Can Royal Cornwall Hospital Trust be "brilliant" ?


written this month by Dr Kath Maguire and John Forsyth

Early in May, the Board of the Royal Cornwall Hospital Trust (RCHT) was presented with a Strategy for 2019-2022, called ‘Journey to Brilliant’. It’s an important document; RCHT provides acute and emergency services in Cornwall- through its sites at Treliske and West Cornwall Hospitals, plus St Michaels Hospital - to over two-thirds of Cornwall’s population. After all the troubles at RCHT, the next few years are critical. The Strategy contains a number of things that we welcome, though it also raises some serious concerns (and possibly overuses the word “brilliant”!).

RCHT must work within the recently published NHS Long-Term Plan, and is faced by acute financial pressures, critical Care Quality Commission reports, and high levels of staff vacancy and turnover. ‘Journey to Brilliant’ acknowledges past failures in patient safety and quality of care, and highlights how the Trust has been taking on board some hard lessons. The commitment to improve communication within the Trust as well as with patients, families and other care partners is extremely welcome.

Another positive aspect of ‘Journey to Brilliant’ is its commitment to address low staff morale and its effect on recruitment and retention of essential staff. Among other welcome measures are improved management styles, engagement and support for staff, staff training and career progression. It would be good if the Trust were explicitly to extend openness and communication to employees of contractors like Mitie and Q-Park at all its sites.

Proposals to invest in updating and improving RCHT’s buildings are important and overdue. Apparently these include improving car-parking facilities at Treliske (good) but we are concerned at the statement that this would ‘release’ land currently used for parking as ‘income generating assets’. What does this mean?

We welcome the commitment to develop West Cornwall Hospital as a Centre of Excellence, and planned investment is really welcome. We do wonder how plans to centralise most day case activity there, and recent investment in St Michaels Hospital, will fit with the pattern of healthcare across Cornwall – but the continuing issue in West Cornwall is the loss of community hospitals locally. Effective community bed provision would relieve pressure on acute services in RCHT, supporting patients in their return to health and mobility; we continue to challenge the assumption that home is always best, whether for rehabilitation, assessment or end of life care.  Community hospitals are needed!

According to the Plan, central to its delivery will be the development of ‘out-of-hospital’ care but, as RCHT seems to have defined its role as acute, accident and emergency services only, how will it develop community care? We are very concerned that the strategy makes assumptions about the ability of the primary sector, particularly GPs and related services, to pick up new roles and responsibilities, shed from RCHT. This sector is outside the control of RCHT, but within the concept of Integrated Care; what happens to patients if the GPs and community services can’t pick it up?

Healthcare in Cornwall needs to reflect its distinctive geography - many people living in more remote small communities, longer distances and costly or difficult travel to larger centres and hospital services. As a key player, RCHT needs to show its willingness to work up models of healthcare suitable to Cornwall (rather than big towns and cities in England), challenging government to obtain the necessary resources.

On the whole, there is a lot within this strategy document that is positive and encouraging, but there is much important detail still to come and some big issues which will affect us all.

Finally a plea – can RCHT and partners please lose the “brilliant” hyperbole, lay out the issues and the available options in plain English and discuss these things in an open public debate, before all the decisions are made?

If you wish to read the full document " Journey to Brilliant " please follow  the link here .