KEY ISSUES:
UNDER-FUNDING
This country spends less of its GDP than most other developed countries. This means that our Cornish health commissioners (Kernow Clinical Commissioning Group) are running with an eye-watering projected deficit of over £60m, and the acute hospital Trust (RCHT
which runs Treliske, West Cornwall and St Michaels hospitals) is also carrying a high level of debt. This puts our entire National Health Service at risk, and the lives and wellbeing of our communities in jeopardy.
CENTRALISATION
Pressures on funding, and increased specialism in health, has led to the centralising of services. More key services have moved to Devon and beyond e.g. acute trauma and upper gastro-intestinal, along with burns, some paediatrics and breast treatments, neurology and routine back surgery. This makes accessing services difficult, costly, time-consuming and stressful for patients. From the beginning, a key issue for West Cornwall HealthWatch has been access to services, and the need to keep them local.
PRIVATISATION
Nationally 37% of NHS contracts are now with the private sector. The combination of increased overheads in private companies, the expensive tendering and contracting process, and the need for private companies to make a profit, all mean that ‘contracting-out’ leaves less funding available for patient care. It has undoubtedly also greatly exacerbated the NHS ‘overspend’.
INTEGRATION OF HEALTH AND SOCIAL CARE
This aspiration is well intentioned but, without adequate funding, presents a huge challenge to implement properly. It currently seems to be a smokescreen for a reduction in budgets in both NHS and local council funding.
OUT-OF-HOURS
Continuing problems with and lack of public confidence in the 111 phone service the out-of-hours service leads too many to arrive at the main A&E Department in Truro, causing queues and delays. There need to be more local solutions for care out of GP surgery opening times.
COMMUNITY CARE AND MENTAL HEALTH
There are glaring gaps in the provision of community care, no 24-hour district nursing, for example. Admirable attempts to help, with pilots such as ‘Living Well’, have not been adequately evaluated, depend largely on volunteers and may not attract continuing funding. Patients in the community with mental health issues are also very poorly served due to lack of funding and staff, and long
waiting times which can prove fatal for the vulnerable. High quality ‘Care in the Community’ hasso far failed to materialise.
COMMUNITY HOSPITALS
The much quoted ‘patients prefer to be at home’, has resulted in a reduction in community hospital beds. This, combined with a lack of sufficient suitable nursing home places, has put intolerable pressure on acute hospitals, leading to cancelled operations and chaos in the system. Community hospitals offer vital ‘step-up step-down beds’, rehabilitation and end of- life care, and we cannot afford to lose them.