West Cornwall HealthWatch update on Cornwall March 2017
West Cornwall HealthWatch is a voluntary, independent campaigning health watchdog that has been serving West Cornwall since 1997.
We monitor developments in the National Health Service in our area – we attend the public meetings of health and social care organizations, like NHS Kernow (the clinical commissioning group for Cornwall), the Royal Cornwall Hospitals Trust (RCHT) and Cornwall Council – and we examine their publications and proposals, and comment on them.
Most importantly, we campaign to safeguard and improve local health services. Right now, the future of our hospitals – West Cornwall Hospital in Penzance, Edward Hain Hospital in St Ives and St Michael's Hospital in Hayle – is at the very top of our agenda.
Today the NHS in Cornwall is stretched as never before.
The situation is particularly bad in the hospital sector:
· 'Delayed Transfers of Care' (DToCs) of patients who are medically fit to be discharged but aren't – mainly because they need further non-acute NHS care, or they can't manage at home, or there isn't a place for them in a nursing home – mean that beds aren't available for emergencies, and scheduled operations get cancelled at the last minute. In December 2016, these patients took up 68 beds every day (on average) and 70 scheduled operations were cancelled on the day they were due to take place.
· Some patients are discharged too soon after treatment and have to be readmitted. Emergency readmissions have been significantly above the target level recently.
· Ambulances are held up outside A&E until they can deliver patients: recently 60% of ambulances have been kept waiting more than 15 minutes. For many the delay has exceeded 30 minutes.
· Many community hospitals, where patients can recuperate after operations, need updating and renovating, and we are told they are expensive to run and difficult to staff: they could be sold off to raise capital. With Poltair already sold and Edward Hain closed for a year – for fire safety reasons, but no work has yet been done to improve fire safety – Penwith now has no community hospital.
Data from RCHT Integrated Performance Report, February 2017
Health and Social Care – the need for integration
What happens when patients who have been discharged as 'medically fit' get to return home? A recent survey for the Stroke Association found more than 45% of patients said that when they’re discharged from hospital they feel isolated and abandoned. They say that physiotherapy is not adequate and they’re not given access to the right psychological support.
The Chief Executive of the Stroke Association says: 'People are not getting access to speech and language therapy in a timely manner. Many stroke survivors have a physical disability, depression or psychological needs, suffer chronic fatigue or have aphasia, where they cannot speak. You’ve got stroke survivors at home with serious disability, often still in wheelchairs, unable to communicate, suffering the damaging psychological effects of what is a life-changing condition and not being given the proper support.'
The Guardian, 4 February 2017
So what does 'Medically fit for discharge' actually mean? It means that you no longer need the treatment that an acute hospital provides. But that does not always mean you're fit to resume life at home. Community hospitals have a vital part to play in re-enabling you to achieve this. What does the new-fangled Sustainability and Transformation Plan, the STP, have to say about that?
The Sustainability and Transformation Plan (the STP)
The STP is a plan to reorganize health and social care in Cornwall. It is set out in two documents: a draft Outline Business Case and a lavishly illustrated report for public consumption called Taking Control, Shaping our Future. What do they say about our hospitals' future?
Taking Control, Shaping our Future says: 'We want to adapt community hospitals so they become community hubs which offer multiple services and prevent or reduce acute hospital visits. This may mean a reduction in sites and concentrating services in better locations because we expect changes in community services to reduce the need for community hospital beds. We also need to address the significant cost of community hospitals with many in a poor state of repair and needing major investment.'
The draft Outline Business Case says: 'There are major health and safety issues at some sites and considerable investment is required ... The small scale of some sites is not economically viable going forward.' So community hospitals should be 'repurposed' to become Integrated Community Hubs, which will be nursing and therapy led ...' These would be 'co-located' with Urgent Care Centres which would be strategically located 'across the spine of Cornwall'.
What would Urgent Care Centres be? Where? And how many?
The Sustainability and Transformation Plan (continued)
Urgent Care Centres: Taking Control, Shaping our Future says: ‘We want to provide high quality services in a timeframe people need them to prevent unnecessary visits to the Emergency Department … This will probably mean changing the Minor Injury Unit service into Urgent Care Centres but on fewer sites.’ Probably? The draft Outline Business Case reveals, in a table called 'Our health and care system geography', that just three Urgent Care Centres are proposed, one each in the North East, Central and West zones of Cornwall.
A number of things follow from this.
If Community Hospitals are 'co-located' with Urgent Care Centres, they could be reduced in number from 12 (including Edward Hain) to 3. Whatever it means to 'repurpose' them as 'integrated community hubs', clearly there would be a considerable loss of beds where people can recuperate on their way back from acute care to normal active life.
Minor Injury Units could be reduced in number from 13 to 3. So 'probably changing the Minor Injury Unit service into Urgent Care Centres but on fewer sites' could actually mean reducing the number of locations for treatment from 13 to three – a cut of more than three-quarters! – meaning longer and more difficult journeys for patients.
The Sustainability and Transformation Plan (continued)
n the case of Urgent Care, it isn't made clear where the boundaries of the three zones are, but if Penzance-Newlyn and St Ives are in the same zone as Camborne-Pool-Redruth, which has a much larger total population, there will obviously be a risk that urgent care will be removed from Penzance's West Cornwall Hospital.
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The need to join up health care and social care
Remember what the Stroke Association found. Stroke survivors need support that crosses the boundary between health care and social care. People recovering from surgery need the same kind of support, to enable them to lead normal lives again. Currently we have:
· The Royal Cornwall Hospitals Trust trying to move patients out.
· The Cornwall Partnership NHS Foundation Trust, which runs the community hospitals as 'Lead Provider', evidently finding them a burden to run and visibly itching to get rid of them.
· NHS Property Services, which owns the community hospitals, looking to realise the assets that the buildings and land represent.
· Cornwall Council, responsible for funding Social Care, under huge pressure from Central Government to hold down its spending.
The STP, along with the Devolution Deal for Cornwall, is supposed to get these organizations working together. But we see the NHS trusts aiming to offload their 'medically fit' patients on to Cornwall Council, highlighting what they call the 'out-dated model of bed-based care', delayed transfers of care 'blocking' hospital beds, and the run-down state of many community hospitals.
Community health ands ocialcare must be improved before hospital beds are cut! We must resist these ill-thought-out plans!
How you can help
· Join us! The more members we have the stronger we are, the louder our voice, and the more effective we are.
· Tell us your stories! Have you been helped by the NHS? Do you have reasons to appreciate what doctors and nurses and other staff have done and are doing for you and your family? Or has it been a struggle to get the health care and support that you need?
· Give us your suggestions! Patients often see opportunities for improving matters that people within NHS and social care organizations miss.
We will feed your experiences into our campaigning.