concern that the additional journey distance to
      Calderdale would pose risks to women and their babies.




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Midwife led unit

7.8.5 The proposal for a midwife led unit at HRI raised concerns amongst the
      public. People expressed strong concerns about the risks of transfers
      between a stand alone midwife led unit at HRI and the obstetric unit at
      CRH

7.8.6 Aside from the possible risks of transfer there was also a feeling that
      transfers during labour would have a negative on women‟s experience
      of care

7.8.7 People were concerned that while women are aware of limitations of a
      home birth and implications if complications arise, they may not
      understand that a stand alone midwife led unit essential provides the
      same level of care.

7.8.8 The comment was made in a number of responses that the proposals
      will lead to increased litigation costs if things go wrong on a midwife led
      unit.

7.8.9 Another concern expressed was that the number of women able to
      deliver in a midwife led unit would be small and there could be
      questions about its long term sustainability.



General comments

7.8.10 The view that the proposals were financially driven was widely
       expressed and that the issues should be addressed in current services
       by employing more doctors.

7.8.11 There were concerns about the additional travelling for women and
       families and the feeling that access to the Calderdale Royal was poor.

7.8.12 People felt that the proposals reduce the choice available for women in
       Huddersfield.

7.8.13 There was some support expressed for the need to move away from
       birth being seen as a medical event and the concept of normal birth be
       promoted.




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Key stakeholder Comments: Maternity Services

„The Forum…remain strongly opposed to the proposed option for maternity services
and do not believe it is in the best interest of the patients or staff‟ – Calderdale and
Huddersfield PPI Forum

„The Committee acknowledges the need to improve early access to maternity
services, and that a shift in emphasis towards more community-based provision is
required in order to tackle inequalities in experience and outcomes for women and
their babies„ – West Yorkshire Joint Health Scrutiny Committee (Calderdale and
Kirklees Subgroup)

„The Calderdale LMC has considered the above strategy and would support the
proposals to integrate services for the residents of Calderdale and Huddersfield.
One area of particular concern to the residents is the provision of maternity services.
The LMC has been reassured of the safety of this provision and would not hesitate to
support these plans„ – Calderdale and Kirklees Local Medical Committee

 „We support the general concept of midwife led maternity care and a partial move
from hospital to home confinement‟ - Calderdale PPI Forum.

„The Forum‟s remain unconvinced that the proposed option for maternity services
would be in the best interest of local people‟ Whilst the Forum appreciate the
legitimacy of the clinical rationale for centralisation of all inpatient gynaecology at the
Calderdale Royal site, they are unable to support the proposal in it‟s current form‟

In planning future Maternity services consideration must be given to all local factors,
which could impact on current standards of service delivery……The college believes
that midwife-led care is clinically appropriate for far more women than the number
that presently choose to give birth in mid-wife led units and birth centres‟ – The
Royal College of Midwives.

„The Huddersfield branch of the Royal College of Midwives would like to respond to
the consultation document “Looking to the future”. Our members are unanimously
opposed to the centralisation of obstetrics and paediatrics at the Calderdale Royal
Hospital albeit with a stand alone midwife led unit in Huddersfield. W have all signed
a declaration to his effect (enclosed)‟ - Huddersfield branch of the Royal College
of Midwives

„Whilst acknowledging that many labours are absolutely straight forward and trouble
free we are well aware that sometimes they are not and that things can go wrong
absolutely at the last minute. Therefore as a group we are against moving complex
maternity services to the Calderdale Hospital. We feel that the midwife unit planned
for Huddersfield Royal should have doctors available in that hospital if need should
arise‟ - West Yorkshire Federation of Townswomen Guild.

The Calderdale LMC has considered the above strategy and would support the
proposals to integrate services for the residents of Calderdale and Huddersfield.
One area of particular concern to the residents is the provision of maternity services.
The LMC has been reassured of the safety of this provision and would not hesitate to
support these plans. Calderdale and Kirklees Local Medical Committee,
Calderdale Division




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PAPER 04/06 (1)   16
E.     Estates and St Luke’s Proposals

Comments from the general public: St Lukes

‘There need to be more rehab beds, couldn’t these be provided at St Lukes’ –
comment from a member of the public

‘The Barton Unit is easily accessible and if we go to the HRI we’ll probably have
further to walk and parking will be a nightmare. We’ll also lose the family
atmosphere. It will be like moving from country to town.’

How long until Acre Mill is up and running? Will St Luke’s be closed before new
locations for services are identified?



7.9 People using the services at St Lukes raised questions about the future of
    these services.

7.9.1 Some people asked whether the site could be refurbished and kept
      open
7.9.2 Other people recognised that the service at St Lukes did need to be
      relocated but were keen to ensure that the environment of care, in
      particular in terms of access, was replicated in the new sites.
7.9.3 People wanted more detail on where specific services would be moved
      to.


Key stakeholder Comments: St Lukes

„The evidence considered above, taking into account the proposals in the concurrent
Mental Health Trust consultation, convinced the Committee that the proposal to move
services away from St Luke‟s represented the best option for the users of those
services. They believe that accessibility to these services will be improved by the
move‟ – Joint Health and Scrutiny Committee (Calderdale and Kirklees).

„The Forum has requested clarification on the site or sites that will provide beds for
mental health services, stroke rehabilitation service, renal service and the X-Ray
service that is currently provided at St Luke‟s Hospital. Until this information has been
provided the Forum cannot support the proposed changes‟ – Calderdale and
Huddersfield PPI Forum.

„The Forums are supportive of the proposals, however, they seek clarification and
reassurance on the future of renal services (as part of the proposed consultation
process led by Leeds Teaching Hospital). Furthermore, the Forums would
recommend that the psychological and psychiatric services are located to the Acre
Mills site‟ – Huddersfield Central and South Huddersfield PPI Forum.




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F.     Transport

Comments from the general public: Transport

Proposals are good providing transport is available for family visitors. I would have to
take two buses to get to Calderdale Royal from Sowerby Bridge, then another bus to
Huddersfield, which means I could not visit my husband as often as a wife should’

‘You hear about children, maternity ans other areas, however the elderly are
frightened coming from Denby Dale and Skelmanthorpe and having to travel to
Halifax.’

‘Transport is a problem and cost, Huddersfield is very far from Todmorden’




7.10 Transport was an issue that ran through people‟s responses to all the
   areas of consultation.

7.10.1 The practical issues concerning congestion and travelling at peak times
       and poor parking facilities was raised by a number of people.

7.10.2 However, the difficulties facing people, particularly visitors, who would
       need to sue public transport was the primary concern. This was both in
       terms of the additional costs this would pose and the inconvenience. It
       was generally felt that older people and families would be worse
       affected and that specific action would need to be taken to alleviate
       this.

Key stakeholder Comments: Transport

„Whilst supportive of the proposed move in principal, the committee believes that it
will be crucial to ensure that the transition is carefully managed to ensure that
services are in place before existing ones are phased out. Adequate consideration
must be given to the provision of transport links, car parking etc. Staff considerations
will need to be taken into account‟ – Joint Health Scrutiny Committee

„Travel matters between Huddersfield and Calderdale sites have been the topic of
much comment. We recognise that such distances are no greater than experienced
in many parts of the country for travel to any hospital‟ – Calderdale PPI Forum
„The subject of transport, not only between the two towns but to outlying areas, is of
great concern to the public. The Forum has met with representatives from the Trust
to encourage and support the Trust in providing suitable transport services for
patients, families and visitors and an increase in parking facilities at both sites‟-
Calderdale and Huddersfield PPI Forum.




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Key stakeholder Comments: Transport cont……

„Despite the promise of enhanced local services, the Forum‟s are concerned about
the additional travelling many of the proposals would pose on patients, carers and
relatives. This would be most felt by older people, families with children and the
lower socio economic groups who already experience inequalities in health‟ –
Huddersfield Central and South PPI Forum.

„ Longer and more uncomfortable journeys to and from hospital, longer time for
carers to spend travelling on our even busier roads‟ – Huddersfield Arthritis Care.

„little has been said about senior citizens quite a lot of whom live in rural areas and
find it very hard to travel to Halifax, if their spouse is admitted there it means that they
have to catch at least two buses, not all of which will connect, and if they wish to
spend some time with their loved ones they will need to find somewhere for lunch,
consequently it will be very long and tiring day for them‟ – Huddersfield and District
Pensioners Organisation.




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G:     Ambulance Service (WYMAS)

Comments from the general public: Ambulance services
I have today at a quiet time travelled to the Halifax hospital. At 12:25pm it took 40
minutes, all lanes were full, nowhere to move, even an ambulance with blue flashing
lights could not come along. If this was the case when I had been pregnant neither
myself or my child would be here to make this comment’ – comment from a member
of the public

I am sure you must have considered the risks involved in travelling such a distance
on such a congested road, and the disruption this could cause to a woman in labour.
Fear and stress can disrupt an otherwise normal labour, and make it much more
difficult for the woman, and the baby. There would also be costs to the NHS Trust in
terms of ambulances used to transfer women. There is really only one route between
the two hospitals.


7.11 The ability of the ambulance service to cope with these changes and
   ensure safe transfers was raised throughout discussions of the different
   service models. This concern stemmed from a number of causes:

7.11.1 The capacity of WYMAS to cope with additional transfers

7.11.2 The feasibility of WYMAS being able to transfer patients fast enough
       between the two sites in an emergency

7.11.3 The safety of transfers in themselves.


Key stakeholder Comments: Ambulance Services

„ The committee had noted that safety during transfers had been a significant
concern throughout the public debate. However they have seen that, in reality, a
large number of transfers on a daily basis are currently taking place, and this is
routine activity. They have also learned that transfers of some of the sickest patients
to other hospitals outside the area for specialist treatment is also a normal part of
current service activity‟ – Joint Health Scrutiny Committee (Calderdale and
Kirklees)

„ Emergency transfers are recognised as being an emotive matter, but we accept that
any patient movement in an emergency may be subject to abnormal and
unforeseeable delays and must be placed in the context of statistical significance in
relation to cost or practical provision of alternatives‟ – Calderdale PPI Forum.

„The Forums recommend that a full risk assessment be carried out, by diagnostic
groupings, in relation to bed to bed patient transfers by the Trusts in conjunction with
WYMAS‟ – Huddersfield Central and South Huddersfield PPI Forum.

„There is no risk assessment on what has been done on the movement of very ill
patients‟ – Huddersfield and District Pensioners Organisation.




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8 Staff Views


8.1 In addition to the activity to consult with the general public and
    stakeholders there was also numerous briefings and workshops for staff.

8.2 Staff raised many of the same issues that were raised by the general
    public and stakeholders however, they had particular interest in:

8.2.1 The likely timescales for implementation if proposals are agreed

8.2.2 The choices they will offered if their service area is reconfigured

8.2.3 The training and development needs that some fo the service model
      may require

8.2.4 The implications of the proposals on clinical support services and
      therapies.

8.2.5 How service developments would be integrated with partner
      organisations.




March 2006




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