Transcription:Meeting the Challenge Consultation

Public MeetingMorley Town Hall20th March 2013

Printed 5 May 2023

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

Steve Richards:...Steve Richards, a journalist. I'll be chairing tonight, chairing in the most informal way because frankly, there are four of you. So we can have a conversation and you can ask questions to a range of guests. But I think the two of you have seen this presentation but you two haven't, so I think we are still going to do it for your benefit. And then, you know, let's have a conversation with the range of guests.

I'm going to introduce Mike Potts, who's Chief Executive of the Primary Care Trust, who will guide you through the presentation and introduce the other speakers. And then, frankly, we'll open it up to a conversation.

Are you our specialist? Let me just…what I've done in the previous evenings. Sorry?

US:Am I in the wrong spot?

Steve Richards:Not at all. No, you're absolutely…you're welcome. Just if you could introduce yourselves.

Karen Stone:So hello, I'm Karen Stone. I'm a paediatrician, a children's doctor in the Mid Yorkshire Hospital.

Anne Ward:I'm Anne Ward, I'm Head of Midwifery at the Trust.

Andy Simpson:My name's Andy Simpson, Head of Ops for Calderdale, Kirklees and Wakefield Yorkshire Ambulance Service.

Paul Mudd:Good evening, my name's Paul Mudd. I'm the Locality Director for West Yorkshire, Yorkshire Ambulance Service.

Steve Richards:It might be useful as well if the two local GPs introduce yourselves. Is that okay?

Steve Ledger:Hi, my name's Steve Ledger. I'm a GP actually in Morley and I sit on the governing body of Leeds West CCG, of which Morley is at the south end of the patch.

Diane Hampshire:Hi, I'm Diane Hampshire. I'm Director of Nursing and Quality for Leeds West CCG.

Steve Richards:Okay, thank you very much. So what I will do is hand over to Mike Potts next, who will guide you through the presentation. And then we will open it up for questions. I'll just let those of you who have just arrived come in. [pause] Great, thanks for coming. I was just saying to the others, we're going to have a short presentation from the panel and then we'll

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open it up for questions in a very informal conversational way because it's a small group, so we can have a nice range of questions and answers.

Mike, you're going to guide us through the presentation.

Mike Potts:I was going to sit here but now other people have come in, I'm not so sure whether I might be better up there, because I don't want to sit here if you can't see me. So shall I stand here, and as long as you can see me and hear me, and my operative here will press the buttons.

First of all, a very warm welcome to you this evening. My name is Mike Potts and I'm the Chief Exec for the Calderdale, Kirklees and Wakefield Primary Care Trusts. And just before we start, I just want to explain about what's happening in the organisation of healthcare. Because many of you will know that from the 1st April, primary care trusts are being disbanded, abolished, as are strategic health authorities, and we're handing over to the clinical commissioning groups. And we've got some of the representatives from the clinical commissioning groups in Leeds here with us this evening. And for some of you who have been to previous presentations, you've met some of the other clinical commissioning groups in Dewsbury and potentially in Wakefield.

So those changes are going to happen at the end of this month, so actually by the end of next week. And so from 1st April, it will be the clinical commissioning groups that are responsible for the commissioning of local healthcare for the populations of the areas that they serve. And they will be responsible for leading this consultation, which, at the moment, is my responsibility but I will be handing that formally over to the CCGs from the 1st April.

I think I'm going to stand up there because I can…I needn't fiddle with this mic. Is this on? Thank you.

Right, so what we want to do tonight is we want to just start a conversation with you about some really important changes in the way that we're proposing to organise hospital services across the Mid Yorkshire Hospital Trust. So that's Pontefract, Pinderfields and Wakefield; so Wakefield, Pontefract and Dewsbury areas.

And this is the start of a conversation, and I just wanted to share with you some of the ways that you can actually contribute to that discussion and that conversation over the next three months, because we've been doing quite a lot of what we call pre-consultation work. So in terms of the proposals we're going to share with you this evening, we've already done upwards of about 40-odd meetings across the patch with local elected members, specialist groups, members of the public, to try and shape and get some idea about what are the things that are important to patients, and to help shape some of the proposals that we're putting forward to you tonight.

M1:Can I ask a question about that, please? Just a quickie.

Mike Potts:Yeah.

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M1:Well, you said you've had 40 meetings, so I suppose members of the public have spoken at the meetings. Has anybody changed your mind on any point at all?

Mike Potts:Right. Well, let me just finish and we'll answer your questions.

Steve Richards:Yeah, there'll be plenty of time for questions. That's been raised at other meetings, so I promise you, you'll get an answer. But if we hear the presentation first and then there'll be plenty of times. Thanks very much.

Mike Potts:Okay. So what we've done is, we've engaged with as many people as we can do in shaping these proposals, but we now have to talk to the public, people like yourselves, officially, as part of a legal requirement that, if we want to make any major service changes in terms of how we organise services, we have to go through what's called three months statutory consultation. And that is the start of this three-month consultation.

At the end of that, we will then - and I'm using the royal we - the clinical commissioning groups will then review what members of the public have said and what the various overview and scrutiny committees that are engaged in this with us as well, because they have to look at these proposals. And then we will look at everything that comes out of the consultation and decide whether there's justification for anything to be changed. And then we will make a decision, or the CCGs will make a decision about how we move forward. Okay.

In order for you to be able to contribute in those next three months, we've got a whole range of ways that you can do that. So we've got eight public meetings; we've got the summary document which is going out to 242,000 households; we've got the website, so we've got an online questionnaire that you can fill in; we've got about 36 road shows that we're going to be doing over the three-month period; we've got dozens of meetings with smaller groups and individuals; we've got drop-in sessions; we've got dedicated phone lines and email; and there'll be quite a bit that you'll see in the media. So this is just one opportunity for you to engage in this process. And I would encourage you to take part and access those vehicles for letting us know what your views are, because that's really important.

So moving on. The principles that underpin these clinical changes, and govern the services and the decisions that we take about those services, are that we want to end up with safe, high quality services, delivered to people at the right place at the right time. And that's about understanding what your needs are when you actually want to access the NHS. And that might be as an emergency or it also might be as a planned patient accessing services. And we want to have hospital and community services that are of equally high quality.

Now what we're going to talk to you about tonight is just about the hospital services. But actually, what we're looking at is a bigger transformation programme looking at how we need to organise care outside hospital as well. And that's care that we might deliver in the community, care that might be delivered through primary care. Because without us

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looking at how we deliver care across the whole system, we will need to make sure that it all adds up, it's all integrated and it all works effectively together.

So I just want to make the point that this is about the hospital changes tonight but we are actually looking…and I'm going to give you some examples about how care outside hospital has changed, just to set the scene before we get into the detailed proposals about the hospital services.

Things are not as they used to be, I wasn't quite around when some of those pictures were taken. But you just need to watch the television and see the advances in medical technology that we've had over the years, the advances in drug therapy, the techniques of doing surgical procedures now. So gone are the days where, if you're going for an operation, you're kind of slit from here to here. There's keyhole surgery, which is called minimally invasive surgery. And you can have procedures now on a day case basis where, before, you had to be in hospital for a number of days or even weeks.

So there have been huge advances in terms of the way we treat people. And as a result of that, we're getting better outcomes. So patients are getting outcomes that are better than they were in the days when those pictures were taken. And those outcomes, we want to continue to improve on and we want to continue to save more lives as a result of how we organise services in this part of the patch. And that's what we're going to talk to you about this evening.

So it's about putting the pieces together; it's about the promotion of good health. And that really is about also promoting people to adopt healthy lifestyles and to make sure that we work further upstream, so that people don't get ill in the future. It's about having strong primary care. It's about having what we call integrated community and social care. We know that health and social care services are inextricably linked. And social care is delivered through local authorities, and healthcare is delivered through the NHS. And sometimes we've got maybe duplication in services.

By putting them together and making sure that they're integrated, we can provide a better service to the public that we serve. And really, it shouldn't matter to you who delivers the service; it should be about you need to access care, and actually who delivers it shouldn't matter which organisation. It's about it all being joined up in a way that meets your needs and is delivering you a good experience of the local NHS.

We want to communicate well. And it's about having high quality facilities. And that's not only in terms of buildings but it's about having high quality care. So it's alright having a nice, bright, shiny, new building; you've got to have good care within that as well. And we were just having a conversation about that a bit earlier.

So care outside hospital. The BMJ did a survey, and 84% of doctors believe hospitals are not the best places to deal with the frail elderly. And many patients that we've talked to as well agree with that. Frail elderly, wherever possible, need to be cared for in their own home, and we shouldn't just be picking them up and taking them into hospital. So there is a lot that we can do to keep the frail elderly out of hospital and to provide that care in a community setting, in their home setting, wherever possible. So it is about making sure that we do that. But in order to do that, we need to join all the services up in a meaningful way, that actually delivers that care to that individual patient at the time and the place where they need it.

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F1:Don't the frail elderly have a voice of their own?

Mike Potts:Yeah, they do, and they've been telling us that. Yeah, okay.

Steve Richards:We'll have so much time for questions, let's get the presentation done. Thank you.

Mike Potts:Patients have been telling us that as well. And CCGs have a duty to promote integrated care. And all authorities agree that this is key to a sustainable health service going forward.

We know that we're going to, in the next 20 years, improve the life expectancy of people. People are going to live a lot longer. We know that by…I think it's about 20 years' time, we'll have double the number of people who have long term conditions; so things like asthma, coronary heart disease, diabetes. And all of those people will put an additional burden on the NHS and on social care services. And we need to start and anticipate that now, and look at how we might deliver care in a different way that will get people into the right part of the system at the right time, and improve outcomes and save more lives; and also, meet the huge challenge that's going to be coming forward to us over the next decade and beyond.

So care outside hospital. The key principles of this are built around the needs of patients, rather than the organisations. We want people to have more control over their care. We want care to be based on their need, available when they need it. We want one assessment process. And one of the things that people keep telling us is, they get fed up of every time they come into contact with different parts of the service, having to give the same information again. If we are all part of one system, why can't we have one assessment process?

We want that care to be seamless. So inevitably, we've got a whole raft of different providers, providing different care. But that shouldn't matter to the patient who provides it, it's about it being seamless, and they can get and access that care in a seamless way, when they need it. And that we need to use and share information better, so that we're not having to continually repeat and ask people the same questions. And we need to share that information about patients in a way that we don't do now.

So moving forward then, care outside hospital. We're already doing some of this now. So there are examples of new and different ways of delivering care that are happening today. But it's not happening what I call universally across the whole patch. So we've got examples of good practice in various parts of this patch but we haven't got it uniformly delivered and available across the whole pathway.

So just to give you a couple of examples. Breathing problems: we've now got specialist teams of nurses caring for people in their own home. We've got telehealth for the most vulnerable. So we've got people able to monitor their long term conditions at home, via telehealth and telemedicine. And that has really, really, from the patients that we've talked to who are experiencing this telehealth, they're saying it's really liberated them. So they're

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not waiting in for a healthcare professional to come and take their blood pressure or monitor their various signs, they can do that themselves. The technology will take those key measurements through to some specialists, and they will monitor them from a distance. And we're not exploiting that telehealth and that telemedicine in a way that we should be, that would really transform the way we look after people, particularly people with long term conditions.

Diabetes: most of the care of the people with diabetes now is done in a GP's surgery or at home. Consultants and nurses support GP clinics. And the standard is national best practice. So we shouldn't be taking people with diabetes into a hospital all the time, we can monitor them outside, in their own home, and working with specialists alongside primary care and working in the community.

So what we want is joined up care, where people are at the centre, with a single contact; social care and healthcare in one team, so not fragmented and people being bounced from one organisation to the other; we want community-based teams improving care for people with long term conditions. So, you know, maybe some of the specialists that we have currently sitting in hospitals should be out there and operating those specialist skills in the community, alongside other team members, to keep people out of hospital, when they don't need to be in there. We need intermediate care teams, giving urgent short term support in a crisis. So when people have a crisis with their particular condition, we need to deal with that very quickly; we need to be able to get them into the right place in the system; we need to sort it out and then get them back out into the environment which they're more familiar with. And we want people to feel much more in control and supported all the way through the process.

And we've got examples of some of that, that's going on now. But as I said earlier, we're not doing enough of that to make sure that we can meet the challenges and the pressures that are going to be on the system, going forward.

So just to give you a nice diagram here. This is a good example, and this is…we've taken this from Torbay. So Torbay have already done this. So, you know, we're not just reinventing the wheel here, we're taking examples of good practice where it's happening elsewhere in the country. And that's a good example of maybe what we've got now, lots of jigsaw pieces, lots of services that are surrounding this frail elderly person, but they're actually not all joined up. And it's an absolute nightmare for that lady to access all of those services, and indeed, for sometimes healthcare professionals to access the services as well, because they are fragmented.

And the position we need to get to is that all of those pieces are joined up; that we have a single assessment process; integrated teams and people working effectively together; we're engaging and we're working alongside friends and family, and involving relatives, carers in the care of the individual; and also, being able to access those specialist services when we need to.

So that's the journey we're on, that's where we're trying to get to, in terms of making sure that we can save more lives; we can keep people out of hospital where they don't need to be in hospital; and we can provide a much more integrated service than we're providing at the moment.

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So just before I hand over to Richard Jenkins to talk about the changes that we're proposing in the hospital services, I just wanted to say to you, in terms of the proposals that we're putting forward tonight, these proposals have been looked at by clinical experts. So we're not allowed to stand here and start a formal process of consultation with the public, without having the proposals that we're going to share with you tonight externally verified by clinical experts. And what those clinical experts do, they come and they look at our proposals, and they test them to see whether they are clinically safe; whether it is the best way to organise services, to improve patient outcomes and save more lives; and to look and see questions about sustainability moving forward. So it's no good us putting proposals to you that are not sustainable going forward.

So the proposals that Richard will talk to you about have all been externally verified and they've been tested, and they have been deemed to be safe, sustainable and the best way of improving outcomes and saving more lives. So I just wanted you to know that because that's really important, that we haven't just dreamt these up and we're suddenly just standing here. There's a whole process behind this that tests out, and checks and challenges us, in terms of what we're proposing.

So I'm going to hand over to Richard now, and he's going to go through, in detail, the changes that we're proposing around the hospital services.

Richard Jenkins:Right, thank you, and good evening. I'm going to talk through the hospital services, as Mike said. It's really important to remember though, that's just part of a system of healthcare that includes all of the community care as well. And it's best to think about this as a whole package.

So I'm going to talk through four main areas, and particularly on maternity services but especially at the time of birth; children's inpatient services; A&E and unplanned emergency care; and also, surgery. And for each of those areas, I'm going to tell you what happens now, what we're proposing, and why we feel that's going to improve things.

So for births, at the moment, when a woman's pregnant, the antenatal care makes an assessment of the amount of risk that, that pregnancy has attached to it. And it's possible for the teams to work out whether a woman is low risk or high risk. And the options available to women depend upon that, in terms of where she can give birth.

I'm not going to spend too much time tonight talking about what happens at Pontefract because I don't think that's relevant particularly for local people. If people want to know about that, I can talk about that later on.

Predominantly, a person living in this area would have choices…a low risk woman living in this area would have choices, either having her baby at home or at Wakefield or at Dewsbury. If the woman was high risk, she'd have the choice of going to Wakefield or Dewsbury. But if it was recognised that there was likely to be a risk to the child such that neonatal intensive care would be needed, that would necessitate her having her baby in Pinderfields because that's where that service has been for some time.

So what we're proposing is that we would have all high risk births delivered on a consultant-led obstetric unit at Pinderfields. For women in Wakefield and Dewsbury, they would have the option of having their babies at home if they were low risk, or at the local

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midwife-led unit. There'll be midwife-led units at all three of the Mid Yorkshire hospitals. All of a woman's antenatal care will be delivered close to home. It's only the birth where this will be a change.

So why do we think this is better? Well, we know from evidence that's been published elsewhere that for a low risk woman, midwife-led care is just as safe in a midwife-led unit and actually provides a better experience. And so we think that this change will promote choice for women. We know also that if a woman is a high risk pregnancy, then you really need to go to a unit where there is the expertise there for as many hours of the week as possible. And the proposal here is that we would get to have 24 hour a day, seven days a week consultant presence on the obstetric unit at Pinderfields, which would be a benefit to women from the whole area if they needed that care. So we believe that would improve the outcome for women with high risk pregnancies and for sick children; and also, would provide more flexibility in dealing with caesarean sections.

Right, moving on to children's inpatient care. Now we're not changing anything about outpatient care, that'll be delivered in our local hospitals, as it is now. Currently, if a child needs inpatient care, they can go to the inpatient ward at Dewsbury or the inpatient ward at Pinderfields, whichever is most appropriate for them. Neonatal intensive care for the sickest babies has been in Pinderfields for this area since 2010, and all inpatient surgery for children, which is a more highly specialised type of paediatric care, is done in Pinderfields. And for some very specialist care, that's already done in Leeds.

What we're proposing is that inpatient care for Dewsbury residents would be at Pinderfields in the future. We would put in an urgent paediatric assessment area into the Dewsbury hospital. And that would deal with probably about half of the children presenting. But if a child is sick enough to need to come into hospital, spend time in hospital, then they really need to go a unit where you can have consultant presence for more hours in the week than we're able to provide on multiple sites. But we continue to have outpatients on three sites and we continue the urgent assessment of sick children on three sites.

So why do we think that's better? We think for the more less severely ill children, that allows care to be continued on a local level and people should be able to go home quickly, as they do now. But for the sicker children - and this is where we think we can make a difference - there'll be more easy access to senior doctors round the clock; more consultant presence on the wards until late in the evening and at weekends. And altogether, we think that will provide a safer service. But as much as possible of children's care will be kept in our local hospital.

Emergency care: So at the moment, we have three A&E departments and we're going to continue to have three A&E departments. People can take themselves to any of the A&E departments now. If they call an ambulance, the ambulance crew will make a decision about where the best place to take that person is, based on where they live and what's wrong with them, and what facilities are available in each hospital. Next slide, please.

What we propose to do is that we propose to make Pinderfields the main A&E department for this area, and that will deal with the sickest patients. That will allow us to have 24 hour a day, seven day a seek consultant presence in the department, which is something you can't do in three hospitals because there aren't enough doctors to do that. Pinderfields is the trauma unit for this area, and Leeds is going to be the trauma centre from the 1 st April.

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So most patients who have a very serious illness will go to Pinderfields under these proposals.

However, we believe that, that will be…won't affect the vast majority of people who already use Dewsbury A&E department. So 60% of the people using Dewsbury A&E department are what are classified as minor cases. And we believe that, as a minimum, 60% of the current people who use Dewsbury will continue to use it, and we think probably closer to 70%. Sorry, can you just go back, please?

All three A&E departments will have full resuscitation facilities and there'll be a consultant anaesthetist on site in all hospitals, to provide care for the sickest patients if there's a need for that. Thank you.

US:[Inaudible - microphone inaccessible 0:27:48 - 0?27:50] intensive care unit?

Richard Jenkins:No. Let me go onto that in a minute. So if…

US:[Inaudible - microphone inaccessible 0:27:54 - 0:27:58].

Steve Richards:The presentation, if you just…yeah. I promise you, trust me.

US:It's trying to remember when you get to the end because you're telling us so much.

US:Of course it is.

Steve Richards:Yeah. I promise you, I'm going to bring each of you in on the points raised already.

US:Right, okay.

Richard Jenkins:So if you call 999, things have changed from the position some years ago, where an ambulance crew might just pick someone up and drop them off in hospital. These days, the ambulance crew will start assessing the patient and treating straightaway. And so by the time someone is brought to hospital, if that's what's necessary, treatment will have been commenced. We've got colleagues here from the ambulance service, we can talk about that later on, if there's any need to do so.

So why is that better? Well, we feel that, that allows us to, again, provide better care to the most seriously ill patients, or the ones where it will make a difference to survival and outcome. This allows us to have more specialties available at senior level, at consultant level, for longer hours through the week, and concentrated in one place where multiple expertise can be brought to bear. The sickest patients these days need co-ordinated care from a number of senior teams, and you can't do that in every hospital.

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People would not move more than one hospital away from where they live. So if you were in Dewsbury, you wouldn't go further than Wakefield, and if you're in Pontefract, you wouldn't go further than Wakefield. But people who have relatively more minor illness would continue to be seen at their local hospital, as they are now. And as part of that, we're also intending to develop something called emergency day care, which I'm just going to talk about now.

So we know that some people who currently come to hospital and stay in hospital for a few days probably don't need to. So about half the people who come to hospital spend under two days in hospital. And often what's going on is, we're ruling out more serious illness. We're getting better at doing that and we've got better protocols to do that than we used to do. And many hospitals have started to do this on more of a day case basis. So people come in and spend a few hours on the ward and maybe come back the next day, have scans or whatever's necessary to make the diagnosis, and maybe treatment on an outpatient basis.

In my experience, most people prefer to be able to go home and stay in their own bed, in their own comfort and eat their own food, than spend a day or two in hospital. We already do this for many conditions, so deep vein thrombosis or blood clots in legs, we already do that, but we plan to do that for a wider range of conditions. And we're going to start rolling out at Dewsbury and Wakefield from this summer.

And the last area I'm going to talk about is surgery. So at the moment, we have inpatient emergency surgery at Dewsbury and Wakefield. We also have short stay and day surgery at both sites. And at Dewsbury, we also have surgery for orthopaedics and gynaecology, and a wider range of specialties at Pinderfields.

What's proposed is that we separate emergency surgery from planned elective surgery under this model. So emergency surgery will be done at Pinderfields under this model, and elective surgery will be done at Dewsbury and Pontefract, apart from the more complicated elective surgery that might need intensive care, for example, which will be done at Wakefield. We'll have a wider range of surgical specialties represented on the Dewsbury site under this model, doing a wider range of procedures as day case and short stay surgery.

We believe that's better because separation of emergency and planned surgery has been recognised in many hospitals to provide better care for both groups of patients. It prevents the emergency work squeezing out and causing cancellations of the routine work. It also allows concentration of expertise for the sickest patients, in the way I described for, for medicine and A&E. It will provide less risk of infections because the sort of clean surgery for planned surgery isn't compromised by people coming in with infections. And it will reduce the time people need to spend in hospital. Thank you.

I'm going to hand over to Stephen, who's going to finish off the presentation.

Stephen Eames: Hi. Thanks, Richard. And good evening, everyone, and thanks for listening for so long. And I appreciate that quite a bit of this is a lot to take in all at once. I'm going to be quite brief. But before I just go on to what I want to talk about, could I just mention a couple of things. I've been here about a year, just over a year. And obviously, I came here to deal,

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in part, with colleagues here, with a particularly challenged organisation in lots of ways, financially and in other ways that you'll have read about in the local papers, and so on. So I'm new in the patch, although I did actually start my career at Dewsbury Hospital, or Batley actually, and then Dewsbury, 40 years ago. I'll be celebrating that on the 7 th May.

And I should also just say, because I'm very passionate about these changes, and I know they're quite contentious in parts of our patch, but my mum, my two sisters both live in North Kirklees. My mum's lived in North Kirklees for 60 years. She's had her health services provided by local hospitals, both Dewsbury and Pinderfields all that time. Both my sisters - they've got six children - all born in Dewsbury. And my stepfather sadly passed away about eight years ago in the intensive care unit at Dewsbury Hospital, actually. So, you know, I do understand and have a real sense of the issues in this area.

What I just want to do very quickly is - if you could go on to the next slide - is just pick up a few concerns that have come up in our conversations. I think Mike and I are not always together but certainly, in the year I've talked about, in this area, we've done something like 35 meetings with people. So I think…and we've been listening very carefully to what people have said. And the sorts of issues that have come up are these, and they came up last week in Dewsbury on Monday, and they came up in Wakefield and they came up in Pontefract last night.

The first thing is - sorry, can we just go back - the first thing is - and we talked a lot about emergencies - just important, as I'm sure you've all realised, that there are three sources for emergency care. The first is 999, everybody relates to, the blue light ambulances. We've now got a new service, only started about three weeks ago, 111. And that's about providing people at home who are anxious, providing them with advice and hopefully to help them care for their elderly relative or their child that they're concerned about, or to be directed on to the most appropriate place to get their care. That's a new service. We know from the first four weeks there's been a fairly massive take-up, as we've been piloting it across the patch. So it's a new service that everybody can use. And, of course, we've got lots of access for urgent care into our GP practices across the area. So it's just important when we talk about emergency care that it's not just about the hospital accident and emergency department. Okay.

The next issue is transport. And that's a picture of a bus, but what we know from every single meeting that we've had is, this is an issue. And it's completely understandable because it's all about if you have to go further for something that you didn't have to go further for before, how do you get there; how do you visit your relative; does that have an impact, certainly, on people who are, in some parts of our community, deprived.

One thing to say about this, it's really quite important - and Mike talked about it at the beginning - is, of course, while some things are changing and access may be more difficult in some services, we're actually bringing an awful lot more services locally. And when you look at the facts around that, a lot more services will [inaudible 0:35:35] locally - and if we just say Dewsbury in this context - it means a lot of people who are currently moving around the hospitals won't be, they'll be getting their services much nearer to home, in the hospitals. But more importantly, an awful lot more care is going to be provided away from the hospital in the home, in the local community. So it's just important, again, to balance off that need for access and support for transport with that set of changes.

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If we could just move on, I'm not going to go through all these. But these are the issues that we've turned into proposals that have come out of the discussions we've been having for seven or eight months about transport. I'm not going to go through them all, and they're not exclusive. We've already had - if we go back to last night - other suggestions about things to look at. And this is all about trying to respond. So these things we may do, some of them we will do, and there's some things that actually we probably haven't thought through yet because those ideas are just coming in to us. But be in doubt, we're very focused on the transport issue. Okay, if we could just move on.

Now can I just deal quickly with these common concerns. 'It's all about the money'. Well, it's not all about the money, it's all about better services; sustainable services; consultants at the front door 24/7 if you've got a critical illness; more access to care in your own home, in the local community. That's what these changes are about. And if we had a significant surplus - which I wish we did have but we don't - in the Trust, we'd still have to be addressing these questions.

But, of course, I, with my responsibilities and accountabilities, have to use the taxpayers' pound wisely, and we need to make sure that whatever we do, we do it as efficiently as we can, especially in the economic environment that we're all in. These proposals will save, if they go ahead, around about £10 million by 2015/16. So they do contribute to the financial issues but it's a secondary issue.

'Pinderfields is not big enough to cope'. Absolutely right, if things carry on as they are today, that is true. In fact, Dewsbury wouldn't be able to cope, none of our hospitals would. The system currently isn't designed to deal with the growing elderly, more people with dementia, all of those pressures that I'm sure we're all aware of. We have to change the system, which is what these proposals are about.

And we're aware as well of the growth in the population that's predicted for our area, we've factored all that in. And we are going to put some additional beds into the Pinderfields site, as part of these plans if they go ahead, to take account of some of those things. But we're expecting to operate, in overall terms, on less beds across the Trust, as those changes take place. And I've partly answered that third point on there, 'there won't be enough beds'. Well, actually, if those changes take shape, we believe that there will be.

'We're going to close Dewsbury'. I mean, I don't know how many times I hear that wherever I go. Well, can I just tell you, tell everybody, we're not. I am passionate about Dewsbury Hospital - I started work there, my family use it - as I am about the other hospitals. It's not closing under my regime or anybody else's. So let's be clear about that.

And 'there's a hidden agenda to close the A&E'. Well, Richard's explained what we're doing. We're not closing it, we're changing it. And actually, most people who require moderate or minor care, which is actually the majority of care that happens at Dewsbury now, will get it there in the hospital. Those people who have a serious condition - and by the way, this is already happening if you have a trauma or if you have a stroke, it's already happening - but those people with a serious condition, it's going to be better. You'll go to a hospital, whether you go on a Saturday night, a Sunday morning, you will get front-ended consultant services for children, for women and if you have an emergency. That's completely different to what we do in all three of our hospitals. So for the 500,000 people that we serve, that's a better service. And as has been said by all my colleagues, it will save more lives than we're able to do today.

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So I think on that note, if I may, Steve, I'll hand back to you in the chair.

Question and Answer SessionM = Male; F = Female; PM = Unidentified Panel Member; US = Unidentified Speaker

Richard Jenkins:Stephen, thank you very much indeed. Even though there are very few of us, we are recording all these meetings. So if you could wait for the microphone, but hopefully we can make this as conversational as possible. And as promised, I was going to bring each of you who raised questions during that presentation right back in. You were the first. Did you want to follow up your question about the nature of this consultation? Thanks for waiting for the mic.

M1:Okay. What I asked was, you've had 40 meetings or so, so you'll have a lot of questions from the public and suggestions. Have any of your minds been changed on any point that's been brought up at those 40 meetings?

Mike Potts:When we've gone to those public meetings, we've listened to what the public have said to us. The public are obviously interested in how they can get better outcomes, how we can deliver joined up services. The real concern that people have is around transport. And that keeps…time and time again, wherever we go to, people talk to us about transport. People have also talked to us about not wanting to travel from Dewsbury across to Pontefract, or Pontefract to Dewsbury. These proposals will stop that happening, as colleagues here have mentioned this evening. And they've come up with their concerns, which are about, more about issues of transport, how we care for people, how we get people's outpatient appointments right. Because we know the outpatient appointment system isn't right at the moment.

And we've given a commitment that where people go for their surgery, their inpatient care, if that's not in their local hospital, they will have what we call the pre and post-operative care delivered in their local hospital. And we need to be able to deliver that. And Stephen and colleagues have been doing a lot of work about looking at re-profiling and getting a much better appointment system, so that we don't have the public ringing up and asking for an appointment, and they end up getting an appointment in Pontefract when they live in Dewsbury, or vice versa.

So we have made changes, we have listened to what the public are saying. And some of the proposals that we've put up on here are as a result of some of the feedback that we've had. But don't forget, we were shaping those proposals. It's now the proposals are the ones that we're putting to you formally, and this is now the start of that consultation for you to give us formal feedback on all of that.

M1:Yeah. Well, it seems to me that all you're thinking about changing is transport problems. I live in Heckmondwike, I go to Pinderfields five times a year because I've got Parkinson's Disease. So I go see the Parkinson's nurse and the consultant. I've no problem getting to Pinderfields, it's the least of my worries. I can get a bus from Cleckheaton, Heckmondwike, Dewsbury, Batley to Wakefield, and there's a service straight to the hospital door. So

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that's the least of my worries. It's A&E is my big worry. I want it to stay as it is at Dewsbury, A&E and…

US:Here, here, yeah.

Steve Richards:Okay. Well, that seems to be a common concern, the A&E service.

M1:Oh, it is, yeah, not transport.

Steve Richards:Not transport but the A&E, okay. Richard?

Richard Jenkins:Yeah, we understand that's a big issue for people in this area. As I said before, the vast majority of people who use A&E and people who take themselves to A&E will continue to do that. So that’s at least, you know, we think 70%, it could be as high as 80% but we think 70%'s a reasonable estimate to get. If you're sicker than that and if the ambulance crews have to take you in, then what you need actually is everything behind the A&E, not just the A&E. And if you get to the A&E, you really need there to be senior presence there 24 hours a day.

US:[Inaudible - microphone inaccessible 0:43:38 - 0:43:40].

Richard Jenkins:No, that's not what's there at the moment.

US:[Inaudible - microphone inaccessible 0;43:42 - 0:43:52] I can estimate anything I want and it's an estimate. Actually professionally, sitting there saying to me I'm facing these massive changes on an estimate is insulting.

Richard Jenkins:I'm sorry you feel that way. We know that 60% of the people who currently use Dewsbury A&E are minors and we know, therefore, as a minimum, 60% of people who currently use A&E will be able to use it in future. We believe that more than 60% will do that, and so that's why I've said an estimate of 70%.

So what I was going to say is that if you're very ill and you go to A&E, what will make a difference is seeing a senior person there. There's evidence from other hospitals that if you have a consultant in your A&E all night, then people get better care, get better survival, people sometimes get sent home when they don't need to come in appropriately, who otherwise would have been admitted by a junior doctor who wasn't quite sure. All ways round it's better care. You can't provide 24/7 consultant presence in every A&E. It takes 24 consultants working on a rota to provide that, and there aren't enough consultants in the country to provide that in every hospital.

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So the purpose of doing this is to improve the care for the sickest patients and to maintain good quality care for people who are less ill.

Steve Richards:Okay, thank you very much. I think you wanted to come in at one point during the presentation, didn't you?

F1:Yeah, I did at one point but I've forgotten what it was. We've got that much information going on.

Steve Richards:Oh, right, okay.

F2:Somebody wanted to…

Steve Richards:Right, sorry. You also wanted to speak? Yeah. If you just say your name, then we'll bring it forward. Yeah, thank you.

F2:Yeah, I just wanted to know what was happening with the intensive care unit at Dewsbury Hospital, if the A&E facilities change, do they lose the A&E and HDU? And if so, can Pinderfields cope with an increased number of patients.

Steve Richards:Okay, thank you. Richard?

Richard Jenkins:Thank you. Yes, the intensive care and HDU would not stay at Dewsbury at the end of this process, when the inpatient emergency beds move to Pinderfields. And the reason for that is that the thing that requires…the reason you have an intensive care and a high dependency unit is to deal with the sickest patients, either people coming in as an emergency or people who are recognised…who need planned surgery who recognise that they might need intensive care to let them survive their surgery. So that would have to move to where the sickest patients were, which would be Pinderfields. And we believe it can cope. We've looked at the modelling and we're confident about that.

F2:What would happen then if you're doing day surgery at Dewsbury or you've got an A&E running for less minor problems but you have a crisis crop up on site? What would happen to the patient, if someone comes out of an anaesthetic on day surgery with unforeseen problems?

Richard Jenkins:Yeah, that's a very good point, and we've planned to deal with that. In fact, we've been doing exactly that at Pontefract for the last two years without any problems. So as I said earlier, we'll have a consultant anaesthetist on site. Anaesthetists are the people who keep you alive, essentially, in that situation, who can put a tube into your lungs and ventilate you.

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F2:So you could be ventilated at Dewsbury and then transported to Pinderfields?

Richard Jenkins:That's correct, yeah.

Steve Richards:Thank you. If the mic could go one desk forward. Thanks.

F3:The things that you're proposing sound really good but don't think you're going backwards, not having A&E at Dewsbury? And Pontefract, my husband went the other week and there's no services there. You can't stay, there aren't any beds, they've got to transfer you to Pinderfields.

US:They haven't got any beds.

F3:I was giving my leaflets out at the car boot sale on Sunday, and the stories people were telling me. There was an ambulance outside…someone in an ambulance outside Pinderfields, they couldn't take them in, they were outside for two hours waiting to be seen. So do you think that's better than what things are now? People can't go to Dewsbury Hospital unless they go in their own car. If they go in an ambulance, if they're picked up in an ambulance, they take them to Pinderfields. So this is all being done underneath, it's not being done…you're saying things that aren't true.

Steve Richards:So you raised two points. The shortage of beds is a fundamental one. And the second one was about the length of time it then takes someone to even be seen.

F3:Yes. And also, someone who said they'd been sent to Wakefield from Dewsbury, a young woman, and she was sent to a clinic in Wakefield. And she said, when she got there they hadn't got the appropriate machine, so she'd to then go to Pinderfields. And she hadn’t a clue how to get to Wakefield, she'd never been to Wakefield before.

Steve Richards:Right, she had to get there on…?

F3:Yeah.

Steve Richards:Right, okay. So that's another transport related point as well about getting from these different places. Right, three quite major issues there.

Stephen Eames:I'll start. I know Richard might want to come back in. Can I just break that down? So let's just deal with your point about the emergency services, and effectively, can they cope, and

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can there be enough beds, and so on. Well, like I was saying just now, if things stay as they are, no. That's absolutely right, I agree with you. What we're planning is a completely different way of organising our services in two ways. As we've described, for the sickest patients, providing a centre of excellence for them in Pinderfields 24/7. [Voices overlap 0:49:36]. Hang on, let me just finish the point because it's very important. So now that actually, if you look at the total demand of emergency care in hospital across our Trust, is the smallest bit. So when you talk about Pontefract, actually it does have beds, it has 64 beds, and those beds will remain.

F3:They're not being used.

Stephen Eames:They are being used. And if you want to talk about it afterwards, I can explain to you in some detail how they are. They're being fully utilised and, in fact, been utilised much more in the last year, where you might be right about that, they haven't been, you're absolutely right, which is a terrible waste of public money, but that's a different debate. But essentially, the vast…the largest part of our emergency service isn't the critical part that we've been talking about here, it's the walk-in, it's the moderate care. We're going to provide that locally, as we're saying.

What we also believe is, we know, from a lot of work that we've done in the last year - and I've got some experience of this from elsewhere - is that a lot of the people that get admitted - now let's just take Dewsbury Hospital as the example - to Dewsbury are older people, and they get admitted for a day or two days. If we had some of the measures that were being talked about earlier by Mike, in place, they wouldn't need to be. It's the wrong place for those people to be. It's a default at the moment. So that's the other big factor in here on the emergency.

Now I absolutely agree with about the complete shambles, if I can put it that way, because my mum's experienced it; three letters on the same day for the same appointment; being given a procedure which is a day procedure in Pontefract when she lives in Mirfield, and to get there for 7.30. It's bonkers. Yeah, I completely agree with that. And there's lots of issues there that we're dealing with. We've not dealt with them all but, again, rather than hogging the time here, I could spend some time talking you through how that's improved in the last year massively, and it's going to improve more in the next year, because together, we've spent an awful lot of money and time putting that right. And more people now, and certainly more people in the future, will get their procedures in the Dewsbury area, in the Pontefract area, rather than having to go from one end of the district to another. That's very much part of our plan. It's a big concern and I'm glad that you raised it.

I think the third point was more about transport, wasn't it?

Steve Richards:Transport from [voices overlap 0:52:08].

Stephen Eames:Transport from one end to the other. Now, of course, if we get some of that right - and we need your voice as another input to that - if we get that right, that problem will also be minimised. There's always going to be the case, we were talking about one last night, of someone who has to go…I mean, today, somebody from any of our area might have to go

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to Pinderfields because they've had a stroke, because that's the place you go because that's where you're going to get the best input and recovery. But we know in some of those circumstances that those people don't necessarily have the support system, their family can't get there, and so on. So our focus is on trying to get that person, as quickly as possible, back to their [care 0:52:38], as soon as they've had the intervention, get them back. And where there are people who have real difficulty in getting transport or paying for it, we have systems for supporting that. So, you know, we're very mindful of that issue as well. Okay.

Steve Richards:Do you want to respond to that? Yeah.

F3:My next door neighbour, she took a day, lunchtime 'til six o'clock, travelling to Pinderfields. And the cost of it as well, as you say, is really high.

Steve Richards:Right, okay. That's sort of reinforcing the third point that you made originally.

F3:Yeah, that's okay.

Steve Richards:Which I think you've addressed. Yeah, why not have another question, because…?

F2:Yeah, I'd like to know what's going to happen in the interim. You're talking about making changes, you're talking about how things are going to be better, how it's going to be a centre of excellence at Pinderfields, but what do we now, what's happening now?

Steve Richards:Yeah, good question.

F4:Because Pinderfields is absolutely struggling. The staff are wonderful…

Stephen Eames:Well, I think that's the public perception and I think there's a lot of…

USIt's not a perception, it's a fact.

Stephen Eames:Well, just let me answer the lady's question. It is the public perception - if you just let me finish the sentence - and I agree and I understand why that perception's there. There's lots of reasons why that perception is there.

US:It's not a perception. It's my turn [laugh].

Stephen Eames:

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Well, hang on, let me finish. Let me just give you some…so I see every single complaint, I look at every single complaint, and if there's anybody in this room that comes directly to me, they get a response straightaway; straightaway by email. I do it every day, so I know exactly what's going on, and there's lots of things that are not right. So I'm agreeing with you on that point, but let me just give you a fact about the pressures on the hospitals.

This year, in terms of the emergency demand on the hospital, it's been very significant. It's the first year in five years that we've met the national standard for managing our emergency care; the first year, with the greatest amount of activity. And, in fact, we're in the top performing - if you wanted to use a measure - against that standard in this region. Now that has never been done before.

F2:So what standard are you talking about, A&E?

Stephen Eames:I'm talking about your or my mum being the shortest possible time on a trolley. That's what I'm talking about, the four-hour standard. Now again…

F2:It depends where the trolley is [laugh].

Stephen Eames:Again, I mean, you know, if you want the data, I can give it to you. Now…

F2:Yeah, I wasn't actually talking about A&E and time on trolleys, I was talking about generally people coming in for ops and surgery, and how Pinderfields is struggling to accommodate these people coming in and where we're going in the future.

Stephen Eames::I think we need to talk separately about where your information is and mine, because I don't think that's true. But we need to have conversation, we need to have more detail and I can try and answer the question. Because I don't…if you say they're struggling to get their surgery, what do you mean?

F2:I mean when people go for surgery, you're struggling for beds aren't you, at the moment. It is very difficult within the hospital.

Steve Richards:What, to actually literally accommodate them in beds when they [voices overlap 0:5616]?

F2:Yeah, you've got a lot of patients. I mean, you've lost beds since the old hospital closed. Are there not less beds now?

Stephen Eames:You see, again, that's not factually correct. The hospital at Pinderfields this year, under our initiative, now has 50 more beds than it did have last year; 50 more. And by the way, there's another 70 across the Trust which we've used for the winter. And the other

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measure I play back to you is, we have waiting time targets for our patients and we've hit them all; we have cancer targets for our patients and we've hit them all. Not perfect, not perfect. I'm agreeing with you, there's lots of things to do, but I think we ought to deal in the facts of what's actually happening rather than the perceptions. Okay.

F2:You still haven't answered my question. Are there enough beds within Pinderfields to accommodate the work that needs to be done?

Steve Richards:Yeah, what now?

F2:Now. I'm talking about now, I'm not talking about in the future.

Steve Richards:Now, yeah.

F2:I'm saying…and we're looking at future plans, which…but what happens in the interim between now and the future?

Steve Richards:In the transition, yeah. Richard?

Richard Jenkins:Yeah, demand for beds varies through the year. We're currently at our sort of highest levels of demand with winter and we're coping with that. So that's that.

The thing I wanted to answer about your question earlier was, what are we doing about trying to improve things now, rather than waiting for all these things to happen. And there's quite a lot of things we're doing. I mentioned in my bit of the presentation about the emergency day care work. So we're rolling out, from June, Wakefield and Dewsbury, and we're working on those protocols now.

As well as that, we're trying to work on improving our discharge arrangements. We know we don't do those as well as we should do. So when people are medically fit to go home, they should go home and people want to go home, but sometimes the social arrangements are a bit more tricky to sort out. And we're trying to do that better with our partners in the local authority.

Also, we know that for people who do need admitting now and will still need admitting in the future, we can do things quicker there as well. So, you know, when I see people on wards, sometimes they spend time waiting for things to be done; waiting for a scan, waiting for a different specialist, and so on. And we're looking at all of those delays and trying to take them out of the system. So what we want to do is get people better quicker, and not have people's time wasted waiting for things. We know other hospitals can treat conditions in less time than we are, even though we are improving continuously, we plan to improve that further. So that's another area we haven't talked about yet is shortening the length of stay for people. You know, it's not good for people to spend time in hospital when they don't need to be there.

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F2:So is this happening now, you are doing this now?

Richard Jenkins:Yes.

F2:Yeah?

Steve Richards:Yes, is the answer. So let's have a question over here, and then you can come back. There's time for everyone.

F5:Thank you. Well, actually I don't think you answered his question, but anyway, maybe you want to follow that up because I don't think they answered your question.

Steve Richards:What, about the consultation itself?

F5:Yes.

Steve Richards:We can come back on that if you like. But what would you like to ask?

F5:Right. Stephen Eames said, when he stood up there, that he will be spend…he wants to spend the taxpayers' money wisely. I do know in the past month, beside the PFI - you all know what I feel about the PFI - that it's costing Mid Yorkshire Trust £38 million. How much did it cost to build? You say it cost £300 million. When I've looked at the figures, that's not what it says but we'll go with your 300. It costs…Mid Yorkshire Trust are paying back £38 million a year for the next 25 years. So it doesn't take a rocket scientist to work out what the interest rate and what you have to pay to start with. So that's, firstly, a complete waste of the taxpayers' money.

Secondly, this month, Balfour Beatty, who is responsible for this PFI - and this is something I can prove - changed a flick switch into a dimmer switch. Now I can do that myself, because I did it in my bathroom and it took me ten minutes. They charged Mid Yorkshire Trust £604 for that. So I wouldn't have said that, that is a good…yeah, that is not protecting taxpayers' money. And that is just one instance.

Secondly, you brought a company in, Ernst Young, and they were brought in to do a job that, again, I could have done myself, brought in to tell you where you could cut costs, where you could save money. Now I could have done that, ordinary member of the public could have done that job. And you paid millions. So that is once again…so don't you dare stand up there and try to tell me that you're spending my taxpaying, my tax money wisely, because that is not a fact.

Steve Richards:

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Okay, thank you very much. Let's get you to respond specifically about the consultation that you paid presumably Ernst Young for, and the issue of the PFI, which I know is a much broader issue.

Stephen Eames:Yeah. Just on the PFI, correct figures. The total cost of the PFI when it was built, two and a half, three years ago, was £378 million.

F5:Well, it's gone up. Can I just say I've been to four meetings…no, this is important.

Steve Richards:Okay.

F5:Right, I've been to four meetings, right, different meetings, that this has been mentioned. The first meeting - actually you came with me, didn't you - the first meeting, I was told it was £180 million, that's how much it cost. Is that what we were told? Right, that's the first meeting. The second meeting, I was told, again, it cost £180 million, so that's two numbers that are the same. The third meeting, which was last week, which was packed and is recorded, we can check the recording, you yourself told me that it cost £300 million. So suddenly, my goodness me, I hope you never become an accountant, suddenly this year, this week it's £380 million.

Stephen Eames:Okay, I'm sorry if I gave you the wrong figure, but I'm quite clear about the figure. It's £378milion and the contribution per year for the next 28 years is £34.2 million per year. Those are the figures.

F5:No, it's not exactly, it's not, because it goes…well, tell the truth.

Steve Richards:Please let him give his answer.

F5:Well, if he tells the truth.

Steve Richards:Yeah, but let's hear the full answer.

Stephen Eames:Okay. Well, that is the truth.

F5:It's not the truth.

Stephen Eames:But anyway, we can debate that. The second point about Ernst & Young, we've used a whole range of different advisors, Ernst & Young are just one of those advisors. And we've spent in the order of about £3 million on that this year. What we've done also this

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year as part of that is make sure, for the first time ever, this Trust - which has had very serious financial problems for many, many, many years - this year, has delivered its efficiency target on a recurrent basis. It's never done that before. This gentleman and his predecessors have put £80 million in loan money into this Trust over the last six or seven years. That's not happening next year. The underlying deficit that we started with at the beginning of this year is going down, and we have a full recurrent financial programme for next year. Now that is good for the taxpayer; a lot better than the last five years. So it's money well spent.

F5:Spending £3 million on Ernst Young is not good for my…I pay the tax.

Stephen Eames:Well, that's a debate isn't it, and I'm just explaining to you the impact and the benefits.

F5:And would you…the £34 million is incorrect. It starts off at around £34 million and then it goes up year on year on year.

Steve Richards:Okay. Well, we could go on all evening about…clearly, you’ve gone one very strong view about the cost and you've got another, but…and I think that gap isn't going to be bridged this evening. But you’ve made the points very clearly about Ernst Young and the PFI. Let's move on. Yes, why don't you come back?

M1:Your 'Meeting the Challenge' consultation leaflet, it's really a propaganda leaflet, isn't it, you know?

US:Yes, it is.

M1:There's two scenarios in here, one on page two, 'Seeing Well', one on page seven, 'Open Wide'. The first one is about a young lady that goes to the opticians to have some contact lenses fitted. She finds a mark in her eye and she thinks she might have to go to the GP; which isn't a bad thing really, is it? It isn't hard to go to your GP is it? And as well, she said, you might have to go to hospital. But no, hey presto, the optician can give her antibiotics. But do you think it's right the optician should be dishing antibiotics out at a time when we're told that antibiotics are being less effective for treating illnesses? Shouldn't only doctors hand them out really? And what if this patient has some other medication being taken which doesn't react properly with the antibiotic and that could cause problems?

The second one is this - I don't know if it's a man or a woman - needs oral surgery, and he's told he can go to his local hospital or to a - what's it called - designated dental surgery, whatever that is, I don't know. Now then, he goes to the designated dental surgery because it's nearer home and he doesn't have the hassle of parking his car in the hospital car park. Are these two things two more steps towards privatising the whole National Health Service?

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Steve Richards:Right, okay. Thank you. Mike, do you want to respond to those points?

Mike Potts:Right. Well, first of all, on the ophthalmic one, I'm not a clinician but ophthalmic opticians out in the community are highly skilled and highly trained professionals. They can and are now doing various glaucoma screening and treatment, rather than people having to be referred to hospital. Now that service has been put in place, it's properly governed so not every optician will do it. And what we have to do is, as the commissioners of the service, is that we have to make sure that where we're asking these people and they're willing to do some of this treatment, that it's properly set up. We're making sure that we actually govern it clinically appropriately. And we only ask those professionals to do what is within their scope of practice.

But those services are quite widely used now across the whole of this patch and elsewhere in the country, and are helping patients get treatment nearer to their home, not have to sit on hospital waiting lists not having to travel to hospital. So it's another good example of where those individuals with highly…with really good skills and professional skills, are able to help deal with patients closer to their home. I'm not aware that they're doing antibiotics, so I'll have to ask for somebody else to advise me on that.

M1:Is it your [voices overlap 1:07:55].

Mike Potts:But you're absolutely right about antibiotics.

US:[Inaudible - microphone inaccessible 1:07:54 - 1:07:55] your own leaflet.

Mike Potts:Now come on, don't start that.

US:Because it's true, it's your own leaflet.

Mike Potts:Alright, but…okay, well, am I going to try and respond to you? We need to have a sensible conversation, not attack each other all the time, don't we? Yes, you're quite right about antibiotics and you're quite right about we need to be making sure that we're not just giving them out willy-nilly. And that will not be the case. So those opticians will be giving things out within some really strict agreed protocols.

If we move onto the dentists. We've got dentists out in the community, so all of those dentists have a contract with me at the moment for delivering a service to health NHS patients. And what we're doing is, we're developing some of those practices to do more than just your normal dental care. So again, it's another example of where those people with the right skills, and those services that are set up and properly governed, patients can get those treatments much closer to home and not have to travel to hospital, or get involved in sitting on waiting lists in hospitals. So it's about trying to improve access and it's about trying to get you treatment a lot quicker than you were able to in the past.

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Now you talk about privatisation. It's worth knowing that I've been in the service for a lot of years, and not too long ago, people would have to wait two, three, four years for treatment. You would wait a long time after you'd been referred by your GP to see a hospital consultant. You'd then wait sometimes two years-plus if you needed an operation. And that has changed considerably. So now there is a constitutional right to be treated within 18 weeks. And that 18 weeks is predominantly six weeks from the time that your GP refers you to get your first outpatient appointment; six weeks for there to be diagnostic tests, to get a definitive diagnosis; and then six weeks for you to start to receive your first definitive treatment. Now [voices overlap 1:10:04]. Just hang on.

And the reason why we've been able to deliver that is we've actually used capacity that's in the private sector, still free to NHS patients, so NHS patients are not being charged for this, and you are able to choose now from a number of different providers if you need an operation. Some of those are private sector providers but you still receive the care free of charge. And by using that capacity, we've managed to pull those waiting times down absolutely dramatically and people can receive treatment now in 18 weeks. Now I know that all of that's very contentious because people believe that private sector companies deflate wages to [voices overlap 1:10:54].

M1:Well, they're after the profit, they're not bothered about the patients, they're after profit, aren't they?

Mike Potts:Okay, you know, and I absolutely agree that, you know, they are there to make money for their shareholders. And I know that, that's a particularly contentious issue, but when we set up these services, those private sector companies, if they are awarded those services, deliver against a very clear specification. And when they're bidding for that work, we do a lot of detailed analysis of whether their bid is reasonable, deliverable, and whether…we explore with them what they pay their staff, et cetera, et cetera.

So we do really specify the services that those private sector companies deliver. And I know people have strong views about…some people say privatisation is because the private sector deliver services even though they're still free of charge to the NHS patients. I see privatisation as when patients are being started to be charged for that care, and those patients in this system and in this system at the moment are not charged. NHS patients aren't charged for accessing those private services.

M1:No, the NHS is being charged by these private companies to carry out these operations or whatever they're doing.

Mike Potts:Good point, yeah. No, absolutely right.

M1:So it might not cost me anything to go and have it done there but it's costing my Health Service money to put into private pockets.

Mike Potts:

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Okay. Can I just try and explain that then? So the way any organisation gets paid for work that they do for the NHS is they're what's called national tariffs. Okay. So if you have a hip operation in Barnsley, Brighton, Bognor, wherever, there is a national tariff for that hip operation. The private sector companies have to deliver those services at national tariff. Now to be fair, when those private sector companies first came onto the scene, they were paid slightly more for setting up those services, creating that additional capacity that we could access to bring waiting times down. But the deal was that, over time, they then offered that service at the same tariffs that Mid Yorkshire get. So whether you go to BMI in Sheffield or wherever it is, or wherever you go to Mid Yorkshire, we're charged the same, it's that national tariff.

But I absolutely agree, they're there to make profit for their shareholders. And that's a fact. But we have to make sure, as we commission that service with them, that they have a focus on care, quality, and we govern them correctly. And that's all described in the specification.

M1:If they charge the same prices and make profit for their own pockets, why can't Mr Eames charge that price and make a profit for the Health Service?

Steve Richards:Okay. Steve?

Stephen Eames:Could I just make a general point about the private sector? I mean, this is a non-political point, it's a factual point, that if you looked at the history of the NHS over the last three decades, the private sector has always played a part under every government. And, in fact, the initiative that Mike was describing was developed by the Labour Government in 1997. Let me just finish my point.

So it's always been part, and especially in areas for people with mental health services, it's been a big part of that sector for many years. But put it into perspective, the NHS…the public spend on the NHS, if you like, or the spend that's committed by Government at the moment I think it's £65 billion per year, the private sector contribution, if you like, within that is miniscule. So, you know, the private sector doesn't deliver babies; it doesn't deal with people's emergencies; it doesn't…

M1:It cherry picks doesn't it, it cherry picks the best parts. Of course it does.

Stephen Eames:That's one way of looking at it. The other way of looking at it is, would you want your Health Service to concentrate on the really complex and challenging areas? And if it means that you don't have to wait as long for your operation and you can get it paid for by the NHS, possibly cheaper than by the local hospital, it's better. And that's the Government's position. And it's been every government's position, whether they're Conservative or Labour.

M1:Well, whichever government it is, they're wrong.

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Stephen Eames:I don't want to have a political debate, I'm just laying out the facts.

M1:No, they're wrong. Whichever government it is, they're wrong. [We 1:15:02] want everything done by our National Health Service, not private profit making make bucks for himself.

Steve Richards:Yeah, okay. Thanks very much. And it's going to be an important debate, and you've raised a crucial point. I promise you I'll bring you back in, but as this is a small gathering, is there anyone who hasn't spoken, this is a good opportunity, because there's very few of us. So yeah? Thanks for waiting for the mic.

M2:Have you altered the appointment system now, or is it still the same as it was a couple of months ago?

Steve Richards:The appointment system changing?

Stephen Eames:Can I just check…

M2:The last time, I got a letter saying will you ring up and book an appointment. So then you ring up and it costs you ten pence a minute, to start with. You're waiting at least half an hour.

Stephen Eames:Okay, I can answer that. Okay.

M2:Okay. And then you can't get through, so you put the phone down. You try again a bit later.

Stephen Eames:Okay.

M2:And I've found out that there's a local landline number which they don't tell you about.

Stephen Eames:No. Okay, I think I can explain all of that.

M2:So that's a big con, isn't it? Ten pence a minute.

Stephen Eames:No, let me explain what's been happening. Since December, we've set up - without going into the details - we've set up a completely new system for our appointments, which means

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we've spent a lot of money doing that. When we made that change, there was a problem with Cisco, who are the company who provide that equipment. And that has meant that the experience you described, for a few weeks has been happening. We're well aware of it. That’s stopped, we solved the problem ten days ago. [Voices overlap 1:16:44] let me…I'll come back to your point about the charge, let me just finish. So I'm monitoring that daily, and I've got it all here. And I can tell you that our response times are somewhere between five seconds and 16 seconds now for everybody that calls. So last Friday, we had nearly 1,700 calls on that day and they were all answered within 16 seconds. It's a much better system now, but there has been a problem with it.

The landline was a temporary measure that we put in place because of the problem that we had, okay. It's not a permanent arrangement, okay. In the previous consultation meeting that we had like this, someone else raised the point about the cost of that call. And we've taken it on board, I'm looking at it.

M2:It's costing you money. You're sending a letter out with a stamp on, I'm ringing up then to make an appointment, so then you're sending another damn letter with a stamp on.

Steve Richards:Right, so that's a third point about the sequence.

Stephen Eames:Yeah, I can say…

US:[Inaudible - microphone inaccessible 1:17:45 - 1:17:49].

Stephen Eames:Well, that's exactly…let me answer your question. I referred to my mum in the same…she had three letters with a stamp on. You're right, it's a complete waste of money.

M2:Exactly.

Stephen Eames:So we're dealing with it, okay. Just be assured…

M2:Why didn't you think about that to start with? Are they brainless or what?

Stephen Eames:Okay, I mean, do you want to have a normal conversation or one…?

M2:Of course I do

Stephen Eames:Well, let me answer you.

Steve Richards:

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You've phrased the question, you're going to get an answer.

Stephen Eames:I explained to you at the beginning, or I said in answer to that lady over there, there are lots of things wrong with the system. I am trying, on your behalf, to put them right, okay.

M2:Who makes them wrong in the first place?

Stephen Eames:Well, that's how it has been, I agree with you. It doesn't happen [voices overlap 1:18:26]…alright, okay.

Steve Richards:Okay [inaudible 1:18:33]. Hold on, I think…

M2:You can't answer that, can you? Put a red rose on.

Steve Richards:Okay, you raised three questions and you got three answers, and you'll have to decide whether you're satisfied with them. Yeah.

F2:I didn't really want to go along this line but wouldn't it just be easier to go back to sending an appointment, because you don't actually get a choice any when you ring? I think it was put in place originally so if people chose appointments, they're more likely to turn up, but you don't actually get too much of a choice. So wouldn't it be easier just to go back to the system of sending appointments out to people? Because you've still got the reminder service, you've got the Talking Hospital that rings you up to remind you to come.

US:Much better.

Steve Richards:So you think the old system was, in effect, more efficient and straightforward?

F2:Very much so, because we don't get choice with ringing up, so we're not getting anything, no one's gaining anything.

Steve Richards:So what's the point of doing it, okay.

Stephen Eames:Okay, three points to make about that. We offer different ways of accessing the system. And, you know, if people want that service, we can provide it. The problem is at the moment, some of the people historically has been as this gentlemen was describing. Lots of people use our system now by using the Internet, lots of people do that, book their appointments. And they do have choice actually when they do that. So that already happens, it's available. And, you know, again, members of my family have used it and it

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works perfectly well. It wasn't working very well, it's working a lot better now because of the improvements that we've made.

Where I want to go, the hospital I used to work in used to ring you up, if you were a patient and you'd been given an appointment, they would call you and say - not give you an appointment - they'd call you and say we can offer you an appointment here in Bishop Auckland Hospital in two weeks' time, there in Durham Hospital in six weeks' time, or there in Darlington in four weeks' time, where would you like to go. And some people chose to go to their local hospital and wait for six weeks, some people said I'd rather go to Bishop Auckland, even though it's not near where I live, because I can get it done quicker. That is the system we're going to have. We're not there yet, it's going to take about another year to get there, in order to make all the changes that we need to make to get there, but that's what we're planning to do. So you get away from the whole set of issues about letters and confusion. You have a personal conversation with somebody about where you might want to go for your routine procedure. That's what we're aiming to do.

F2:But for your first appointment, for a first appointment, you're sent that anyway, so you have to go. So wouldn't that be the time when you see your consultant or whatever to say it's easier for my repeats to be at Dewsbury or Ponte, or whatever's easier, and then the letter come out, so that we can get away with this keep ringing people up to try and get an appointment. It does seem a lot of work for people, you know. And if you put your letter to one side and you're on holiday, if you don't ring within a fortnight you get struck off anyway, so you've got quite a short timespan really to…

Richard Jenkins:Can I pick up the issue about…if you…you’ve gone to your first appointment, you've seen a consultant and you'd rather be followed up somewhere else. If the same clinic's available somewhere else, that's absolutely fine.

F2:No, I don't mean that. I mean looking at Mr Eames saying it's nice to have choice. I would say then your first appointment, you don't get to choose anyway, you're sent that appointment. So then when you go to that, if there is choice, you can have it. Granted, a lot of the time there isn't choice anyway because the clinics are held at certain hospitals at certain times, so the letter could still come out because you're not going to…there is no choice to be had.

Mike Potts:Okay. Where we're trying to get to is that there's a system called Choose and Book, okay. So it's not available in every GP practice or surgery at the moment, because there's issues about systems talking to each other and being able to do the electronic booking. But the idea is that, over time, we'll get to a position where, if you're having a conversation with your GP and your GP says you need an operation, and you can choose where to have that operation, your GP or somebody within the practice will be able to give you information about what services are available locally, what you can choose from. And over time, you're also going to get information about how many operations various surgeons have done. So at the moment, you get information predominantly about the hospital or the service that's available in that hospital but the government have already given a commitment to make more information available to patients about specific clinicians' success rates in doing particular operations.

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Now some people have said to me, we don't want any more information, you know, we've got too much information, it's information overload. Others are saying well, actually I'd quite like that. But the idea is that you get the information and you're then able to have a sensible conversation with your GP or somebody within that general practice, and that you make a choice at the time that the GP's referring you. And that GP should be able to then book you directly on your first outpatient appointment. Okay, so they should say to you, you want to go and see Mr Smith in Barnsley Hospital and I can book your first appointment at a time that is convenient to you. So the idea is that eventually you leave the GP's surgery with an appointment, at a time that's convenient for you. You then go and take that appointment up and then appointments are booked after that.

Now that's not happening right across the system yet. Some GPs have got Choose and Book, and they're connected. A lot of people are given a reference number now, and that's when you need to ring the various appointment systems to then make that appointment. But that's where we're trying to get to. And that will then give patients real choice and real choice about who they're going to be treated by and where, and the choice about their first appointment and have that booked actually at the time they have the conversation with the GP.

F2:Yeah, I can understand that and I realise that. And I was really just generally talking about follow up appointments with doctors within the hospital and the appointment system, and not so much from the word go, choosing your consultant, looking at where you want to go for your op, et cetera. Yeah.

Steve Richards:Before I bring you…okay, just before you ask…

US:It's alright.

Steve Richards:Is there anyone who hasn't spoken want to ask a question as, you know, you've got the chance to? And then I promise you, I'll bring you back in. Thank you.

M3:Evening. Mr Potts championed the use of telelink services during your presentation. Would it be possible that they could be used in A&E, in the maternity unit, to spread the load of consultants? There's all this electronic transfer of scans, x-rays, et cetera, you know, to put consultants in each site and use these telelink services across the sites?

Steve Richards:Yeah, interesting question.

Richard Jenkins:Yeah, it's a really excellent question. We already do that, to some extent. So for example, if you go into a hospital, you don't get an old x-ray film any more that you still see on the telly sometimes, it's all electronic now. So we look at x-rays on computer screens. So an x-ray taken in any of our hospitals can be seen instantly in any of our hospitals. So for example, if someone in Dewsbury had an x-ray done and they wanted a specialist in

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Pinderfields to look at it, that can happen now, and does happen. So when I do my on-call at Dewsbury, I frequently will be getting people scanned and I'll be talking to a radiologist who's an x-ray expert at Pinderfields who's advising me about how to interpret the scan. So we do that already.

We do have some facilities for remote viewing in the A&E departments, but more often than not, what you really need is actually someone there on site with the expertise to do things. So sometimes, you know, you can see things and get advice but more often than not, it's more important to have the specialist there to actually give you the treatment or…because you can't do everything over a video link. Sometimes…I think the clinical interaction between a patient and a clinician is about the relationship and talking to people, and sensing how they are as well. So some of it you can do remotely, some of it you can't. And we already have facility to do some of that remotely now.

Steve Richards:Do you want to come back on that, or…?

M3:Webcams and things, I've seen them used down south where, you know, a consultant can talk via a screen. I know it's not the bedside consultation but.

Richard Jenkins:Yeah, it does happen. I mean, for example, in Cornwall and places where there's a very long distance between hospitals, that's been a major step forward. It's less important in places like West Yorkshire where there's not that far between the hospitals, you know, you're not two hours away from your local hospital or an expert. So it does happen. It does happen in Yorkshire, to some degree. So some of the prison hospitals, so prison health service is done remotely from Airedale Hospital via video link because of the issues about prisoners travelling. So some of that happens already.

In our hospital, we do multi-disciplinary team meetings where, for example, in cancer care, where a number of experts have to get together to discuss the care of a patient, people will join that meeting remotely from Leeds sometimes, rather than be there physically. So we do use that technology but I think there's more scope to use that in the future than we are doing now.

Mike Potts:Can I give you another example? I chair what's called the Northern Burn Care Network. And that's a network of hospitals and healthcare professionals that deliver burn care services across the whole of the north of England, and North Wales and the Isle of Man. Now thankfully, the number of people that end up being taken to hospital after being severely burned or burnt in any way has come down. So that's absolutely good news.

But what we've got is, we've got people who are burned being taken to A&E departments and they need to get access to a burn care specialist. So for example, Pinderfields is a burn centre. And what we've done is, we've put telehealth into a number of A&E departments across Yorkshire and Humber, linked in to the burn centre in Pinderfields. And if patients get taken into those other hospitals, they can actually use those telelinks to get specialist burn care advice, and to make sure that we get those patients to the right part of the system.

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So we're starting to use this technology, you know, quite regularly but we haven't used it as extensively as we can do and should do, going forward into the future. So that's just another example of how we're using that technology now.

M3:Can that be used to curtail the number of consultants, we're told 24 that are needed to cover…

US:So would it needed to be downgraded?

M3:…you know, to allow consultants to be spread across…?

Stephen Eames:No, because…no, it wouldn't do that because you need 24 consultants to cover 24 hours, seven days a week. There has to be somebody there at the front door. I think where it does help - and it's a really very important topic this - it might help those consultants, the more we use that technology, to make better decisions more quickly. And I think that applies actually in the other direction. It's called assisted technology, and that's often health and social care working together, where you might have a particular long term condition that you've been going backwards and forwards to hospital for; or you might need some support from home help or whatever it might be, from the local authority.

And technology can start to make - and it's already happening, isn't it, in parts of the country and what we're looking at developing ourselves - sorry, this has just been turned on. So you can actually get support live in your home without going to hospital, in terms of advice, and access support and care from social care as well. You know, so it works both ways that as it develops. And that is the future. I think we're going to see a huge explosion of that sort of activity over the next five to seven years.

Steve Richards:Okay, thank you. Yeah, could you just pass the mic along? Thank you.

F5:Thank you. Right, first of all, I think it was you who mentioned in your speech about the hospitals, that Wakefield Hospital, you talked about it like it was just down the road. Well, actually for some people it's not just down the road, it's three buses away. Dewsbury may be just down the road but for a lot of people it's not. It's not affordable. The time…if you've got children that they're at school in Dewsbury and then you've got to go with a child over to Wakefield, there's lots of practical areas like that. So that's the first one.

But where you said about the beds, I think you'll find that you'll have more beds than you realise. Because I live in Upper Batley and if the changes do go ahead, I won't use Pinderfields. I now use Dewsbury but Pinderfields but then won't become my choice, because my choice, my nearest hospital then will either be LGI or it will be St James's, it won't be Pinderfields. So there will be lots of people that live in my area and this area that just won't be going to Pinderfields. So that's…and I've just got one more point as well.

This is full of spin, and I think it's disgraceful that you don't even know what's in it. On the back, it says, 'Are you closing A&E and Dewsbury and/or Pontefract?'. It's very flawed. If

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you were to tell the truth and actually say, in here, in black and white, there will be no high dependency, there will be no intensive care, we are actually - I don't think the word downgrade there is not used, not once - we are downgrading A&E, I think you would have a much different view. Somebody brought this into work and say to me they aren't changing Dewsbury A&E, Jan, you've got it wrong. And I said, they are. No, they're not, look, read it. And that's people's perceptions. So this is spin, this is flawed. What you have done here, you've lied to people.

Steve Richards:Right, thank you. Well, you've raised three points. One is about the nature of the way this consultation is projected, which was your last point. The first point was about the cost of travelling from place to place. Who's best to answer about that, the cost of transport?

Mike Potts:Well, I think we've already said that one of the things that people have expressed concern about in the pre-consultation, those 35, 40 meetings that we've had across the patch, the consistent theme is about travel and about the distances. The proposals that we're putting forward will reduce travel, because at the minute we've got people travelling all over the district. And the way we've described how these services will be organised in the future will reduce the number of people who are moving around the system.

But even having said that, there's still an issue about travel. And that's why we've put it up on there, in terms of it's one of the things that we will be responding to, and we'll gather more information about people's concern around travel as we go through the consultation process. But we absolutely acknowledge that one of the biggest worries that people have got is around travel. And we are trying to address that and we will address it as we go through.

What was the other thing?

Steve Richards:I'll go through them all. Yes.

Stephen Eames:Just a further point on travel, which just I think brings the point to life. If you think about children who attend for surgical procedures. From this area actually, very many children already go to Pinderfields. And we talk to those families all the time. And sometimes that can be an issue and that's carefully managed by our paediatric consultants and the team. But most people that we talk to are not that concerned in that area about travel, they're more concerned about making sure that they're getting to their specialist. So there's a balance [voices overlap 1:35:31]. Well, I'm just explaining to you what we do. Obviously, we do surveys, we listen to our patients. So…

F5:You're not listening.

Stephen Eames:Well, I am listening to you, I'm trying to just give you…okay

F5:You're not though, because I've heard people in other meetings…

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Stephen Eames:Okay, alright.

F5:…bring up these questions. You said [voices overlap 1:35:43] you're not listening.

Stephen Eames:Okay, well, I'll close my point, because…

Steve Richards:That's…I mean, again, I think there's going to be an unbridgeable divide between the two of you. Just on the third point…I think the second point about the surplus of beds was the sort of point you were making about your wider concern about the changes. The third point about being…

F5:I think it's a very valid point.

Steve Richards:Yeah. No, and you've made it very powerfully. The third point to get a response to specifically was, are you being totally candid with the literature that you're putting out about what has been downgraded, what has been changed, in ways that might be more negative perhaps than you are suggesting. That was the third point. Who's going to answer that?

Mike Potts:That is a summary document which also points to the full document that's on the website, which goes through every service and exactly what the proposals are. Have you looked at the website and have you accessed the…?

F5:Don't insult my intelligence [voices overlap 1:36:52].

Mike Potts:I'm just asking you a question. No, I wasn't. Hang on a minute, just a minute. [Voices overlap 1:36:55] No, hang on a minute, I'm not insulting your intelligence, I'm asking you a question.

F5:You are. And the answer's yes.

Steve Richards:Okay.

Mike Potts:Okay. So right, well, let me ask my question then. So is there enough information on the website to give you the answer to the questions that you've just asked?

F5:That's not the question I'm asking.

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Mike Potts:Well, you've just said we're lying in there.

F5:No, no. The majority of people will get this through their door. They won't go further than that, they won't go and read it on the website like I have. They will look at this, and this is your document 'Meeting the Challenge Consultation'. So I'm asking [voices overlap 1:37:30].

Stephen Eames:Just to come back you, could we just ask, when we finish the meeting, could you say to our communication team what you want us to say that's not in that document, and we will communicate with all those [voices overlap 1:37:43] - hang on, let me finish - with all those households.

What the main document does is in detail - it's here, I've got it in front of me here [voices overlap 1:37:50] but that’s not what you're saying. You're saying, in the summary document, it doesn't say there are changes to the intensive care, and so on. So what would you want us to say - don't answer it now - just talk to our communications people and tell us exactly what words you want to use [voices overlap 1:38:04] and we will communicate that directly, as a result of you raising it with us.

Steve Richards;Okay, that's a very [voices overlap 1:38:10] you can't get a fairer answer that you're going to get a practical response. Let…

F5:If it happens, and it's not another lie [voices overlap 1:38:18].

Steve Richards:Alright. Anyway, that's…well, look, hold on, that's what…

F5:Right, okay. Right.

Steve Richards:I've heard the response and let's see. You wanted to come in I think again, and then you can. And then we'll close.

M1:During your address, you said that all these proposals had been put to clinical experts, and they're all in agreement that they're good ideas. But you're the piper, they'll come up with the answer you want them to hear. Every barrister [give me 1:38:51] the barrister and he'll give you the opinion you want. There'll be another clinical expert who'll come up with exactly the opposite if they pay them enough.

US:It's your job to sort them out.

Mike Potts:

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Okay, well…no, hang on a minute. Whoa, slow down. We don't pay these people to come and do it, it's part of a national process. So we haven't, you know, paid somebody to come and give us the right answer.

M1:Well, somebody must have paid them somewhere down the line.

Mike Potts:Well, hang on a minute, that's absolutely not correct. So I'm telling you that is not correct. And they will not come and tell us what we want to hear, they will come and they will test the proposals. The report that they produced is publicly available. The names of the people that came are publicly available. But what you've just said there is absolutely not correct. And if the proposals weren't safe, they would have told us.

The strategic health authority also has to check whether the proposals that we're putting forward are sound. So we can't go forward to public consultation without the strategic health authority agreeing we can go. They need to have that external assessment before they will give us permission to go. And I've got experience of changes elsewhere, where clinical assessment teams have come in and said these services can't go like that because they're not safe or they're not sustainable.

So absolutely, that is incorrect. We have not paid somebody to come and give us the answer that we want.

M1:Well, somebody must have paid somebody something. They're not guardian angels, looking after you for n'owt, are they?

Steve Richards:I think you've had a very clear answer, but you've raised an absolutely valid point.

M1:Yeah, and I accept what he says, it hasn't cost him anything but somebody's paid somewhere, haven't they?

Steve Richards:Okay. Well, that's the point…anyway…

M1:Nobody does nothing for nothing.

Steve Richards:Let's have two more brief…

F6:We're not asking for a lot. All we want is for Dewsbury Hospital to stay as it is, with an A&E, an high dependency. And I'm sure there's some way they can pay for that. We've lost a lot of hospitals in Dewsbury, and that’s all we're asking for, for the people of Dewsbury.

Steve Richards:

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Okay.

F5:And I've not met one person, not one single person that agrees with your proposal. Not one. If anybody here apart from [voices overlap 1:41:04].

US:A lot of doctors don't agree with it, no.

F5:There's not one single person.

Steve Richards:Okay. So that's specifically about Dewsbury Hospital. Okay, right.

US:[Voices overlap 1:41:13] a high dependency children's ward.

Steve Richards:Very clearly made. And you've been waiting to come back in.

F2:I have been, yeah.

Steve Richards:Well, you've had quite a lot of chances. Here's your final chance.

F10:My arm aches, it's been up all the time.

Steve Richards:Yeah, I know [laugh].

F2:There were two things I wanted to ask. One was, you talk about proposed changes. Are there any more than we don't know about yet? Because the Stroke Unit moved from Pinderfields across to Dewsbury, and there have been other things happening. These are the main ones. Are there other things happening within the Trust, other changes going on that we don't yet know about?

Steve Richards:Okay. What was the other point? Or was that it?

F2:The next point was going to be, when Mr Eames was talking, it's quite a while ago now and I can't remember how he worded it, but he said something about he was sort of expanding at Pinderfields or doing further developments at Pinderfields.

US:£38 million [inaudible 1:42:07].

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F2:And I wondered what they were. I mean, I know there's a lot of waste ground in front of the old dining room and theatre area. Is there going to be more build, or is it within the hospital itself, or what's happening?

Steve Richards:Okay. On the point about Dewsbury Hospital, you've made it, and all have you made it very clearly, and obviously elsewhere as well. On your two points, any plans being considered that aren't being highlighted in this process? And the second point as well, I think you were going to answer about…

Stephen Eames:Yeah, I'll answer both. I'll take the first one first. The only one that I'm aware of, which again has been in discussion for at least two and a half years, are changes to vascular surgery, which are part of a national - to use the sort of jargon term - mandated system. And that's happening on the 8th April. That affects a small number of patients. Currently, if you have an aortic aneurism, a very serious condition, you would go today, or for the next few days at least, I think I'm right in saying, to Pinderfields Hospital. From the 8 th April, you'll go to Leeds. And the reason for that is, all the specialists in this area are concentrating their expertise there. That's the only change that I'm aware of that is current. What we do is obviously publicise those changes on a regular basis. It only affects a small number of people annually, but what it means is, they'll get better outcomes than they do. So that's the one change I'm aware of.

On your second point about the various developments. In the detailed document, so it's all there in sort of a pie chart the spend, it shows the expenditure in relation to these changes. [Voices overlap 1:43:52] Well, there's only so much you can get into a summary document. It shows the expenditure in some detail around the £38 million. And might I say it may not be £38 million, we're trying to minimise that investment as far as we can. That's the maximum cost. Now within that, we're spending nearly £5 million at Dewsbury on paediatric assessment, changes to maternity. So that's that. And then we're spending the rest on expanding our intensive care, so we can cope with the demand. Some additional…

F2:How many beds will you have on intensive care?

Stephen Eames:Some additional labour ward facilities, some additional beds which I referred to earlier, and I think you were talking about, in the presentation. So that's what we're doing with that money.

US:And how much on each hospital, and how much at Pinderfields?

Stephen Eames:Roughly about £28 million or something like that are the current figures. Because we're spending all that money on extending the facilities for the changes that we're describing here. So just…

US:

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Why can't there be more spent at Dewsbury on the A&E and the [voices overlap 1:45:01]?

Stephen Eames:Well, if we were centralising our intensive care and emergency services for the Pontefract, Wakefield and Dewsbury residents at Dewsbury, we would. But obviously, our recommendation is not to do that.

US:Demographically [voices overlap 1:45:13].

F2:So how many intensive care beds will you have then?

Steve Richards:Can you answer that specific point about intensive beds?

F2:If you're expanding intensive care, how many beds will be then at Pinderfields?

Stephen Eames:On the current assessment, we're talking about in the order of 12 to 16 intensive beds. The reason why that's…

F2:Haven't you got 12 now?

F5:The whole number [voices overlap 1:45:37].

Stephen Eames:Hold on, let me finish. Because intensive care operates across the whole of the area. So we're developing the detail of our plans in concert with other hospitals who also have developments. So those details are available, but we've not finalised that position, there will be more beds in intensive care at Dewsbury.

F6:Do you think it's right that all that money's spent at Pinderfields?

Mike Potts:Well, it's [about to 1:46:07] deliver and organise the services in the way that we've described tonight, so that we can avoid people having to travel from one…you know, Pontefract across to Dewsbury.

F6:But they're only going to be in Pinderfields, they're not going to be at Pontefract or Dewsbury.

Mike Potts:No, because that's where all the…

F6:

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[Voices overlap 1:46:22] all them beds there, why can't they be at Dewsbury?

Mike Potts:Right, because that's about separating the planned surgery from the acute surgery, the emergencies. And what we've described this evening, in order to save more lives and to get better outcomes, and to make sure that we're getting a consultant delivered service, we've got to put these services in one place, rather than three places. And can I [voices overlap 1:46:49]. Okay, just hang on a minute.

F6:You're not saving lives. It's [voices overlap 1:46:55].

Stephen Eames:I just want to answer your question which is, you know, a really impassioned question, isn't it, from the local community, about why can't it be Dewsbury. If I just give you an answer from a different angle, which is where we've just been debating about the finances. So if we decided…bear in mind that we don't just serve Dewsbury residents, we serve residents in Wakefield and in Pontefract, and in a number of areas. And, in fact, we [voices overlap 1:47:22]. Well, just let me…please let me finish. Now, theoretically what you could do is say actually, we don't think Wakefield's the right place, we think Dewsbury is the right place to put [voices overlap 1:47:34]. Hang on, let me finish. You might not agree with the reasons why we think we need to centre these services but let me just explain in answer to your question. You're saying why can't we do it at Dewsbury, and I'm giving…

F6:As well.

Stephen Eames:Well, you can't do it as well, for a number of reasons. But…

F6:Because you're spending the money.

Stephen Eames:But if you just let me answer the question. Because if you don't let me answer, you don't get an answer, so let me just answer your question please, because it's as very important one, okay. We could have said that we're going to centre all of our services, for the reasons we've argued here, we believe we have to do that. We can't do it in Pontefract, Dewsbury and Wakefield because we can't put what would amount to, if you took the A&E figures, something like 72 doctors that don't exist in each site, to run a 24/7 service. We can't do that. That's not money, just the people are not there.

So we have to make that…fundamentally, we have to make that choice, okay, in terms of making these proposals. If we said we wanted to make Dewsbury our centre of excellence, so we put all the ITU care, all the maternity care, all the children's care, all the emergency care at Dewsbury [voices overlap 1:48:48]. Let me just finish. That would cost hundreds of millions of pounds.

F6:No, it wouldn't [voices overlap 1:48:55].

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Stephen Eames:Yes, it would. Yes, it would because you'd have to [voices overlap 1:48:58] you would have to build another hospital with lots of facilities that don't exist currently at the hospital, some things that have never been there being placed there, okay. Now it's not affordable, it couldn't be done. That's one of the reasons why we…and the fact is [voices overlap 1:49:18]. Let me finish. Dewsbury Hospital doesn't provide specialist surgery for children, stroke services, plastic surgery, burns…

F6:[Not plastic surgery inaudible 1:49:30].

Stephen Eames:It doesn't provide…and I could go on, it doesn't provide those services now, they're provided for you now and for the thousands of people that use them every week at Pinderfields. So that's why we can't do what you're asking. What we're trying to do is keep…is do as much…

F6:You can do but you don't want to.

F5:And by the sounds of [voices overlap 1:49:50] what you're saying, you're saying that it's impossible…

F6:You're not listening [to people 1:49:55].

F5:…so what's the point of this consultation [voices overlap 1:50:00]?

Steve Richards:Okay. Well, that question…we end the meeting as we began it, with a question about the nature of the consultation. I think you'll agree that even though obviously, I can tell you're not entirely satisfied with some of the answers, you've had [voices overlap 1:50:11]. No, but I think you'll agree that in the context of this evening…

US:You're telling us [voices overlap 1:50:16].

Steve Richards:…you've had the chance to raise questions and statements.

F5:[Voices overlap 1:50:21] post it all out again, there is no way will I go to him and you, reprint all this and re-send it to all those people. You think I'm an idiot.

Steve Richards:Anyway, well, look, thank you for coming and…

F2:Can I just say one thing at the end, please?

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F5:That's what [voices overlap 1:50:38].

Steve Richards:Well, okay, very briefly, yeah.

F2:Just one thing. When I came to this meeting, I hadn't been to a meeting like this before. And sometimes when I've made points, they're valid points, we use the service, we're there, we see what's going on. And when I get put down and people say, no, you don't understand or it's what you hear, we are actually using the service and we do have our own opinion. And I think they should just be respected, please.

US:[Voices overlap 1:51:06] we just feel as though you're laughing at us.

F2:And I think in future meetings, if you're talking to patients or whatever, please just respect our opinions on that.

M1:You're not taking a blind bit of notice.

US:No, you're not.

Steve Richards:Well, okay, that's…you've, again, had the chance to make that point. All of you have made your points. Thank you for coming.

US:And if you run a business of your own, you wouldn't behave like you do.

US:No, you wouldn't.

Steve Richards:Yeah, okay. Well, you've made your points very, very clearly. Thank you.

End of recording

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