Transcription of Public Meeting:

Pontefract Town HallThursday 16th May 2013

Printed 6 May 2023

Please note, this is a verbatim transcript. To respect the privacy of the public, names of members of the audience have been removed.

M – Male speaker in audienceF – Female speaker in audience

Steve Richards:Thank you very much indeed for coming along to tonight's consultation meeting. I'm Steve Richards. I write for the Independent newspaper and do bits and pieces for the BBC, and I will be chairing the evening for you.

What I'm just going to do for about 30 seconds is tell you how we're going to structure the evening. So we're going to have two very brief introductory talks and then we open it up to you. And as there aren't many of you here, you'll get the chance to pose the questions you've presumably come to pose.

So what we're going to do is, we're going to sort of structure it, otherwise it can get a bit meandering. And so we're going to focus on each of the areas where there are proposed changes, to make sure you get the chance, if you've come here to ask about a specific area of proposed change.

So we're going to begin, once we've had the two introductory comments on the proposed changes to maternity services; then inpatient paediatrics; and then emergency care; finally, surgery in terms of the specific areas where there are proposed changes. And then in the remainder of the time, if you've got other questions or points you want to raise, obviously you will have the chance to do that.

You can see there's quite a big panel here. Obviously, before we begin the questions, I'll make sure every panellist has introduced themselves, so you know their area of expertise.

Before all of that, I'm going to get Phil Earnshaw, who is…oh, I've got to do one other thing actually. In the event of a fire alarm being activated, please leave by the nearest fire exit and assemble outside Thomson travel agent, which is across from the main doors of the Town Hall.

Registered Address: PO Box 28956, Gorebridge, Midlothian, EH22 9BP

Tel/Fax: 0131 510 5105

Email: enquiries@1stclass.uk.comwww.1stclass.uk.com

1st Class is the trading name of Lawson Hardwick LimitedRegistered in Scotland, number SC311027

Right, now we can return to the business. And Phil Earnshaw, who is chair of the CCG and has been involved in this from the beginning, and has been involved in the consultation all the way through, will give you a brief introductory overview.

Dr Phil Earnshaw:Good evening, everybody. Thanks for coming along. When we did this a few days ago, we went straight into question and answers, but then we realised that for some people that this was actually their first time they'd been to one of these consultation events. So if it's your first time at one of these events, could you just put your hand up and let us know? Yeah, that's okay because if there was nobody that had been first time, we didn't really need to go through the outline. So we plan to go through the outline really quickly, so those that have been to one before are not bored, but then we quickly want to get into the meat of the evening, which is the questions and answers.

So the first question is why do we need to change? And healthcare is always changing. I'm getting to that sort of age where I start to look back, and I came…I'm from this area but I came back to this area pushing 30 years ago. Hi, Mavis, sort of Mavis worked in x-ray 30 years ago at Pontefract Infirmary. And things were very different then to what they are now. And in the future, things need to be very different from where they are now.

In my practice yesterday, we were talking about heart disease and the mortality statistics for the last 40 years have just been published, the latest update. And in a practice like mine, 40 years ago, we'd have expected a death due to heart disease in people under 75 every fortnight. Now we expect a death due to heart disease once every two months. So statistically, we have six deaths a year, compared to 25.

And why that is, is a complicated mix of how people live their lives, prevention, diagnosis, treatment, rehabilitation, ongoing care. And things have changed dramatically over time. And things are continuing to change dramatically, and this proposal is all about getting the health service and local hospitals ready for the future. People tell me, well, it's not, it's about saving money, but this is about making efficient hospital services that will take us forward. And that is the truth. People won't believe it, people feel that it's not right, but this is happening all over the country. Because if you look at a Royal College proposal for any of the specialities, it's all about getting what needs to happen to make services fit for the next ten years.

So the services that we feel that need change, I know we're consulting about surgery and where emergency surgery is performed, and then where elective or planned surgery is performed; inpatient children services; maternity services; and probably most topical of all, emergency services. So they're the things that we're talking about and we're just going to briefly outline what the proposals are, just to frame the questions as we move forward.

And things are changing. The population is aging rapidly, and over the next 30 years the number of people with long term conditions are projected to triple. So if we don't do everything differently, we will not be able to cope. The overall population is getting bigger and the number of interventions, what we can do for people, is getting more and more each year.

And to do that, things have to become more specialised. And the corollary to that is that people that are older and vulnerable are better cared away from home. So hospitals are the place for the acute specialist treatment. My mum's getting on a little bit and she needs

3

a valve replacement, and she is not fit for the traditional treatment. So what would normally have been planned will be open heart surgery. She would not be able to cope with that physically. But in this day and age, she can actually have a valve inserted through her groin, with a catheter, into her heart. And hopefully, that treatment will prolong her active life.

But that treatment is very expensive. There's only a few people in the country can do it. Fortunately, we have somebody in Leeds that can do that. But if she comes through the treatment well, she will only be in hospital for a few days. And that is typical of the innovations that are happening that make these changes necessary, because medicine's becoming more technological, more advanced. And particularly the surgery, but to some degree, some of the medical inputs, mean that patients have to stay a lot less time in hospital.

Doing this, we believe will concentrate the specialist care that will save lives. And Karen may be talking about paediatrics later on. If one of my children in my surgery in Ferrybridge is ill, I now can ring up one of the consultants at Pinderfields and literally - I mean, and this is a real success - they can pop down to children's A&E and the assessment unit in Pinderfields and be seen by a senior decision maker. And often, with children, it's either a specialist opinion or just maybe to watch them for four or five hours, to decide whether there's something measure or whether it was just a fever and that peaked, and they come home.

We already have that service in Pontefract because our patients, most of the time, now go to Pinderfields. In this, the Dewsbury end will send their patients for children through to Pinderfields. And it's something that I truly believe that bringing specialists together into a real specialist centre saves lives and gives better clinical outcomes for patients. It's not just about improving outcomes, also this is about improving experience.

I'm a GP, I live in Wakefield, and I've told the hospital that the experience of care needs to improve as much as looking towards the future. Some of the things and some of the systems don't work. This is all about putting those systems in place, as well as getting the specialists in the right place and the services in the right place. One example of that is that we'll be separating planned and unplanned surgery, so that customer care is a lot better, so that surgery lists don't get cancelled due to emergencies, and that the most critically ill patients are treated quickly by a specialist.

So that's the overview of what we're planning. And now Simon's just going to go on to give a little bit more detail about those individual services.

Simon Enright:Thanks, Phil. My name's Simon Enright. I know a number of faces in the audience already. I'm a consultant in intensive care at Mid Yorkshire, have been for 15 or 16 years. I'm presently the lead clinician for service strategy. I'm going to, very briefly, go through the major changes in the four areas that Phil has already outlined, saying what's going to change. And for Pontefract, the changes are very minor. So I'm going to focus on any changes to the Pontefract situation, an overview, and those four basic areas.

So first of all, maternity. For Pontefract, there's no change proposed. There will be a midwife-led unit for birthing at Pontefract, as now, so that ladies who are deemed at low risk can either deliver at home, on the midwife-led unit or in Pinderfields. If they are

4

deemed at high risk, they deliver at Pinderfields, as now. Local antenatal care and postnatal care will be available on all of our three sites, including Pontefract, as now. So no change in maternity.

In terms of inpatient children services, again, no change for Pontefract. At present, there is paediatric assessment or children's assessment in Pontefract, but if your child needs to have an overnight stay, they go to Pinderfields. That will not change.

In terms of emergency care, no real change at all. As now, there will be open access at Pontefract for emergency care, with full resuscitation facilities and the presence of an anaesthetist on site 24/7 at Pontefract, able to treat a whole wide range of conditions, with some ambulance attendances, but with the sickest patients, as now, going to Pinderfields.

We'll have consultant presence, as now, during daytime, Monday to Friday, and an on-call consultant 24/7 at Pontefract. And the only development will be what we call emergency day care for patients who have very, very short lengths of stay at present and probably don't need to be managed on an inpatient bed, we'll be managing those patients differently on all of our three sites, including Pontefract. And that should mean a significant number of patients who are currently inpatients, have to stay in hospital waiting for tests or a review, or something that they don't really need to stay in hospital for, they will be managed on a day case basis on all of our three sites.

And lastly, surgery. As now, we'll have planned orthopaedics and ophthalmology. These are the two developments we've had in this year, whereby a couple of weeks ago, we opened the planned orthopaedic centre at Pontefract for straightforward hip and knee surgery. And also, Pontefract is the major ophthalmology eye surgery centre. Pontefract will also offer a range of inpatient short stay surgery and day surgery. For emergency surgery, as now, and complex surgery requiring critical care, those patients will be transferred and done in Pinderfields.

So just to summarise. The changes for Pontefract, no real change actually. As now, the A&E will have open access, with the most serious cases going to Pinderfields, where we have a specialist centre. We will still have our clinical decisions unit at Pontefract. We will develop what we're calling emergency day care and we will be developing this on all three of our sites. We will have a range of planned inpatient surgery, including our main orthopaedic centre and ophthalmology centre. We'll still have outpatients. As now, we'll have our midwife-led unit. And as now, all antenatal and postnatal care will occur locally.

Do you want me to mention the next steps now? Just before we move onto the forum, I'm just going to mention the next steps in the consultation process. As you probably know, this consultation period has been going on for ten or 11 weeks. It closes on the 31st of May, after which, all of the feedback that we've got from all of our different sources will be analysed and we'll produce a final report. And that report will be analysed by independent experts.

There will be a major event on the 2nd of July, with all the partner organisations who are involved in these changes discussing what's been found with the consultation. And there will be a report, with recommendations from the 2nd of July event, which will be considered by the Boards of North Kirklees and Wakefield CCGs on the 25th of July, with a decision taken there as to the future.

5

Okay, that's my brief overview. I'm going to hand you over to Steve now to talk to our experts.

Steve Richards:Simon, thank you very much indeed. Well, you've met two members of the panel. I'll just get the other panellists to introduce themselves to you, and then we'll open it up for questions. So you've heard from Simon. Matt, if you just want to…

Dr Matt Shepherd:Hi, I'm Dr Matt Shepherd. I'm a consultant in accident and emergency medicine at Mid Yorkshire.

Dr Karen Stone:Hello, and I'm Dr Karen Stone. I'm a paediatrician in Mid Yorkshire and I'm here representing our maternity services as well.

Jo Webster:Hello, I'm Jo Webster and I'm the Chief Officer of Wakefield Clinical Commissioning Group.

Stephen Eames:Hi, I'm Stephen Eames. I'm the Chief Executive of Mid Yorks Trust.

Dr Richard Jenkins:Hello, I'm Dr Richard Jenkins. I'm a consultant in diabetes and I'm the Medical Director at Mid Yorkshire Hospitals.

Steve Richards:Yeah. Okay, we're going to sort of open it up now for questions. What I would like to say before we start is…oh, sorry, yes, you're not…there are panellists elsewhere in this room. Sorry.

PM:Good evening, my name's [inaudible - microphone inaccessible 0:16:43 - 0:16:48].

Steve Richards:Great. Thanks very much. Just even though this is a relatively small group, we're recording the evening. All the consultations are being recorded and put on the website I think, aren't they?

PM:That's right.

Steve Richards:So if you don't mind waiting for the mic, even though it's a relatively small group, that's for the basis of the recording. We can hear you all fine, I suspect, in the room. Let's begin by having a brief overview of proposed changes to maternity services from Karen, if any of you have got questions on that. And by the way, if you don't see questions fitting that criteria, there'll be time to ask other things as well. But Karen, could you just give us a brief overview on what's being proposed for maternity services.

6

Dr Karen Stone:Thank you. Well, maternity services, as Simon has already said, there is no change to the provision you're going to have in the Pontefract area. We have a lovely midwifery-led unit in the new hospital in Pontefract that is able to cater for ladies who are deemed to be low risk. So they're women who we know are unlikely to have problems during their labour. Ladies who are low risk can choose to either have their baby at home or in the midwifery-led unit, or they may choose to have their baby in our consultant-led unit in Pinderfields. So none of that changes with our service changes that we're proposing. The antenatal and postnatal care will stay the same in this area, so you have it local to home.

The main service changes affect ladies in North Kirklees, where we're intending to centralise our consultant-led labour services into Pinderfields Hospital; and at Dewsbury Hospital, have a midwifery-led unit like we have here in Pontefract. So we're experienced at running one of those, we've done it here for a number of years and did it in Wakefield before we moved here. And we're going to do that now in…well, we're hoping to do that in Dewsbury. So the ladies in Dewsbury will have a similar choice. If they're low risk, they could deliver at home or in the midwifery unit, or in the consultant-led unit at Pinderfields. And if they were deemed to be high risk, they would come to the labour ward at Pinderfields, or they could choose another hospital, because there is an element of choice.

So I'm probably better to stop talking there and then take questions that are specific, if anyone has any.

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

Steve Richards:Okay. Any questions on the proposed changes in this specific area? Yeah. If you don't mind waiting for the mic, thanks.

F1:I'm from Pinderfields, I work there still. I'm just wondering if a woman goes as a normal no risk patient, suddenly develops complications, what's the speed going to be like, the fast care to get her transferred somewhere, especially if it's during the day with all the traffic?

Dr Karen Stone:Thank you, and nice to see you. We do already have protocols in place for transferring women. So if you're deemed to be a low risk woman and you're delivering in our Pontefract midwifery-led unit, there are a few women who run into some difficulty and may need transferring into the consultant unit. We have protocols in place for the midwives on the unit to know which those women are. Midwives are very experienced at birth, that's their job, they know what they're looking for. And when anything starts to go outside normal, then there is a protocol for transfer.

Some of those women, or the majority of those women who need transferring actually are transferred because they didn't anticipate how much the pain was going to be during labour and actually decide during their labour that really they'd like an epidural. And we can only offer that service on the consultant unit. So that's the usual reason for somebody being transferred.

7

Very occasionally, there is an emergency that requires the very quick transfer of that mother, or mother and baby if the baby's just been born, to Pinderfields. Our ambulance service are well aware of our requirement to move those mothers fast, and do so. In the time that the Pontefract unit's been open, I believe we've had eight of those such transfers and there's been no negative outcome to mother or baby.

So does that answer your question sufficiently, Mabel?

F1:Yes, thank you.

Steve Richards:Yeah, okay. Would anyone else like to ask a question about this area? Sure, no further…? Okay, let's move on to inpatient paediatrics. And I think it's you again.

Dr Karen Stone:It's me again, double act tonight. Sorry about that, everybody. So paediatrics is…

PM: Solo act.

Dr Karen Stone:Solo act, yes. So paediatrics is my real special area of interest because I am a trained paediatrician. We had some very significant changes in this area a couple of years ago when we moved into our lovely new hospitals. And so children in this area currently, as Dr Earnshaw said, if they're unwell, they present to the GP, they give me a ring or one of my colleagues, and we make a decision about the best way to look after that child. Whether it be staying at home with advice from their GP as what to do; it could be pop up and see us at the hospital, we'll confirm a diagnosis and send you straight home again, we might want to keep you for a few hours or we might end up with an overnight stay or a few days stay, if you're very unwell. That service runs really well and I'm pleased to hear that Phil's pleased with it, because it took a lot of effort to make sure that, that was right for you.

So under the proposals in the service strategy, we intend to keep that service because we know it's good and it works, but we want to offer a similar level of service to the residents of North Kirklees. So our intention would be to build a brand new children's assessment unit for the children at Dewsbury, so that we can get senior staff really quickly to ill children, make decisions quickly and hopefully get those children home, rather than stay in hospital at all. And the inpatients, those children who need to stay overnight would be transferred to Pinderfields Hospital, where we can then have, as we do now, a concentration of staff with the skills required to look after children who are really poorly. Because it's not just a paediatrician that you need, you may need surgeons with expertise in children, you may need our orthopaedic colleagues, our plastic surgeons, our anaesthetists, our radiological colleagues, the doctors who do scans and things.

So we want to try and make sure that we've got everybody that your child needs to see there for as many hours as possible round the clock. And we can only do that by trying to bring all those services together and keep the inpatients in one place. We're going to struggle a lot with the number of doctors that we have, over the next few years. And that's one of the real big drivers, along with making sure we get a really good service for you.

8

So again, I think I've probably said enough and it's probably easier to take questions, if people have any queries about it.

Steve Richards:Okay, any questions on this area? Okay, right. Yeah, okay, you again. Well, why not?

F1:I've been around too long. I'm just asking, if a parent wants a child to go somewhere other than Pinderfields, have you any links with other hospitals where they can get them there quickly?

Dr Karen Stone:We already send children to other hospitals for certain reasons. Paediatricians are a bit like general practitioners in hospital for children because we deal with everything. But there are some conditions for children that are very, very specialised and require somebody who only sees that sort of child. And so our usual link would be into Leeds, that's where most of what we call our tertiary children's services are delivered. We sometimes use Sheffield, because there are some services that are even more specialised, or Manchester even for some of the conditions. We use a network of hospitals to look after our babies, our new born babies who require special and intensive care. So they already will use other hospitals if they need more than we can give them in our hospital.

So there's a big network of paediatricians and paediatric units in the area and nationally; we send children to Great Ormond Street sometimes. So we already have lots of links, so that we can make sure your children go to the right person, if they've got something very specialised and very complicated. Okay.

Steve Richards:Okay, thank you very much. Well, let's hear a brief summary of proposed changes to emergency care from Matt Shepherd. Thank you.

Dr Matt Shepherd:Hello. So essentially, what we're proposing is that we don't change anything for our Pontefract emergency department. We want it to remain open 24 hours a day and to take anybody who walks in, as it currently does, and to keep the same group of selected patients arriving by ambulance. And that selection's based on the patients we think we can safely manage at Pontefract, without them needing to transfer.

The big change for people at the Pontefract end of our patch is that the changes we want to make at Pinderfields involve bringing in consultants like myself to be present 24 hours of the day at Pinderfields, so that whatever time of day or night you arrive at the Pinderfields emergency department, you have access to a consultant who's obviously highly trained and, therefore, able to deliver you the highest standard of care. And that means for those patients that go in an ambulance who are critically ill or critically injured, they get rapid access to the people who are best able to sort out what sort of care they need.

But it's not just in the emergency department because we don't hold all the skills to deal with everything. What we're also proposing is that we build up the specialists further into the hospital, those that look after patients in our inpatient specialties in medicine and surgery, so that we're able to offer those patients who are ill or injured access to

9

specialists in cardiology, which is looking after hearts, or respiratory, which is lung disease, so that they also get a much more rapid access to those decision makers. Because what makes a difference in terms of people getting better quickly and more people surviving at the extreme end of illness is the time it takes you from developing your illness to seeing someone who can make the right decisions and start the definite, the right treatment for you.

And so what these proposals are about from us in emergency and urgent care is getting patients who have that need seen much more quickly by a specialist. And that's what we're proposing with these changes. But from those patients who aren't that ill, who have cuts, bruises, broken bones, we still want those to be seen as they currently are now, close to home in their local emergency department.

Simon's already mentioned at the start that we also want to do something called emergency day care. And that's using changing technology, changing tests, to be able to get diagnoses much more quickly for people that, three or four years ago, or even last year, we would have had to bring into hospital for 24 or 48 hours. But with the changes in technology and with the way medicine is moving, we are in a position to look at places elsewhere in the country and bring some of that practice here, to deal with people in a day case fashion. So you come, you might stay for two or three hours, have some special tests done and perhaps see a consultant. And that will enable us to be able to safely deal with the problem you've come with, or answer a clinical question that maybe your GP's asked. So has my patient got a blood clot in their leg, and we can get the right tests done and have everything sorted for you in the same day, so you don't need to stay in hospital.

And that's probably enough from me, in terms of trying to describe to you what we're offering. And I'm happy to answer to any questions.

Steve Richards:Okay, any questions in this area.

F1:Sorry.

Steve Richards:It's absolutely fine, you can do. But let's get someone else in first. Thank you.

F2:Yeah, my name's Yvonne Crewe, I'm a local councillor, and I do know all the people on the top table. I'd just like to ask a question, because yesterday on the news, on the BBC news, there was problems about the A&E departments up and down the country. And again, it were televised in the LGI, I think it was the LGI, but it were in one of the Leeds hospitals. How safe is Pontefract with what's going off up and down the country? Are we going to be closed again? I understand when it was opened 24/7 again, that it could only be for 18 months. You know, is it going to be in jeopardy again?

Dr Matt Shepherd: I think it was well publicised the reasons why, unfortunately, we had to temporarily close the Pontefract department. It was a shortage of not the consultants but of the middle grade doctors who traditionally have provided that senior presence through the 24 hours of the day. That's still a national shortage, that group of doctors.

10

Our proposals are about being able to manage the emergency department safety by bringing in consultants at Pinderfields to do that, but continuing the model that we've got at Pontefract currently, which is a model that works in a few places around the country and has been really successful at Pontefract, which is some specially trained GPs working alongside our specialist nurses, supported by an on-call consultant who's trained in emergency medicine.

The initial commitment was that we did that for a period of time. This consultation is us saying we want to continue that arrangement, we want to continue Pontefract being open 24 hours a day in the same model that we've reopened it with now. So that's what we're saying.

Steve Richards:Stephen Eames?

Stephen Eames:Yeah. Thank you, chair. Back to your point about safety, and Matt's very [inaudible 0:31:23] described the model that we have. It's much safer than what we did have. Because what was happening which led to that closure was on and off closures. So we might be planning to run the service 24 hours on a particular day and then we couldn't get the doctors, and then you have to close quickly. And that causes all sorts of difficulties for patients primarily, but also how do you patch that service up, issues for the ambulance service, and so on.

So, you know, I'm really confident that what we've got now is a safe, sound and sustainable service. And I don't think there's any world in which I can see in 18 months' time we'll be in the same place.

Steve Richards:Okay. Before I bring you back in, is there anyone else who'd like to ask a question? Okay.

F3:Sorry. You mentioned about getting the investigations done, like MRIs, CT scans, et cetera. Is that going to be a 24-hour cover? Because otherwise you've got patients that will go in and will require things like that, but you will have to wait 'til the following day to get them done, to have the staff there…please.

Dr Matt Shepherd:I don't think we…we don't currently offer access to some of the very special tests 24 hours a day. But in the emergency day care model, actually what you don't need is access 24 hours a day, because we bring people back in a planned way. So they're not kept hanging around, waiting for an emergency slot to be available, we have slots already available. So we know we can do…keep you safe and manage your condition safety, and plan and bring you back and say, if you come back to us at half past nine in the morning, you'll have your scan by ten o'clock and we'll have your answer and you can be away by 11. So that's the way we plan to do it. There isn't the need for it to be available as there once was and as an emergency throughout 24 hours. It's much more of a planned way of delivering the service.

11

Steve Richards:Phil Earnshaw wanted to speak.

Dr Phil Earnshaw:Just one big benefit of the changes around emergency care. My patients absolutely - and it's nothing against Dewsbury - hate the scenario where they need to be admitted, and currently that they can't be accommodated at Pinderfields, so they have to be admitted through to Dewsbury.

Under these proposals, that will not happen at all. And to me, in the emergency care bit of the changes, that's one of the biggest advantages to patients that live over the eastern side of the Wakefield district, and particularly my patients because they're Ferrybridge, Knottingley and out into North Yorkshire, and it's a long way to Dewsbury. So under these proposals, that will stop. And I think that's a major experience improvement and that's one of the things that I'm really happy about.

Steve Richards:Okay. You there and then…yeah.

M1:My name's Michael Farrar, I'm Sharlston Parish councillor. You're just on about sending people back home. What about the people who need transport, patient transport to get back to the hospital on these?

Steve Richards:Yeah, this has come up a lot.

Jo Webster:Yeah, that's been one of the biggest concerns actually that's been brought about while we've been in consultation. And we know transport is really important to people. So what we're doing at the moment is looking at what people are saying to us in terms of the impact, and then we're going to be considering what the proposals might be to mitigate against that.

Now I'm going to say this - and I said this on Tuesday night in Wakefield Town Hall - that we understand about inconvenience for patients around transport and travel, and we're committed to trying to minimise the impact that it has. But for every pound we spend on transport, we're not spending it on healthcare. And the only other thing I would say is that I think the number's about 1,200 people will actually not have to travel as a result of these changes.

PM: 12,000.

Jo Webster:12,000 people, sorry, will not have to travel as a result of these changes. So a lot of people will benefit from that. I'm not dismissing it. We are considering it and we will look at it, but we have to think about what we have to spend our resources on. And I'm sure you'd understand that.

M1:

12

Yeah, I can understand it.

Steve Richards:Great, thank you.

Stephen Eames:Could I just add one additional point to what Jo said about Pontefract actually? Because, you know, I'm relatively…you won't be, I'm sure most people in the audience won't be, but I'm relatively new around here. So when I arrived, there were lots of anxieties, concerns from people like Phil, but also from ordinary members of the public. And I've been to the town councils about the fact the hospital is underutilised. And it was significantly underutilised.

And, therefore, I think there are…Jo is right, 12,000 people, and that's across the whole of the changes we're talking about, will have less further to travel. But actually, a lot of people are already benefiting in Pontefract because we've put, as has been described earlier, a lot of new services into the hospital, including the orthopaedic unit we've just opened.

So, you know, I just wanted to say that. Obviously, we can't cater for every single need but, you know, we had a hospital there, locally orientated, which wasn't being used fully. And we've got more opportunities beyond what we're doing already to improve on that.

M1:Right. I live in Sharlston, I'm actually in between both hospitals, Pinderfields and Pontefract.

Jo Webster:In the middle. Yeah, I understand that.

Steve Richards:Okay, yeah, so there's a specific issue when you're in that situation. You wanted to ask a question.

F4:Thank you. My name's Paula Sheriff, I'm one of the councillors for Pontefract North. I'm also a healthcare worker, have been for the last 12 years. And until February this year, I was employed by the Mid Yorkshire Hospitals Trust. Dr Earnshaw alluded to the fact that hopefully we won't be sending people from this area to be admitted in Dewsbury, but I just wonder exactly where and how we're actually going to accommodate all of the inpatients.

I note from the consultation information that there are plans underfoot or the proposal is to possibly reduce the number of beds Trust-wide. And that causes me a huge amount of concern, particularly as an ex-employee of the Trust, I know that earlier this year, obviously with winter bed pressures, that some of the ancillary staff were tasked to go into cupboards, garages and storerooms in Pinderfields and locate beds, and a lot of the four-bedded bays became five-bedded bays. And I think we can all understand with winter pressures why that occurred.

But since I started with the NHS, which was, like I say, 12 years ago, we've been talking about care in the community and people being treated in their own homes, which is fantastic, but I haven't seen a great deal of progress in that area. So it causes me huge

13

concern that, in this day and age, with a rapidly expanding population and also an aging population that we're talking about cutting beds.

I've also got another point I'd like to make, that a number of you on the panel have alluded to, improving patient experience. And, of course, we acknowledge that the patient journey is absolutely critical, but the key factor to this is taking the staff along with you on that journey. At present, although I no longer work for Mid Yorkshire Hospital Trust, I still work on the Mid Yorkshire Hospital's premises, because I was TUPE'd, I was transfer out of the organisation. So I'm very aware of the culture that still exists and I think it's reasonable to say, you know, morale is beyond rock bottom. Staff are really, really angry, frustrated and often emotional. So I just wondered how is this consultation being relayed to staff, and how are you helping them to deal with the changes that may occur?

Steve Richards:Okay, thanks very much. I'm going to get Richard Jenkins to address the first point about the demand on beds and space, and Stephen Eames, and the relatively slow progress of getting people out of hospital and being treated at home or wherever. And then the other point about rock bottom morale and internal consultation, you will answer, okay. Richard?

Dr Richard Jenkins:Yeah, it's a really important point you make about making sure we've got enough space to look after all the patients. I think many of us who have been here for some years have had aspirations to improve some of those things, and they've not really come together. And I think this is a real opportunity for us to do this together. And I think this is the first time I think we've had really good, effective partnership working between the GPs and the community health and the hospitals as well. So I think there's a real opportunity there.

There's a number of different things we're going to do to achieve that. So some of it is about care in the community, so some of it is about trying to make sure people can get rapid access to their GPs and get early treatment, so they don't get ill enough to need to come into hospital. That's definitely part of it.

We're looking with social care to try and make sure we have better support there, so that if a frail, older person falls over, they don't automatically get whisked off to hospital where they don't need to be. Sometimes that's the right thing to do but it's not always the right thing to do, and trying to make sure that people can be supported, with the ambulance service assessing people, which they're good at doing.

We're looking to see how we can manage people who need to come to hospital differently. So some of that's around what Matt and Karen have said about having access to senior doctors in obstetrics and A&E, on the wards 24 hours a day. We know there's evidence that shows if that happens, people don't need to come into hospital so often and that they can go home quicker because the treatment's right earlier.

We're looking at different ways of delivering care. So in the past when people have come into hospital, they've stayed in hospital for many days. And actually, on quite a few of those days, not a lot happens. And particularly weekends is the classic there. We're trying as much as we can to extend the active way we manage people through weekends. So having consultant presence at weekends would be a key part of it. We've done some of that already but there's more we can do. And we've set a goal for this year to do some work on that, and particularly around access to things like scans at weekends, so that

14

actually someone's care in hospital is progressed through the weekend, as it is in the week. So, therefore, people can go home sooner.

We've made a lot of progress in reducing the length of stay in hospital over the last few years, but there's more we can do. And we know we have people staying in hospital after they are well for health and for social care type reasons, and we're working with social care to try and address that.

We've done some changes to move some elective work, so planned surgery type work out of Pinderfields. And we've already talked about the opening last week of the elective orthopaedic unit. That's located space at Pinderfields, which gives us more opportunity to manage some of the emergency cases that will come to Pinderfields in a different and better way.

So there's a lot of different things, is the answer to your question. And I think whilst some of those things we've aspired to before, and some we've delivered some degree before, I think the opportunities now are really there to make it happen in a much better way.

Steve Richards:Are you okay with that? Because the answer to your next one is completely different but equally big theme, but do you want to…? Okay.

F3:In practice [inaudible - microphone inaccessible 0:43:28 - 0:43:30] I'm also cynical because I've heard it for many, many years. So I totally acknowledge the points you're making about include diagnostic access at weekends, I think that's very important, but I'm just concerned [inaudible - microphone inaccessible 0:43:43 - 0:43:45] the prospect of cutting any bed numbers in 2013, I think that's absolutely crazy. So we will see what happens. I just hope there isn't a situation where the same sort of epidemic in the district where, you know, we get back to the situation where porters are having to literally dust off beds to accommodate patients. So we will see.

Steve Richards:Jo?

Jo Webster:Okay. I would…I understand that you would be anxious about that. If I was in your position, I probably would be as well, as a resident. And it's difficult, isn't it, because you don't actually see things. And I was just thinking about something I did this morning when I was hearing from a consultant in Mid Yorkshire Hospitals about how they manage people with breathing problems differently at home. And what was startling about that wasn't just the fact that it was a fantastic service, it was patients actually self-referred. When they found themselves in problem with their breathing, they actually rang up this service and actually they managed their condition at home.

Now I can make some of that information available to you, so that you can actually see that. And there's evidence to suggest that. It's fragmented at the moment, and actually what we've got to do is make sure that services are joined up.

And the last thing I want to say is, we won't be taking any beds out of the hospital unless services are safe. And Phil and I's job is making sure that safety and quality is absolutely

15

paramount. That is the duty of our organisation. So we won't be taking any beds out of the system unless we can manage that demand differently.

Steve Richards:Okay. And on the second point, Stephen.

Stephen Eames:On your question about staff. I'm just going to make one point, if I may, chair, about what we've just been discussing because it's a very important question. But just you mentioned putting additional beds in and so on and so forth, on the Pinderfields site. Now again, back to having not been here for a long time, it's evident to me, based on…but your local hospitals, if I can put it this way, the increased admissions in the last 12 months has been around about 8%, and a lot of that has been at Pinderfields. Okay.

The attendance has not been that dramatic, you know, people just…you know, there's been a 1% increase in that. So you're absolutely right, weren't enough beds on the Pinderfields site. So the four…so moving the bed bays from four to five has created 40 more beds on that site. Now we don't use them all the time because, surprisingly enough, on some days, we don't use all our beds. But often we do and particularly for the winter months. So that's a conscious decision, supported actually by our quality regulator, the Community Health Council, to do that. And I might say, we've put £1 million, which we've saved elsewhere, into more nurses on the frontline.

So I think your point is absolutely right, but we've dealt with that issue. And to reinforce that point further, you probably don't know this but this Trust - and it relates to your point about staff - this Trust was one of the worst performing Trusts in the country on the accident and emergency four-hour standard. You might like to know that, as of this moment, as of this year, we're in the top ten nationally; top ten. So, I mean, that's an absolute accolade to all the people, you know, not just in the hospital but in the community. We don't get everything right, there's still a lot to do. And I think, as I say, your point's really important.

On to the point about the staff. If you asked me, so in a way you have, what's my biggest concern, it's that one, it's engaging our staff. And there's a number of things going on there. The first one is it's a very difficult environment we're all living in, so people are very anxious. Public services are being squeezed. Trusts like ours have got to save more money. Where do you save the money? You save it, and a lot of our costs are in staff, so we have to try and reduce the pay bill. That means - and you'll know this if you've read the local papers - we have to make change to staff terms and conditions, and people worry about their jobs. So I think that's one set of issues that contributes towards staff morale.

Conversely, if you look at the staff survey, one of the questions there that really worries me is, if you ask a member of staff would you recommend this hospital to your relative or friend, we get a worryingly low score on that from a relatively small percentage of staff who talk about that. But we've just been doing the friends and family test, which is the exact same question, to our patients and 95% of our patients say that they would either strongly recommend or recommend our services to a friend or relative. I think what that's telling us is there are lots of issues about the staff feeling about the organisation. Now if I could just offer a few thoughts on this, I know it's quite a long answer but it's quite important.

16

One is, I've never seen in 40 years of working in the NHS, sickness levels as high as in this Trust when I came here. Unbelievable in some departments, all sorts, I won't go into the reasons why. But they're coming down now, significantly so. So that's one set of issues.

F4:[Inaudible 0:49:00] be able to tell us why.

Stephen Eames:Well, I think I do. And like I say, we could go into a long debate about why and I do understand some of the reasons why, but we're addressing those. That's unusual.

Secondly, if you work somewhere where the media, nationally and locally, say every single week you're a basket case, your services are awful - which is actually wrong, they're not, they're some of the best services in the country in these local hospitals - that's not good for staff morale either.

And thirdly, going back to the quality regulator, which I think is to do with the management of the hospital fundamentally, historically. If you've had an external regulator coming in and saying to you on a number of occasions, we told you to put that right and you haven't, and some of that sometimes was to do with staffing levels, it's not surprising we've got some of those problems. And again, I can report none of this is about complacency but we are not in that place any more, because of all the things that we've done to meet those standards from our external quality regulator.

So there's a lot of other things I could say, it's such an important area. Back to what I started with when talking about this particular issue. Therefore - and we can touch on this outside the broader discussion - we're putting a massive effort into staff engagement, we started it over the last few weeks. When I say we, I'm talking about me and my colleagues and Board members, you know, with our staff, listening to them, being on the ground and trying to deal with their issues in a different way to how it's been before. Single biggest challenge that we've got.

Steve Richards:Okay, that's very interesting. There and there, yeah. Of course, yeah.

F4:I've got some significant differences of opinion with Stephen there but it might be useful if we could have a conversation outside the auspices of this meeting.

Steve Richards:Sure, okay. Thank you. The guy here. Yeah, thanks.

M2:Hi. I'm Councillor Tony Dean, I represent the South of Pontefract as well. Just a very brief observation from my point of view. As being the one time Chairman of Social Services when this whole process started back in 1997/98, the issue about staff morale is something that goes back to then. Because I recollect being at a meeting with the then Chief Executive, Keith Salisbury, who had produced the Grasping Nettle document, who had it then thrown back at him because it wasn't his job, it was the health authority's job to produce the Grasping Nettle document, admitted in a meeting in Wakefield Town Hall.

17

The first…in developing the original document, he hadn't even talked to the staff. So there is quite a long legacy of staff being excluded from the process. So that's my first point but [voices overlap 0:51:56] if I might finish.

The main point I'd like to make is, I welcome the development of the orthopaedic services, elective services, but I am concerned because I've been told today that, although you've moved the orthopaedic services, the actual operations to Pontefract, the follow up outpatient clinics are still taking place in Wakefield. And I wonder if there's…can you confirm that's likely to change?

Steve Richards:Do you want to do the staff thing?

Stephen Eames:I'll just deal with the first bit I imagine Simon could speak to that latter point.

Steve Richards:Okay, Simon do you want to…okay, the staff point first.

Stephen Eames:It's just because I realise with what you say, I didn't quite answer one bit of your question, which was, well, how are you engaging the staff. And again, I won't go into a load of details with you, but we've got to, all of our staff really on a very routine basis about these changes, and we're doing exactly what we're doing in this consultation; listening, picking up all those issues, all feeding back in.

Now, of course, people just don't talk about this, they talk about everything else that affects them when we do that. So, you know, we are making a huge effort to engage our staff. And I would say, you know, it's not the sign of a bad organisation when this Trust's educational services, which actually underpin…I mean, frontline nursing and medical which underpin the delivery of services, has won more prizes in the last 15 months than any other Trust in Yorkshire & Humber; more prizes, teams and people. So, you know, it's not all one-way traffic. That's a good sign of good morale.

Steve Richards:And on the…Simon.

Simon Enright:Yes, I mean, I'm going to mention the orthopaedic centre in the talk on surgery in a couple of minutes. We've been open for a couple of weeks, it's early days yet. We do have outpatient clinics for orthopaedics in Pontefract. I don't think we have enough and I think we're working on developing those further.

As part and parcel of this reconfiguration work, we've looked at all patients from our various areas and where they have their outpatient appointments. And we know, for example, that only 60% of the Dewsbury patients - and I know I'm talking in Pontefract, I'm fully aware of that - but 60% of Dewsbury patients have their outpatients in Dewsbury. And we are aiming to get that up to 95%. We'll be doing exactly the same on the Pontefract side. I think there's more work to be done but we do have post-op follow up clinics for orthopaedics in Pontefract, but I don't think we have enough at the moment.

18

Steve Richards:Can I just check, I'll call you both in, in five seconds. I'm conscious that we're talking about staff morale and everything, which is absolutely fine, is going outside that criteria of emergency care. So has anyone got a specific question on emergency care? Yeah. The mic will come to you, if you don't mind waiting. Thanks. Hold on, do you mind? Thanks a lot.

F5:Did you say that you were in the top 10% now for A&E care? Well, may I point out that Stafford was the top and look what happened at Stafford Hospital.

Steve Richards:So are you implying that these tables are unreliable?

F5:Yes.

Steve Richards:No? Right, okay, well, you've made the point and it's there on record. Okay, is this about…are we on emergency care still?

F6:I'm sorry, I'll stand up because I'm really cross. There was talk about consultation with staff, morale in staff. I'm working at Pinderfields Hospital, I've been working through all this trial and tribulations you may call it, I call it. The staff morale is down, sickness is down because they're under so much stress. It really is bad. And this isn't just nursing staff that you have to think about, you've got your medical secretaries, you've got your clerical staff. You can't really do…and we won't go without a [inaudible 0:55:46] fight going out of it. And this is what I think sometimes you try to do is get the hub of the wheel without the rest of it, and it's not on. That's why morale is so low because we haven't been consulted.

Stephen Eames:Well, I mean, just as I said to our Councillor colleague here, I regard that issue as the single most important issue, but it's a very complex issue and there's a lot more than I could say. Some staff morale is low, lots of staff morale is really, really high. And it depends on circumstances and individual situations.

All I would say is, all the research would tell you, and my experience would tell me, that you don't normally get top performing organisations with really poor morale. Now, I think we're in a transition between those two places and all I would say to you is, if you look at the results of this Trust in the last 12 months for cancer care, for waiting times, for emergency care, for how it manages its finances, it's doing massively better than it did before. And all the evidence is there for all to see, independently identified.

So there is a balance in the morale question is all I'm saying. I know there are issues with staff. If you're a member of staff - which you are, and I haven't met you - we'll have a conversation about that one on one. We'll fix it following on from this meeting about that concern.

F6:I'll send you an email.

19

Steve Richards:Okay. Right, well, that's two separate conversations that will follow on staff morale. Let's move on, because I don't think…has anyone else got a question about emergency care? If not, Simon will just briefly give an overview on the proposed changes to surgery.

Simon Enright:Yes. In my initial talk, I briefly said about what we're doing for surgery. I'll just expand a little on that. As much as possible, we're splitting emergency care from planned care, elective from urgent care. That means that the complex, high risk and emergency surgery, and the surgery that requires the backup of critical care, will be done at Pinderfields, where there's more specialists who will be on site for longer. And the same reasons about specialist care occur in surgery as the other specialties we've talked about. So the sickest patients are looked after by the most senior specialists who are on the hospital more of the time.

That means that the more straightforward planned care, including care that does require overnight stay, will be done in our other two hospitals, Pontefract and Dewsbury. And I've mentioned already about the elective orthopaedic centre which has opened, been open a couple of weeks. Already the signs are very good. And speaking to an orthopaedic surgeon colleague this morning, he was suggesting that his length of stay from major hip and knee surgery had already come down by about a day, so from about four days to about three days already.

Now this is early days and I don't want to jump up and down too much but it just shows what you can do when you streamline elective care, not just day care, not just day case surgery, but also inpatient surgery, and you have therapists and you have a ward which is geared up to looking after what is fairly major surgery. Hip surgery and knee is often done on elderly, frail people.

So the signs are very good that what we're planning and what we're planning for the Dewsbury site and the Pontefract site is the right thing to do. It's better for patients, both for emergency patients and for the planned patients, because it streamlines the pathway for each of them and they get the right care, hopefully lead to less cancellations, reducing their length of stay. And as I mentioned before, and I think it needs reiterating, that there'll be more consultants in different specialties on the site where we have the sickest patients, which will be in the Pinderfields site.

So that's all I was going to say on surgery.

Steve Richards:Okay, thank you very much. Any questions on surgery, this area? No? Yes.

M3:Clive Tennant, local councillor. It's a comment if I may, to you. This case what Councillor Dean mentioned is actually a personal friend of mine, about the actual knee surgery. He was in Pontefract on Tuesday afternoon, he was at surgery and he's been discharged this afternoon. So it does work. The reason I'm stressing this is because he's our grounds man, I want him fit for next week.

[laugh]

20

But the actual thing with Jack - I'll name him like - with Jack is his initial operation was cancelled three weeks since, due to emergency surgery. So we do recognise there still is a problem but hopefully, down the line, you know, this will be the common ground.

Simon Enright:Absolutely. You've illustrated the case better than I could. I'm an anaesthetist, I anaesthetise with orthopaedic lists, as well as being a doctor who works in intensive care. And over the years, I've seen many patients been cancelled because of acute work or emergency work coming in and taking precedence, as it always will. But we've shown already and your case outlines how we can reduce length of stay. So thank you.

Steve Richards:Yeah. Thanks very much.

M4:Simon, you know when you've got sleep apnoea, you need another machine to help you do it. [Does Pontefract hope 1:01:15] to have one of them machines?

Simon Enright:Yeah, I mean, you've opened up quite a complex clinical discussion there about obstructive sleep apnoea [voices overlap 1:01:24]. It is an area of some interest to me, mainly because my father's got obstructive sleep apnoea but also I know quite a lot about CPAP and the backup. I think it's best if we had a chat about that outside the room because it probably would be very complex for people who don't understand what obstructive sleep apnoea is.

But there's no reason why, at Pontefract, we couldn't look after patients who have obstructive sleep apnoea. We will have an anaesthetist on site at Pontefract. And I think for people who are having routine surgery, especially those who haven't had a general anaesthetic, there's no reason why they can't be done in Pontefract.

M4:Right, thank you.

Steve Richards:You wanted to ask a question. Thank you.

F7:I'm Margaret Shillito, I'm Chairman of CAVE, Castleford Area Voice for the Over 50s. And I want to know can we still choose where we want to go for…? I've a lady who wants the other knee doing and had the first one done in Dewsbury, wouldn't go anywhere else because…in fact, Dewsbury is one of our favourite hospitals. The service is absolutely wonderful, the staff are wonderful, the food is wonderful. So I'm afraid it's [inaudible 1:02:40]. They did ask if the shuttle bus was still available because of visitors. And one of our ladies is probably yours, Dr Earnshaw, because she comes from Knottingley but still wants to go to Dewsbury for her knee doing. So can we still choose?

Simon Enright:

21

I see no reason why you couldn't choose to have your operation done in Dewsbury. I think in terms of choose and book, and patient choice, Phil might be able to speak on this with a bit more authority.

Dr Phil Earnshaw:Absolutely. It's now enshrined in the NHS constitution that you have a choice at the point of referral. So when you come to see your GP, you can ask to go to Dewsbury, and as long as Mid Yorkshire provide that service, which they're continuing to do so, and it's on choose and book, which it is, then you can choose to go to Dewsbury.

And I believe the shuttle bus is definitely continuing. And obviously, we've got a travel group looking at that and all the issues about travel as well.

F7:Thank you.

Steve Richards:Okay. Can I just ask a question on that as an outside observer on this whole choice thing. If your description is right, don't a lot of your patients ask to go to Dewsbury? And does that not mean there's very long waiting lists, if one hospital requires a reputation for…?

Dr Phil Earnshaw:It's potential, but what happens, the way that the choose and…usually I'm in consultation and I say, now I'm entering travel agent mode. And so we go onto the choose and book website and it tells you…you put in the procedure or the condition and it comes up with a service provide. We've got it set up distance from patient's home. So it starts at the top with distance from patient's home, what the service is, where it is and what the indicative waiting time is. So that's what they expect the waiting time. And you can just then say…people say, well, I actually don't mind whether I go to Pontefract, Pinderfields or Dewsbury, so you click into those three. You put search and then it comes with the appointments, the first one upfront, and people can choose. And they usually go, just let me check your shifts…

Steve Richards:So they usually go for the first?

Dr Phil Earnshaw:And then that's when I start losing patience when they get their diary out and say I just need to check my shifts. Because as I say, really I was joking about the travel agent bit, I'm a doctor really and not a travel agent, but that's how the system is set up. Some practices don't do it in front of the patients, some practices uses their secretary but they should all offer that service. I don't know why we've always done it while the patient's there. And most of the time, it's fairly straightforward and it does offer you real choice.

Steve Richards:Yeah. Thank you very much.

Dr Richard Jenkins:Can I just say something?

Steve Richards:

22

Sorry, yeah.

Dr Richard Jenkins:Whilst it's great that you had a great experience in Dewsbury, and that's fine and you can do that again, the new elective orthopaedic unit at Pontefract is fantastic. I mean, I had a good look round there last Friday in the first week of it. So I think we should be able to offer you fantastic orthopaedic care in Dewsbury or Pontefract, and it might be worth just thinking about that.

Steve Richards:Okay. Any more questions on proposed changes to surgery? Okay. Yeah.

F8:My daughter was admitted to Pinderfields - and this is a good word - in a real emergency and her treatment and the operation, it was more major than we'd expected and she was very well looked after. And I'd like to say thank you.

Steve Richards:Great, thank you. Well, let's wind that up now. We've already sort of wound it up. We've discussed morale of staff and internal consultation, length of transport time, which is a common subtheme to these major categories. Have any of you got any questions that haven't been addressed? Yeah. Sorry, the mic's just with you.

F9:Sorry. Dr Earnshaw said we're an aging population, so you're going to have more elderly patients. There's nobody on the panel tonight representing elderly patients. Now it says in the national press and the Royal College of Nurses have said anybody with dementia having to go into hospital for anything, they do have to have surgery, they do have illnesses that need hospitalisation, are in danger and stand more chance of dying. And I've just recently experienced that with my mother, as Stephen Eames can tell you. So what are the plans for people with dementia that have to go in hospital?

Steve Richards:Thank you. Richard?

Dr Richard Jenkins:Yeah, you're right to raise that as dementia, unfortunately, is an increasing problem. I think people with dementia are really an important part of our planning, so that's the sort of frail elderly are the people who are at highest risk of dementia. And they're a group that we're doing some specific work on, to try and make sure we get the right care pathways.

F9:Some people have dementia in their fifties, I mean, they're not old.

Dr Richard Jenkins:No, but the predominant people with dementia are elderly. So that's one thing we're doing. We've also signed up for the Dementia Friendly Hospitals scheme. We have a consultant specialist in elderly medicine who is our dementia lead, Dr Rachel Holt. And she and others are working on that. So we've introduced a process by which we are aiming to screen every patient admitted for dementia, so we can recognise it early and then we can link people into dementia services.

23

Because one of the things that's really important in dementia is recognising it. Many people are reluctant to go and seek help, and there are now some effective treatments that can help to delay it. But also, if we identify it on admission, we can make sure we put the appropriate sort of safeguards and care processes in place for those people.

F9:You didn't do that for my mother.

Dr Richard Jenkins:I'm not saying we've got it all right, I'm saying what we're trying to do is improve, and that's why we've signed up to this improvement process.

Steve Richards:Phil, you wanted to say…

F9:[Inaudible - microphone inaccessible 1:08:45 - 1:08:47].

Dr Phil Earnshaw:The majority of people going into hospital are elderly, so it's all about elderly people. Dementia is a major issue for society. With our council colleagues, we have a Dementia Board and we're looking at everything that we provide, all social care services, care out of hospital, supporting more carers. This year, I believe we're investing £800,000 [with a lot 1:09:22] to do with the council, so [don't pinch it, 1:09:25] council, to invest significantly with carers. Also, with…

F9:It's hospital care I'm on about, not care…she was safer in the home she was in than in Pinderfields Hospital.

Dr Phil Earnshaw:And I have personal experience because I talked about my mum, she was admitted ten days ago, she's over 80. And just if you want to learn the questions now, they ask everybody, they screen everybody now, so you can tell that the awareness has changed. Just it's John Smith and it's 42 West Street. So if you're asked the questions to remember, they're the ones you need to remember now.

And as you're in A&E, you can hear the questions being asked all the way down the line. So that says to me that there's been a sea change, because what people are doing is, you're seeing what the mental state is when they're admitted and whether that's due to their illness or whether it's due to an enduring condition such as dementia. And they're assessed in A&E and the on the wards, that's checked. And obviously, it's checked before they leave.

So it is a big issue. The hospital's taking it seriously, we're taking it seriously, the council are taking it seriously because you could call it an epidemic, it's something that's going to be much more prevalent in society.

F9:

24

Yes, I told them my mother had dementia. She got a water infection. It was put on her notes but she still had two falls, one nearly killed her. And then I was told when I complained that protecting patient's dignity, a nurse wouldn't stay in the toilet with them while they were attending to their personal needs. Well, that's absolutely ridiculous.

Stephen Eames:Yeah, could I just say, so everybody in the room knows, obviously I know all about your mum's case, as you know. And she fell four times in hospital and there are all sorts of issues with that, some of which you've alluded to. And I'm really sorry that happened, as I've said to you in a number of ways, directly and in writing. As I was saying to you before the meeting, I will do anything you want me to do to try and support the opposition…

F9:[Inaudible - microphone inaccessible 1:11:36 - 1:11:38] for everybody.

Stephen Eames:Well, that's exactly what I'm here for. But just in terms of the specific, I think, given the broader nature of this, I can talk to you afterwards, I'm happy for you to come and see me. You know all of that and, you know, whatever we need to do to support what you're concerned about, we'll do it.

Steve Richards:Okay, thank you. I know you've got a specific and general concern which you've made clearly. Yeah, the guy over there. Do you mind waiting for the mic? Thanks.

M5:Right, I'm John Gill, I'm a resident of Pontefract. I were a bit disappointed really when I walked in the room because there's hardly any people here, but then given that all these that were sent out to everybody's home have Sunday's date on them, not tonight's. And obviously, somebody's done a Joseph [Goebbels 1:12:32] and changed the date on the ones on the tables. That's probably the reason why there's hardly anybody here. So it's not surprising. And there were nothing in the [Pont and Cast 1:12:42] Express today, telling anybody of the change of date. So I think that's pretty shoddy and obviously gives me, you know, a sort of idea of what sort of consultation really, really the Board want, which is not a real consultation. They just want to go ahead with it anyway, whether people like it or not.

The other thing, this document, actually the questions in it, I mean, whoever thought this up, you know, is absolute…why are the questions so dumbed down, you know? 'How important are the following to you, to get the best results from your treatment'? Well, everybody's going to answer very, aren’t they? Nobody…you know, I've got to be honest, I doubt even some of the poor folk with dementia would answer not at all. This isn't a real consultation, this is absolute rubbish. There's no mention in this document of the Health and Social Care Act 2012, which makes Mr Earnshaw in charge of transferring out at least 49% of services away from public NHS providers out to other providers in the private and the voluntary sector. Why hasn't that been mentioned anywhere in these documents? Why is it not on anywhere on the website? Why aren't any of the people from the CCG, who Mr Earnshaw's here to represent, why aren't they telling everybody what links they have with these providers? We want to know these things. The public want to know when these services go out to the private sector.

25

Steve Richards:Okay, thank you very much. On the specifics about this consultation, what about the date and so on of this meeting?

Jo Webster:Yeah, can I deal with the first part first of your concern. So the first thing I think we ought to say is that we do apologise. There was an error made in the documentation that was sent out to residents. And we have made lots of apologies around that. We've done everything we possibly can to make sure that people understood that the meeting was today - and Jane can go into more detail about that specifically - and not on Sunday.

And the other thing is that there will be somebody here on Sunday, so when people do turn up, we will actually talk to them and we will make sure that those people that have come out of their homes to talk to us, they get somebody to talk to.

In response to yours about this not a proper public consultation, I just want to just tell you exactly what we've been doing. So we sent out the summary document to 242,000 households across North Kirklees and Wakefield. That’s 90% of the population was covered in relation to that leaflet that you're looking at now. That document is available on the website. And on the website, there is opportunity for people to use the Freepost address to send back the comments and the questionnaire, or you can actually do that online.

We've held eight Public Meetings, this is obviously the sixth. We've got two more next week. We've had wide ranging covering all sorts of aspects, not just the four services that we're reconfiguring, many other services around mental health, ambulances, et cetera, with the Overview and Scrutiny Committee, the Joint Overview and Scrutiny Committee. And part of that was them testing us at midpoint and at the beginning of the process, will our leaflets and documentation be adequate in relation to the consultation process.

We've received about a thousand emails from residents, all of which, the majority, apart from a handful, have been responded to personally. We've had a really significant direct focus on some of the theme areas. So we've had a meeting with people that are really concerned about maternity and about paediatrics, and we've been able to focus in on those actual specifics. So those mothers and pregnant ladies that are really concerned about how they're going to get their care.

And we're doing more. We're actually doing another telephone survey of 1,000 residents to try and home in on those areas where we feel that we're not actually getting a response from. So questions designed by patients. And actually, it's one of those things, you could change the question, couldn't you, all the time. What we had was a set of questions that are not ideal, I suppose, if that's what you want to say, but they were questions that the residents that we worked with to formulate those questions about these proposals, felt that we would give us the information.

Do you want to answer…

Steve Richards:Okay, that's the consultation. Sorry, do you want to say any more on the consultation? On the…and this is…

26

Dr Phil Earnshaw:The question about privatising.

Steve Richards:Yeah, I mean, this is obviously separate from the specific proposals here. I mean, it's happening around England the NHS reforms. What relationship do you have with the private companies that are going to come into the NHS?

Dr Phil Earnshaw:Nothing. Our job is to provide care for the people of Wakefield. I had to smile because obviously the term 50% was used. Currently, 5% of our budget is spent on private services, and the majority of those are actually surgical procedures. And actually, if these guys do a good job, what happens when I go on my choose and book is people are sensitive to the waiting times, they weren't very good, it was government policy and it was the previous government's policy as well as this government's policy to provide choice. And people chose to go to the private sector for their knees and hips. As the service has improved the waiting times, as they become more local, as the reputation of, for example, the new orthopaedic service improves, we actually expect some of that work to go back to the NHS.

So over the first quarter of last year, 6.5% of our activity went outside and the last quarter it had dropped back. So I presume that Mr Eames is taking more of the activity. And that's about…it was about…so both the last two governments have insisted its NHS constitutional right to have choice. And as I say, the vast majority of spend was around elective surgery, when the waiting times weren't so great at Mid Yorkshire.

And as they improve and as you've got more high quality services, then we actually expect things to go the other way. We're about great care and, if you like, we've been asked to be your advocates. And as GPs particularly, we're a cynical bunch and so we have to have it proven to us that things are improving. And we do support Mid Yorkshire very strongly but we also, in private, push them quite hard about quality of services.

So some of the questions that you asked, we ask a lot of those questions in private because we are your advocates, that is our role. And we use the experience of what we see in surgery and we use the experience of living in the district and having relatives and family that use the same services, that's why clinical commissioning is intended to be different because we use our experience to hopefully drive up patient quality, and particularly in our area, focused on improving the experience of care.

Steve Richards:Do you think even if these specific proposals go ahead and bring about improvements, the general reforms that you've just been talking about, introduced by the government, will inevitably mean you will use more of the private sector in the future?

Dr Earnshaw:As I'm saying, no actually because the biggest driver was from I'll just the previous - I don't want to get political, it's not a political meeting - the previous government, when their key was getting waiting times down, that was proving very difficult, and so it was another source of capacity. And so the big issues of the private sector was, at that point…

Steve Richards:

27

Capacities?

Dr Earnshaw:So capacity. And as that has been solved locally, we actually anticipate our use of the private sector to go down.

Steve Richards:Going down. Stephen? Sorry, Jo.

Jo Webster:What I would say is that there is legislation around co-operation and competition rules, and that's given to us by the government. And we have to, as a public organisation, conform to those rules. So sometimes when we introduce new services or we want to change significantly existing services to make them more equitable or for whatever reason, we have to go through a procurement rule that’s fair, open and transparent, and offers it to everybody.

Right, what I will say to you is that process undertaken enables us to make the right choice, based on the evidence that we do and the process we go through, that’s laid down, that we then make the right choice for patients. And then we monitor that.

So for me, it isn't about whether it's the private or the NHS, it's about who can provide the best care for you. And that's the decisions that we've been entrusted to make on your behalf.

Stephen Eames:Just one small additional point. It's often - and I understand this, why this can be so - it's often very easy to confuse privatising the NHS, a public service, with using the private sector. They're actually different.

The NHS, over decades, has bought services, often actually for people with long term conditions or in mental health services, from the private sector. That's not privatisation. That's providing quality care. And after all, we're all taxpayers here, what we're looking for from our service is high quality and, ideally, best use of your money in providing those services.

So I think there's a distinction, and I'm partly answering the chairman's question, I think the tensions, if you like, that we're touching on here are going to continue over the next decade but I think we do need to separate out the use of public money using private providers, from privatising the NHS. Different question.

Steve Richards:Okay, thank you. Well, we've kind of moved on from the specific proposals here we had. And if we had Andrew Lansley or Jeremy Hunt here, we could develop this debate. But we have got the panel of people who are absolutely clear about the specific proposals and responsible for them. So any more questions about what is being proposed by this panel, rather than Central Government? Yeah.

M6:Mark Harrison, local resident. Actually, it's just a matter of fact. You say you've sent out 242,000 of these. What percentage have you had returned?

28

Jo Webster:Jane, do you know that detail?

PM:1,600 so far.

M6:As a percentage?

Stephen Eames:It's about 2%.

M6:About 2%. Sorry? [Voices overlap] Did you say about 2%?

PM:[No, I didn't say that].

M6:Oh, right. Well, that's the figure I want as a percentage.

Jo Webster:So we can make that available. We don't hold all the detail here. But what we're doing is, that's only one way in which we're capturing the information of views of patients and residents. So we're doing another 1,000 household surveys, telephone surveys. We've got the road shows, we've spoken to people. You know, we've done an enormous amount of activity.

And what we've said is, if there is things that you also want us to do, there's two weeks left of this consultation process and if you feel that you haven't had the opportunity to have your say, then I'm quite happy to talk to you and make sure that you can do that. And if you know of other residents that have got that issue, then we're quite happy to put things in place to be able to make sure we're capturing what patients residents' views are.

Steve Richards:Yeah, sorry.

M6:I just wanted to…that's not actually point. What I want to know is the response rate, that's all I want to know.

PM: Well, we haven't finished yet, so we can give you that.

Steve Richards:Yeah, thank you.

PM: It's whoever can do sums in their head fastest I think. So 1,600 so far out of the…I just wanted to say something very quickly. There will be [voices overlap 1:26:20]. Pardon?

29

PM: It's roughly about 8%.

PM: Right. Can I just…

Jo Webster:Okay, I've got the exact here in front of me.

PM: We've got the exact figure over here.

Jo Webster:So there you go. I should read my briefing notes, shouldn't I?

Steve Richards:You've got the exact figure.

Jo Webster:So we had returned 1,752, of which 1,342 were postal and 410 were via the website. And that was at the beginning of last week. So obviously, we need to tot up the ones that we've had this week as well.

M6:So about 2,000 out of 200,000?

PM: It's about 1%-ish.

Stephen Eames:But I think I can see the inference, just if I can make this brief point [voices overlap 1:26:56]. That's correct, I think it's about 2%, with my maths, something like that. It's quite a small percentage. Actually, in national public consultations, which I think is an issue, if it's what you're getting at, that's quite a good return. They're usually about 1.5%. That's why all these other things that Jo's been describing - let me just finish - that's why we're doing all the other things because we know, even when we make it as easy as we possibly can, post them to people's homes, Freepost back, the levels of response are always very low. So we've got a huge amount of other activity going on to inform the consultation.

Steve Richards:Do you want…?

PM: If I could just say something as well. Somebody here has said to me that in their area, their document wasn't delivered. If you could let me know, we will either bring a supply of leaflets - we're, in fact, doing that to an area this weekend - or we will certainly take it up with the distributors. But we did aim for about 90%. Happy to make those available, let me know your postcode, that would be really helpful. Catch me afterwards. Thank you.

Steve Richards:

30

Okay. Well, there are going to be a few one to ones afterwards but you've got another question for this general meeting.

M1:On the same thing. The only way I found out about these meetings was on Monday when I went to my parish council meeting, from the parish clerk. Nobody in Sharlston knew that it were on.

Steve Richards:Right, we'll get you the response about…

PM: Could I just say that actually proves that some of our systems work, because as well as our posters, I've written, or we have written to all parish councils, we've written to local members, we have talked to GPs, we've put extra posters in supermarkets. I can't guarantee they'll put them up because I can't make them but I think it demonstrates we have tried to find as many ways as we possibly can. And there will be some people we haven't reached, and if there is anybody else you think you want us to contact, we'll undertake to do that.

M1:Next Tuesday, we've actually got an open day, so if you can get me some leaflets, I can [inaudible 1:29:05].

PM: I can let you have some tonight before you go home.

Steve Richards:If you have a word at the end, we'll get that sorted. Sorry, you wanted to add? Sorry, Jane? You wanted to…there are a lot of hands up. Yeah?

F10:I just said, couldn't you ask Look North or Calendar to advertise them for you the week before, or…?

PM: We do send them press releases but I have to say, I'm not sure it's interesting [voices overlap 1:29:28]. Steve will tell us that journalists want something that's different, so they get the information…

Steve Richards:Getting on Look North would be impossible. That's not their fault, that's Look North's fault, if you know what I mean. Sorry, there was somebody on…yeah, of course, you wanted to say something more about…

PM: I just wanted to add to the response rate. There was a consultation done in London, which is obviously a much bigger area, and their response rate was between 1% and 2%. So as well as doing the consultation through the leaflets, the group are also doing focus groups with specific residents. And I'm sure if you asked Jayne or Jeanette if you want a specific focus group in your area because you want to input into the consultation that way, I'm sure they'll be happy to arrange that.

31

Steve Richards:Okay, thank you. Right, any other general points before you raised the specifics at the end of the meeting about leaflets, consultation? I think you said you were going to speak to a couple of people. Any more general questions or points? Okay. Well, thank you all very much indeed for coming, much appreciated. Thank you.

Jo Webster:Thank you.

End of recording

32