Recent Press Statements
ELECTIVE SERVICES TENDERING
Naturally we welcome the news that NHS Kernow has put "on pause" their plans to put some elective services out to tender. The loss of such a contract would indeed have threatened St Michael's ability to maintain its excellent service, so valued across the county. NHS Kernow is indeed correct in stating that "competitive procurement will not deliver what is needed".
However, we must respond with some caution, because nothing these days can be considered 'permanent', and the situation could change after the General Election. There are two other, related, issues which cause us concern:
1. We know that NHS Kernow are planning to transfer millions of pounds from the acute budget into community services. A reduction of this magnitude in the RCHT budget will place an additional financial burden on RCHT and may well make its Board reconsider the role of St Michaels in service delivery
2. We learn from NHS Kernow's recent Board papers that they have just given £2.5m to the private sector to treat 780 patients from RCHT's waiting lists in the couple of months up to 31st March. Again, this represents a loss of income to RCHT, and we are saddened that St Michael's was not given the opportunity to carry out this work - particularly as its current occupancy levels are just 42%, so there is plenty of capacity to treat patients in Hayle
So our response to this pause in procurement is of cautious consolation, but we hope it will not prove to be a 'false dawn'.
CONCERNS REMAIN AFTER 'POLTAIR NEXT STEPS MEETING'
Six months after the decision by NHS Kernow to permanently close Poltair hospital and after nearly two years of consultation, we learned last week that its ten community hospital beds will not be re-provided elsewhere; and its clinics, offices and gym will be spread around the area. In particular, and contrary to expectation, Poltair clinics will not now be relocated to West Cornwall Hospital, but will be moved into GP surgeries; and staff offices to Bellair.
We have been told that NHS Kernow considers there to be sufficient capacity in the county’s community hospitals. This is despite those hospitals running at dangerously high 95% occupancy levels, unable to accept patients from the acute sector who need re-enablement, and unable to discharge patients due to a lack of nursing home beds and availability of care at home services. The knock-on effect of this is felt at West Cornwall Hospital, where delayed discharges prevent other
patients being admitted; and at Treliske, where frequently there are cancelled operations due to a lack of beds.
West Cornwall HealthWatch continues to have serious concerns about both the process and the replacement provision of Poltair’s services. Last year NHS Kernow undertook to ‘ensure that there were sufficient community
hospital beds open with sufficient clinical and ancillary services until sustainable alternatives were in place’ (1). However, we can see that the service is almost at breaking point, with no sign of an early improvement. We are also unsettled about relocation to GP practices including Sainsburys – we don't know the suitability and accessibility of some GP premises and, as rent will be paid by the GP Commissioning Body to some of its GPs, we see a possible conflict of interest here.
We have listened to and understood that health and social provision must be provided in a more integrated way, which includes the aim of fewer people going into hospital and being well supported at home. However, we see little evidence of such an integrated approach; indeed, we are aware that relationships between the ‘key players’ in healthcare provision in the county - NHS Kernow, RCHT, PCH and Cornwall Council – are strained, to say the least. We see parallel working, duplication of effort and services, and awkwardness in communications. This is exactly the opposite of how it should be, which we find most frustrating, and we have grave concerns about their ability to work together. We rather wish we could ‘bang a few heads together’!
Our concerns have just been reinforced by a report just produced by the NHS Emergency Care Intensive Support Team, investigating persistently poor performance against the four-hour accident and emergency standard at RCHT,
who concluded that “the system was fragmented, with teams from the trust, community provider Peninsula Community
Healthcare and adult social care working in silos….. unhelpful relationships were one of the biggest barriers to improving A&E performance” (2)
In all this, we worry that the needs of the patients are being lost in the system. We work in West Cornwall HealthWatch because of them. Anecdotal evidence suggests that many people are being short-changed at the moment, when they are at their most weak and vulnerable – poor care at home, and poor provision of the right care in hospital. We are close to
(1) KCCG 2013/008
(2) HSJ 7 Nov 2014
OUT-OF-HOURS GP PROVISION
We are disappointed to learn that, again, Cornwall's Out Of Hours GP provision is to be put out to tender. We had really thought that the early termination of Serco's contract and the many problems experienced with this private company, would have given NHS Kernow the opportunity to 'reclaim' the service, enabling patients to have access to their own local GP practices with seamless care. When you consider that most of the week is actually 'out of hours', it makes much more sense to strive to have access to the same teams of doctors at evenings and weekends as during the working week. It is also clear that patients prefer not to be passed from one organisation to another once the evening or weekend arrives.
We are very apprehensive about another tendering exercise which will be costly and may lead to a repeat of the SERCO experience. Cornwall really does not need another liaison with a private company. There are enough NHS providers of care already, with GPs, the ambulance service, community services and the acute hospitals' Trust. We can only hope that, somehow, our local GPs will be able to put together an integrated service with the providers already in place, and which will meet their patients' needs and provide continuity of care 24 hours a day, 7 days a week.
Chair and Managing Director, NHS Kernow
GP Lead, Penwith GP Locality Group
Chair and Chief Executive, Peninsula
POLTAIR COMMUNITY HOSPITAL, PENZANCE
In view of
a) the continual and significant pressures on acute services at both Royal Cornwall and West Cornwall Hospitals
b) the significant pressures experienced in our community hospitals (most now operating at over 95% occupancy, which is well above the accepted level for delivering high quality, safe patient care)
c) the lack of high quality nursing and residential home capacity and domiciliary care in the west of Cornwall
d) the fact that the option for a new build with inpatient beds as a replacement for Poltair on the St Clare site has been lost
e) the fact that we remain unconvinced that the Penwith 'Living Well' Project, good as it is, will deliver any significant reduction in non-elective activity
- we request an urgent meeting of stakeholders with a view to re-opening the debate on the loss of Poltair's community hospital beds.
Jane Varker (Mrs)
Chair, on behalf of West Cornwall HealthWatch
23rd June 2014
MAKE SURE YOU 'CHOOSE AND BOOK' CAREFULLY
West Cornwall HealthWatch wants to remind all readers of the choices they have when they are phoned about booking their hospital appointment or treatment. The adviser phoning you will follow an agreed script, which runs as follows:
1. You will be told that the call is from the Referral Management Service regarding a referral from a GP surgery. You have to confirm your date of birth. Your consent must be obtained before a relative or carer speaks on your behalf.
2. When a choice is available, you are told that you have a choice of where and when you can be seen. Then you are told
- when and where the closest appointment is
- when and where the first appointment is
- other locations where the services are held
- the differences in services i.e. see and treat
3. You are asked your preference. When the appointment is booked, you are asked to write down the place, date and time.
Those of us living in the west of the county will almost certainly want to choose local. This will mean West Cornwall Hospital wherever possible, and St Michaels Hospital particularly for orthopaedic or breast surgery. We encourage readers to exercise their choice to have convenient appointments and treatment. We continue to campaign to keep our local hospitals working well, and we worry when we hear that people are perhaps travelling unnecessarily further afield, whether to a private hospital in Truro, or beyond. So please let West Cornwall HealthWatch (www.westcornwallhealthwatch.btck.co.uk) know if for any reason you are not offered the choices you wish in the way you should be offered them. And please remember to “Use it or lose it”!
Saturday 31st May
Reinventing the wheel?
So now we have it: Small really IS beautiful, local IS better, and the wholesale centralisation of services is NOT the answer. The key messages which West Cornwall HealthWatch has been delivering for the past seventeen years have this week been reinforced by new NHS England Chief Executive Simon Stevens, and we welcome his words, which closely echo our own.
Simon Stevens declares that smaller local hospitals have a key role to play in caring for patients. He says that centralisation has gone too far, that initiatives such as the European Working Time Directive have jeopardised local services, that care - particularly for the elderly – needs 'remodelling' to integrate health and social care in providing both community care AND community hospital beds close to home.
It is ironic that his announcement comes hot on the heels of the announcement that Poltair Hospital is to close, with the permanent loss of its inpatient beds, once alternative spaces across the area have been found for its outpatient clinics and outreach services. We have consistently called for a new Integrated Care Centre in Penwith, which would incorporate under one roof all the services needed to support predominantly elderly people and which, crucially, would include inpatient beds for those who need them - because not everyone can be cared for at home, despite the aspirations of the 'Living Well' project.
Now today we have Norman Lamb, the health minister, saying that small integrated hospitals are a really fundamental part of the government's vision. So it seems that we in West Cornwall HealthWatch are entirely in tune with what both the NHS England boss and the government are now saying. We hope that all those entrusted with local decision-making will listen both to them and to us.
Monday 19th May
THE FUTURE FOR POLTAIR HOSPITAL
The decision unanimously approved by the Board of NHS Kernow last week not only supports the option which was the least favoured by the community during the public consultation, but also reveals huge risks and dangerously unproven assumptions, as well as a tragically lost opportunity:
1. The Board approved a plan to relocate all Poltair services (excepting inpatient beds) to alternative locations, though none of these locations have yet been assessed for suitability, sustainability, value for money, feasibility, accessibility etc and may yet prove neither acceptable nor viable, in which case the plan collapses
2. There is an assumption that increased community bed capacity is not required. However, the plan signals a decrease in community bed capacity, now that we seem to have lost permanently the ten beds at Poltair. Furthermore, there is as yet no clear evidence that less community hospital beds are required in Penwith. If evidence is produced to prove that more beds are needed than the few remaining in Edward Hain Hospital, St Ives, again this plan will collapse
3. As the Consultation progressed during January-March 2014, the proposal of a major new integrated health development on the St Clare site provided a golden opportunity to do something ground-breaking to benefit the community*. It now seems that there has been insufficient time to develop such a proposal (which history may prove was exactly what was required) and which has been left to slip through our fingers
Whilst we understand the desire to make a decision about Poltair, we fear that approving the wholesale closure of Poltair at this stage is reckless and premature. Indeed, we could be forgiven for concluding that the entire Consultation was a sham; hadn’t Kernow Clinical Commissioning Group and its partners decided in advance what they wanted to do, and although they clearly heard an alternative solution, were able to discount it with ease? There are many in this community who will see it this way. The detailed report from the Consultation identifies ‘public discontent’ as the biggest major risk, and that is indeed the case.
West Cornwall HealthWatch members, along with many other community representatives, made their position abundantly clear over the past months, and despite everything it seems that this has been no more than quietly acknowledged and then dismissed. We have cause to wonder whether our presence as ‘stakeholders’ does no more than enable decision-makers to ‘tick the box’ of community involvement or, even worse, attempt to diminish or silence an independent community voice. However, as ever, our motivation and commitment is to our local community and particularly its elderly and vulnerable members, for whom we shall continue to campaign with our customary tenacity. So we will continue as ‘stakeholders’, giving time to sit around the table with decision-makers, as they need us to do.
In the meanwhile, we encourage readers to contact us if they are concerned about recent experiences of care in the Cornish health system, whether this was in hospital or with nursing care at home.
Monday 3st March
A well-attended West Cornwall HealthWatch Annual General Meeting was held last Friday, 28th March. The meeting heard calls for the St Clare site in Penzance to incorporate an all-inclusive Integrated Care Centre, incorporating all the services currently provided by Poltair Hospital along with Social Care workers, community hospital beds and training for domiciliary care and voluntary workers. It could also include extra care housing, and a GP centre. Members heard that in some quarters the visionary West Cornwall HealthWatch proposal has been described as a 'game changer', and members strongly hope that this will be the case. Guest speaker Jim McKenna gave a Cornwall Council perspective on the St Clare site; he also discussed the challenges of centralisation, where we may find that more services including A&E are moved out of county; and also the need to integrate health and social care budgets. During the meeting Jane Varker was elected chairman of West Cornwall HealthWatch for the coming year, and a new committee was voted in.
West Cornwall HealthWatch is always keen to hear from the people of west Cornwall whom it seeks to represent. Please contact us with your opinions and your comments: the best way is through our website: www.westcornwallhealthwatch.btck.co.uk or email email@example.com
Wednesday 4th December 2013
CAMPAIGNERS UNHAPPY ABOUT POLTAIR HOSPITAL OPTIONS
Well, there are no surprises here, but I am disappointed, and very concerned for the residents of West Penwith.
It is now even more vital that people take an active part in the consultation exercise which is about to begin.
The views of West Cornwall HealthWatch on Poltair are well known. We believe that there is insufficient bed capacity in the community hospital sector, which has contributed to the problems experienced by the acute sector (Treliske). We also believe that not all patients can safely and adequately be cared for in their own homes, where home care is simply not in place - and will not be without truly massive investment. And we are fearful that such measures will lead to further privatisation of what should be NHS provision.
I note that options involving a new build or reopening 10 beds have been discounted on grounds of 'affordability'. Frankly, we can't afford NOT to consider these. To deliver adequate care to the growing numbers of frail elderly people who need it IS going to cost a lot of money - we have no other option.
Thursday 21st November 2013
LEFT OFF THE MAP? LEFT OUT OF THE PLAN?
Following comments made by representative from Peninsula Community Health that a hospital would need 26 beds to be viable (later backtracked to perhaps 20 beds), it was evident that Cornwall's smaller community hospitals could well be at risk. So to discover a leaflet published by Peninsula Community Health displaying a map which omitted three of the smallest hospitals was not unexpected, though surprising that the company would reveal its plans in this way!
Andrew George MP contacted Steve Jenkin at PCH, and was told that “The omission of Poltair, Edward Hain, and indeed Fowey from the map, was an oversight and not anything people should read into”.
Later, a spokeswoman from PCH said “There's absolutely no connection between the map and where we're providing services".
West Cornwall HealthWatch is concerned at the omission of three cherished community hospitals from this map. It is hard to believe that this was an accidental omission – if it was, then questions need to be asked about competence. Rather, I fear that the map inadvertently betrays a plan for the future, which will not include our smaller community hospitals, and which had until now not been made public. If, as we have been told, hospitals need a minimum number of beds – perhaps 20 – to be viable, then quite a few of our hospitals are at risk. Certainly Edward Hain falls into this category, alongside Poltair (which as we know already faces a very bleak future). This would leave Penwith with no community hospital beds at all.
We in West Cornwall HealthWatch are very clear that we lose such beds at our peril. Community hospitals have been described as ‘jewels in the crown’, and their beds play an essential part in nursing care, assessment and rehabilitation. They need to be embedded in local communities, for equity of access, and their beds cannot simply be sacrificed to leave people at home, where we know that adequate community nursing care is by no means in place.
So we are not convinced by the reasons given by Peninsula Community Health for the map in their leaflet, and we will need much more believable reassurances that smaller community hospitals, such as Edward Hain, are not at risk, before our suspicions can be allayed.
Thursday 11th July 2013
CHOOSE IT, USE IT OR LOSE IT - OUR NEW POSTER CAMPAIGN
This week West Cornwall HealthWatch has launched a poster campaign, entitled "Your NHS needs YOU!" As you will read in the poster, we aim to bring to the attention of the public the possible consequences of patient choice, where they may opt outside the NHS under the Any Qualified Provider legislation. We have produced these posters for distribution across the whole of Penwith and Kerrier. We feel this is necessary because most people don't really understand or realise the implications of choosing a 'private provider' for their NHS care. Like so many other ideas, patient choice is good in principle - but unfortunately can have unintended consequences, which could prove disastrous for the provision of integrated NHS services in the future. There are scores of private companies out there, longing to 'cherry-pick' some NHS treatments, and making handsome profits for themselves in the process. Specifically we have concerns about the impact of Duchy Hospital taking patients who would have received orthopaedic outpatient and surgical treatment at St Michael's Hayle; there is now a question mark over its future because its lists are down, and beds empty. Meanwhile, the NHS itself has to maintain the more expensive and complex treatments, such as cancer care, accidents and emergencies, long-term rehabilitation and care, along with all staff training. With money draining away from the NHS to private pockets, it's clear that it will be more and more difficult for the NHS to sustain all that. As you will see in the poster, over £18,500,000 was paid out of NHS funds to one provider alone (Ramsay Health Care) in Cornwall last year, for NHS treatment at Duchy Hospital and Bodmin Treatment Centre. This trend seems set to continue, or even accelerate; we know that, for example, Specsavers are now offering NHS hearing tests, which is taking business away from the NHS hospitals. Of course we don't want anyone to feel guilty if they have already chosen to use a 'private' provider for their treatment, and we're sure that no-one has made that choice already knowing that it could threaten our local hospitals. We just want everyone to know and understand the situation, and we are simply asking - 'think before you choose, and think of the future as well as the present'.
Tuesday 11th June 2013
GRAVE CONCERNS OVER CONTINUING CLOSURE OF POLTAIR HOSPITAL
We are all aware of pressures on beds both at Treliske and West Cornwall Hospitals, resulting in ambulance queues, trolley waits, and the cancellation of planned operations. This is in part due to the reduction in community hospital beds, over 50 across the county, over twenty of which are at Poltair Hospital, as well as two at Edward Hain Hospital in St Ives. Poltair has now been closed to inpatients for over six months. The company running it, Peninsula Community Health, has given different reasons for its closure over this time: first it was due to a staff shortage, then due to problems with the building, then awaiting the results of a review into community provision in Penwith, which has now been published. We’re not actually sure what is their current reason for closure; but the fact remains that Penwith is woefully short of community hospital beds, as well as having inadequate community care which would enable patients to be properly cared for at home. This means that some patients are inappropriately being kept at Treliske, or West Cornwall, or alternatively are being sent home sooner than they should be.
We are seriously concerned about this. It is simply not acceptable to close needed beds without providing workable alternatives. This week’s St Ives Board meeting of NHS Kernow, the new GP-led commissioning group for the county, acknowledged that the current situation is unsatisfactory, but does not as yet have any plans for the future ready to be announced. So we will continue to press for this issue to be at the top of the health agenda, until we can be satisfied that our elderly people can have confidence in these essential services.
USE IT OR LOSE IT
West Cornwall HealthWatch has growing concerns for the future of NHS services in the county, which are increasingly under threat from the “Any Qualified Provider” legislation. Spokesperson for West Cornwall HealthWatch, Marna Blundy, said this week:“Put simply, it means that private companies can offer their services to the NHS, as we are seeing with the Duchy Hospital, Bodmin Treatment Centre, and even Specsavers! Patients who choose to have their treatment in these places are unwittingly diverting NHS money into the coffers of private companies, at the expense of NHS organisations. Ultimately even core services such as orthopaedics in our hospitals may be under threat, if this trend continues or accelerates. We understand that patients might be attracted by advertisements in the paper; but NHS-run hospitals and clinics are not allowed to do the same. It isn’t a level playing field. “Long-standing campaigning groups such as ours have worked tirelessly, with the support of the community, to keep both West Cornwall and St Michaels Hospitals open and flourishing. All our efforts could be jeopardised by private companies siphoning off work from these hospitals. We understand that this year alone, Ramsay Health Care (who run Duchy Hospital and Bodmin Treatment Centre) have pocketed over £18million from NHS work, the result of patients choosing to be treated there. It will be nothing short of tragic if, as a result of Cornish patients choosing to have their NHS treatment away from St Michaels Hayle, West Cornwall Hospital, or even Treliske, the choice of these hospitals for treatment is lost for everyone else in the future.”