Healthcare in Cornwall

Healthcare in Cornwall, United Kingdom, is now the responsibility of Kernow clinical commissioning group, a National Health Service (NHS) organisation set up by the Health and Social Care Act 2012 to organise the delivery of NHS services in England. As far as the NHS is concerned, Cornwall includes the Isles of Scilly.

History

From 1947 to 1974, NHS services in Cornwall were managed by the South-Western Regional Hospital Board. In 1974 the boards were abolished and replaced by regional health authorities. Cornwall came under the South West RHA. Regions were reorganised in 1996 and Devon came under the South and West (Wessex and South Western) Regional Health Authority. Cornwall and Isles of Scilly constituted a district health authority from 1974 until 2002 when Cornwall and Isles of Scilly Primary Care Trust was established. This was managed by the South West Peninsula Strategic Health Authority from 2002 until 2006 when that was merged into NHS South West. The PCT and the strategic health authority were abolished in 2012.

A report by the Care Quality Commission in October 2017 found that the county's health and social care system ‘is not working well together’, that different parts of the system are not working together to ensure people can move between services as they need them, and that too many people were stuck in hospital waiting for a social care package or a place in a residential establishment.[1]

Sustainability and transformation plans
Further information: Sustainability and transformation plan

In July 2015 a devolution deal, the Deal for Cornwall, was announced by the government under which Cornwall Council and the Council of the Isles of Scilly are to create a plan to bring health and social care services together under local control.[2]

The Sustainability and transformation plan says that the 13 community hospitals in the area with a total capacity of 314 beds are not used effectively, not fit for purpose and are not sustainable. It proposes to develop integrated community care hubs primarily for care of the elderly and to integrate NHS 111 and the out-of-hours service. The CCG’s savings target for 2017/8 is £29.6 million but it has "no viable plan" to achieve this.[3]

Royal Cornwall Hospitals NHS Trust and Cornwall Partnership NHS Foundation Trust established a joint board in July 2017 to “gradually unite clinical and non-clinical services" - a step towards the creation of an accountable care system.[4]

In March 2018, after protests, Cornwall Council announced that it was abandoning proposals to establish an Accountable Care System but they would continue to support the integration of health and care services. They said they would strengthen the existing Health and Wellbeing Board to become a more effective decision making body. Cllr Andy Virr, the Conservative health spokesperson, said that kind words regarding working together were vacuous without a commitment to integrate and combine budgets.[5]

Commissioning

Kernow Clinical Commissioning Group was placed under legal directions by NHS England in December 2015. It has a budget of £728.7 million and expects a deficit of £14 million for 2015/16.[6] It is required to have a turnaround director in place. Keith Pringle, who has previously worked with CCGs in Hampshire and at Gloucestershire Hospitals NHS Foundation Trust is employed at a cost of £396,000 in 2015/6 including agency fees.[7]

Cornwall was one of the 4 areas chosen to trial the integration of specialised commissioning, previously run by NHS England centrally, in September 2016.[8]

In September 2017 it was forecasting a £37 million deficit and had “no viable plan” to hit its control total, a £19.9 million deficit on its allocated £765 million, in the financial year.[9]

The clinical commissioning group proposed in October 2017 that it would no longer pay for non-emergency patient transport to hospital patients who frequently travel to hospital. The policy would particularly impact kidney dialysis patients, who typically have to visit hospital three times a week. The service has been supplied by E-zec Medical Transport Services Ltd. since summer 2016. [10]

In December 2017 it was announced that Cornwall County Council was to take over the functions of Kernow Clinical Commissioning Group as part of the development of an accountable care system for the county. Services are to be provided by one or more “accountable care partnerships” led by the existing NHS providers. According to Cllr Rotchell “Cornwall Council will ultimately become the strategic commissioner for all healthcare for Cornwall that is commissioned by the CCG. The longer term plan is that the CCG becomes a department within Cornwall Council and we will buy services from the providers.”[11]

Primary and Community Care

There are 69 GP practices in the county. St Mary’s hospital on the Isles of Scilly is a small community hospital with a Minor Injuries Unit run by Peninsula Community Health which also runs community hospitals all over Cornwall. The Out-of-hours service contract, worth £8m a year, from 2015 was awarded to Devon Doctors, a GP led social enterprise, and Kernow Health CIC, a community interest company run by member practices. The consortium will operate under the name Cornwall Health.[12] In 2017 it was announced that a £48m contract for Out-of-hours service GP and 111 services had been awarded to a consortium of Royal Cornwall Hospitals NHS Trust, Kernow Health Community Interest Company and Vocare.[13]

Palliative care is provided by Cornwall Hospice Care.

During 2015 there was a programme funded with £44.5m from the Better Care Fund intended to ensure care packages were available for patients leaving hospitals in Cornwall but between July and September a total of 3,815 hospital bed days were lost because of problems with social care packages, compared with 2,255 days for the same period in 2014, meaning that there were 69% more delays in discharging people from hospital.[14]

Community services were provided by Peninsula Community Health from 2011 but from April 2016 will be taken over by a consortium of Royal Cornwall Hospitals NHS Trust, Cornwall Partnership NHS Foundation Trust and Kernow Health CIC.[15]

In May 2017 there was a backlog of 14,000 people unable to register with an NHS dentist in the county. Waiting times for routine appointments were up to eighteen months.[16]

Cornwall Council confirmed Mears Group as lead strategic partner for the delivery of extra care in Cornwall with a seven year agreement for 750 extra care housing units worth £150 million.[17]

Healthwatch

Healthwatch was set up under the Health and Social Care Act 2012 to act as a voice for patients. There is one Healthwatch for Cornwall and a separate Healthwatch for the Isles of Scilly.

Mental health

NHS mental health services in the county are largely provided by Cornwall Partnership NHS Foundation Trust. According to the trust between 8 and 12 patients a month have to be sent out of Cornwall, because there is an "inadequate provision" of beds.[18]

Hospital and acute care

Royal Cornwall Hospitals NHS Trust provides hospital care in the west of the county. University Hospitals Plymouth NHS Trust serves the east. Specialised services are provided from other trusts outside the area. Cornwall Air Ambulance was the first dedicated helicopter emergency medical service operational in the United Kingdom. The Duchy Hospital in Truro run by Ramsay Health Care UK is the only private hospital in the County. It has 27 in-patient beds.

In May 2015 it was reported that Cornwall Partnership NHS Foundation Trust and Royal Cornwall Hospitals NHS Trust were considering a merger.[19]

Cornwall had 134 patients, the second-highest number in England, waiting more than 12 months for treatment in November 2018 [20]

See also

References
  1. "CQC finds 'little confidence' in Cornwall's health and social care system". Healthcare Leader. 9 October 2017. Retrieved 23 December 2017.
  2. "Cornwall devolution: First county with new powers". BBC News. 16 July 2015. Retrieved 27 August 2015.
  3. "Sustainability and Transformation Plans: Find out about your STP". NHS Support Federation. October 2017. Retrieved 14 October 2017.
  4. "Trusts set up joint board in move towards accountable care system". Health Service Journal. 12 July 2017. Retrieved 23 August 2017.
  5. "Plans to 'privatise' NHS in Cornwall are abandoned after protests". Cornwall Live. 2 March 2018. Retrieved 9 March 2018.
  6. "Kernow CCG placed under legal directions". Commissioning Review. 16 December 2015. Retrieved 18 December 2015.
  7. "NHS England permits CCG to spend nearly £400k on interim director". Health Service Journal. 28 July 2016. Retrieved 28 July 2016.
  8. "NHS to trial specialised commissioning with four STPs" (PDF). Commissioning. September 2016. Retrieved 29 October 2016.
  9. "Financially struggling CCG has 'no plan' to hit deficit target". Health Service Journal. 7 September 2017. Retrieved 8 October 2017.
  10. "NHS Kernow in House of Commons Budget 'death tax' name check". Cornwall Live. 24 November 2017. Retrieved 23 December 2017.
  11. "Another council set to take on CCG role". Local Government Chronicle. 14 December 2017. Retrieved 20 December 2017.
  12. "Social enterprises win Cornwall out of hours contract". Health Service Journal. 13 February 2015. Retrieved 24 March 2015.
  13. "New NHS-private partnership wins £48m contract". Health Service Journal. 23 June 2017. Retrieved 16 July 2017.
  14. "Bed blocking in Cornwall increases by 69% as new scheme fails". BBC News. 7 January 2016. Retrieved 8 January 2016.
  15. "NHS consortium preferred provider for Cornwall community services". Health Service Journal. 20 November 2015. Retrieved 19 January 2016.
  16. "Dental crisis in Cornwall sees 14,000 people stuck on waiting list". Guardian. 21 May 2017. Retrieved 21 May 2017.
  17. "Cornwall Council agrees partnership with Mears Group to deliver £150m extra care scheme". Homecare Insight. 24 July 2020. Retrieved 7 September 2020.
  18. "Lack of mental health beds causes concern". West Briton. 10 February 2015. Retrieved 13 February 2015.
  19. "Two NHS health trusts in Cornwall announce possible merger". West Briton. 18 May 2015. Retrieved 19 June 2015.
  20. "New fines for leaving patients waiting more than a year". Health Service Journal. 10 January 2019. Retrieved 13 February 2019.
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