ICEBERGS IN CORNWALL

A dismal recital of three issues in Cornwall: health, children, budget.

Health

The Care Quality Commission (CQC) has published its assessments of the health services in Cornwall for 2008/09. This is the commission that earlier this year took over the regulation and assessment of health services from the former healthcare commission (and social care and mental health commissions).

Once again the Royal Cornwall Hospitals NHS Trust (RCHT), which runs three hospitals in Cornwall, at Truro, Penzance, and Hayle, gets a mixed report. The CQC Commission has assessed it as “fair” for financial management but has judged it “weak” on quality of services, as it did for the years from 2005/06. Two questions arise: Why is the RCHT performance on the quality of services weak in assessments for four years running and how can it be turned around? No one seems able or willing to say.

It is not surprising that some staff talk of low morale and pressure.

It is unacceptable for a hospital group to get these repeated “weak” assessments. Next spring all hospitals must register with the CQC, registration will require compliance with new standards, and the CQC will get powers to intervene robustly when trusts do not meet those standards. It should ensure the RCHT, if still judged weak then, improves massively and speedily. Whatever it takes should be done.

There are grounds for hope. RCHT has just produced a five-year plan for 2010-2014: it reads excellently, acknowledging “unacceptable poor performance, particularly over the past four years” and promising “better, safer, good value care.” People in Cornwall are invited to comment on the plan.

(Note that the Cornwall Partnership NHS Trust and the Cornwall and Isles of Scilly Primary Care Trust have both received acceptable reports from the CQC for 2008/09.)

Children

More very disappointing news about another public service in Cornwall. Read here the Ofsted report of September 2009, Inspection of safeguarding and looked after children services: Cornwall Council.

The council, and government which through Dawn Primarolo said that the report “highlights fundamental weaknesses in Cornwall’s children’s services,” are no doubt working to put things right and there will be a further assessment in a while that should either reassure us or see the service taken over. However, improvements take money and the children’s services are already overspending their revenue budget; that takes me to the third iceberg.

See also Cornwall’s children’s services ‘inadequate’ in the Local government chronicle for 23 October 2009.

Budget

The new Tory leader of Cornwall Council asked for a report on the status of the unitary council’s finances for 2009/10 and thereafter. The report, Cornwall Council financial health check report August 2009, is here.

Achieved unitary savings will probably be less than forecasted; currently there is likely to be significant overspending on the revenue budget, especially on the adult social care and children’s services budgets; and the overspend for the current financial year can be met from the £18.2 million unearmarked reserves accumulated by the previous Liberal Democrat council.

There is no immediate financial crisis but the council has to tackle the issue of overspending: reserves deplete fast. That means more efficiency and productivity, cutting unnecessary spending, and reducing costs. If the intended unitary nett savings can be realised, they will lessen but not remove the difficulties. Cutting costs often turns out to be cutting services and jobs, a sorry thought.

Accompanying the publication of the report there is a media report dated October 2009 from the unitary council here. I do not know why a report made in August is published only in October though I suppose August is a month for holidays not politics.

________________________________________________________________________________

CANCER SERVICES RELOCATION: UPDATE

Upper gastro-intestinal cancer surgery, presently at the RCHT hospital in Truro, is being transferred to a single specialist centre at Plymouth. Opposition still continues: see this report, ‘Protesters fight to keep cancer services,’ in today’s Western Morning News.

I’ve looked at this question already; I thought it was entirely settled and settled right.

In response to the latest moves Ann James, the head of the primary care trust in Cornwall, put the substance very well: the transfer is about “improving patients’ chances of survival.”

I have explained the persuasive reasons for the transfer, including the results of an independent review, in this post and this one.

The arguments for transfer are seriously convincing. For the NHS in Cornwall this debate rightly ended months ago.

________________________________________________________
RCHT: Royal Cornwall Hospitals Trust, an NHS trust running three hospitals in Cornwall

________________________________________________________

HEALTH INEQUALITIES IN CORNWALL

Closing the gap is a disturbing but unexpected report from the Care Quality Commission (CQC) about inequalities in health and access to health services in England.

The CQC report looks at smoking and cardiovascular disease; let me focus on the latter. Two quotations sum it all up.

There is an inequality in diagnosis and getting treatment: “The more deprived an area is, the less likely it is that GPs record CVD [cardiovascular disease], resulting in poorer access to treatment” (Closing the gap page 4).

There is a consequent basic inequality in final outcome: “Deaths from coronary heart disease are three times higher among unskilled men than among professionals, and around fifty percent higher in South Asian communities than in the general population” (page 9).

The chair of the CQC, Barbara Young, says robustly, “We cannot rest while health inequalities exist on the scale they do.” That is a positive approach and the commission makes practical recommendations for primary care trusts to improve their health services.

Cornwall as a whole is not among the most deprived parts of England but there are several deprived communities in the county. The CQC findings and recommendations presumably apply there. Some of the health inequalities associated with deprivation will be the result of the lifestyle and economic aspects of people’s lives and they can be difficult to change. However, it should be a priority in healthcare in Cornwall to tackle these inequalities, to bring everyone and everywhere up to much nearer the best. The primary care trust has a positive strategic aim of reducing inequalities but deprivation does not appear explicitly to be acknowledged.

Everyone who cares about people and life here should be ensuring that we “cannot rest” until we are doing very much better.

VORSPRUNG CORNWALL 5

I shall post here continuing good news for Cornwall, developments which will positively help the people of Cornwall and the local economy and everyday lives. Everyone who wants the people of Cornwall to succeed in the modern world will welcome them. This post covers the first half of 2009. Vorsprung Cornwall 1 and 2 cover 2007 and Vorsprung Cornwall 3 and 4 cover 2008.

* The claimant count figures for 14 May 2009 show a fall in Cornwall to 8847 compared to April 2009. This is the number claiming jobseekers allowance and is the usual quoted measure of unemployment (there are other figures for unemployment). The drop is welcome, especially as unemployment is rising in Britain, though perhaps in Cornwall we are now in the weeks of seasonal work. However, the May 2009 figure was twice that of May 2008, a sign of serious job losses.(17 June 2009)

* The Southwest regional development agency (SWRDA), established in 1999, has announced its budget plans for the next two years, 2009-2011, after having its money cut by the recession. Cornwall is doing very well indeed from the new SWRDA plans. About £52.2 million is available for capital projects in the county, much the largest share of any of the SWRDA areas. Of course, Cornwall also has around £415 million EU Convergence Program money available for viable projects 2007-2013.

A list of the Cornwall projects supported by the SWRDA is given here. A briefing by the SWRDA is here. (9 June 2009)

* Way back in 1997 the Labour government promised to end mixed-sex wards and facilities in hospitals. It has been very slow progress. This January the government acted decisively to settle its promise throughout the country this year; and in April the Royal Cornwall Hospitals Trust (RCHT) was granted £750 000 from the Department of Health’s privacy and dignity program for its plans to end any mixed wards and facilities in its three hospitals at Treliske, Hayle, and Penzance. For patients in Cornwall that is excellent news.

* At the urging of the government, doctors (GPs) have been extending the opening hours of their practices. This is a progressive move which makes consultation easier for people who work in the day and cannot easily get time off, and for their employers and work colleagues too. The Department of Health has released the figures for the incidence of extended hours in primary care trusts, including the Cornwall and Isle of Scilly (CIOSPCT) one: in March sixty eight of the seventy GP practices in CIOSPCT were operating extended hours, that is 97.1 percent of the practices. This is much above the England average, 73.5 percent. The details are here. (April 2009)

* Since February 2007 the Vorsprung Cornwall posts here have been crying up the positive concrete things happening in Cornwall. Now a new project, Confident Cornwall, has been set up by others, supported by the local newspapers and business groups. It is to “showcase the good news” about Cornwall. This is excellent news. There is much to celebrate in Cornwall. (March 2009)

* There are plans to turn the site of Glasney College, a medieval Christian monastery at Penryn, into a garden, thus preserving the monastic ruins which are below the surface. The monastery was demolished during the religious reforms of Henry VIII. A range of facilities, such as arts and crafts, is possible at the garden. (12 March 2009)

* Small businesses in construction Cornwall, plumbers and electricians for example, have been helped by the government’s decision to bring forward £6.889 million of spending in schools from 2010/11 to this year, 2009/10. This is part of a total of £919 million spending brought forward for schools in England to help defeat the effects of the recession.

It’s good news for Cornwall businesses and for schools, though the money will be deducted from 2010/11 school allocations. It is spending brought forward not additional spending.

The education department explains it here and there is a list of which education authorities get what here. (4 March 2009)

* St Michael’s hospital at Hayle, part of the Royal Cornwall Hospitals Trust (RCHT), is to undergo a £6 million renewal. As part of that there will be two new operating theatres for breast surgery and orthopedics and these will be the largest and most up-to-date in the RCHT. This is excellent news for the NHS in Cornwall and for patients. See here for more details. (17 January 2009). The two new operating theatres are funded by the national Department of Health through the exceptional public dividend capital scheme. (Hansard 23 March 2009 column 162W).

* Let me begin the new year with a hopeful and positive report in today’s Western Morning News. The Peninsular Medical School is looking to establish a major research institute on the environment and health at Treliske, Truro. EU funds are being sought and jobs for locals and work for local businesses will follow. (1 January 2009)

A REPETITION OF REPETITIONS

For the Royal Cornwall Hospitals NHS Trust (RCHT) life must seem one damning thing after another, report after report after report. Patients and workers at the RCHT are by now surely both distressed by the criticisms and immune to them.

I gave up posting about it – too depressing, inde irae et lacrimae. I don’t see the point of a system which secures reports on difficulties but apparently does nothing with effect to ensure they are put right.

Now another report criticises the trust. It’s here, dated 25 February 2009 and published 20 March 2009.

A lot of the report is recounting recent history but it also suggests twenty seven changes. The report focuses intentionally on administration not the medical work, though it notes RCHT healthcare reported difficulties, and it can be summed up in one key sentence:

“It is the opinion of this review that, on balance, whilst there are examples of good management from the exploration of the trust’s history during 2007 and 2008 neither the trust boards throughout the period nor the chief executive have achieved the overall standards of management and governance expected of a public service organisation like the Royal Cornwall Hospitals NHS Trust…” (paragraph 98).

That’s clear and supported by a detailed account of their weaknesses and failings.

The concluding paragraph 103 of the report is especially damning:

“…the direction of travel of the leadership and management of the Royal Cornwall Hospitals NHS Trust is towards corporate failure.”

Will anything with effect happen? Well, it would be unprecedented if it did. More likely we shall be given a handful of ritual goings and be drowned in much talk of a clear break and a new start and new initiatives and light at the end of the tunnel or whatever the modish cliches are for these occasions. Then we shall wait, wearily, cynically, for the next report, as we have in the past; and as we have in different circumstances of failure for the disappearing Cornwall county council.

It cannot be impossible to improve the RCHT, to end the sequence of Galatian failings and damnations, to coax or drag it into the sun.

However, I do think the £46 million loan from the Department of health is a difficulty. I can see that the government do not wish to be seen writing off, with our money, the incompetences and failings of organisations: that course does not encourage striving for competence and could be seen as rewarding failure. But who gets punished here? Can the RCHT pay off the debt without damaging services for patients? I don’t know but I doubt it. We should be shown any detailed plan to do this; and the board, the regional NHS authority (the Strategic Health Authority), the primary care trust, and the government should tell us bluntly whether we have to pay for these errors with a lesser service.

_______________________________________________________________

inde irae et lacrimae (thus this anger and these tears): Juvenal Satire I

A repetition of repetitions: DH Lawrence (1921), Ursula musing in Women in love, chapter 15, though the context in the novel is irrelevant here

Galatian failings: see Robert Browning (1842) Soliloquy of the Spanish cloister, stanza 7

Previous posts
Good news about St Michael’s hospital in Hayle, part of the RCHT. Look at the entry for 17 January 2009.

Hinc illae lacrimae 17 October 2008

Unglowing health care in Cornwall 18 October 2007

The review is the Independent review of management and governance at the Royal Cornwall Hospitals NHS Trust by David FIELDING, Neil GOODWIN, Ruth HAWKER, and David STOUT

RELOCATION OF CANCER SERVICES FROM CORNWALL (3)

This is a follow-up of the post of 13 November 2008, which I have put below, about the review of stomach and esophageal cancer at Treliske hospital of the Royal Cornwall Hospital Trust.

A review of these cancer services at all the hospital trusts in Cornwall and Devon has now been published. It recommends that a centralised centre of excellence for these cancers is established at Derriford hospital, Plymouth by January 2010. This means these services presently at Treliske and at Exeter hospitals will be transferred to Plymouth. This is the right and expected decision.

This is a summary of the review report by Cornwall and Isles of Scilly primary care trust, dated 9 February 2009, and this is the full review report.

Original post 13 November 2008

This is about upper gastrointestinal (UGI) cancer. Begin by looking at this post of 24 September. The issue was settled but the rumbles went on. Now the Department of Health has given the figures for survival rates which help make the case for relocation to a centre of excellence. Let it end here. UGI cancer operations should move from the Royal Cornwall hospital and be centralised in a single specialist centre. Exeter should drop any opposition too. It is in the interests of patients that the centre be established soon.

The department gave the figures for survival rates in southwest hospitals involved in this issue.
The figures are percentages for the period January 2003 to March 2006.

Deaths before thirty one days:
Plymouth Hospital NHS Trust 7
Royal Devon and Exeter NHS Foundation Trust 6
Royal Cornwall Hospital NHS Trust 11.

The figures for deaths within one year are 21 percent, 21, and 39.

Source: Hansard 12 November 2008 column 1203W.

Additamentum A 3 December 2008 to the original post

Another question and answer in the Commons, this one about the effectiveness of the government’s national cancer policy: Hansard 26 November 2008 column 2078W. From the statistics given I have worked out the ratio for the 30 day death rate for esophageal cancer in specialist and non-specialist centres: 1999/2000 it was 100:112, in 2005/2006 it was 100:137. The benefit of specialist centres for patient survival is clear.

See too the later post of 7 October 2009.
________________________________________

HIGHER NHS FUNDING FOR CORNWALL

(Additamentum of 20 December at the end)

The Department of Health has announced the revenue allocations for the 152 primary care trusts in England for 2009/10 and 2010/11. The average increase over the two years for the trusts is 11.4 percent. For Cornwall primary care trust the increase is 12.4 percent and only seven trusts have a higher percentage increase.

This is excellent news for people in our trust area; Cornwall has done very well out of the allocations. Let there be no whingeing or whining, let us be glad.

Additionally, the Advisory Committee for Resource Allocation (ACRA) has now issued a report which covers aspects of NHS funding which have excited lamention among some in Cornwall. There are two points to note in respect of claims, explored in this post, that Cornwall is short changed on NHS funding.

Firstly, they conclude that “there is still a requirement for a market forces factor component” within NHS funding (paragraph 5.20). The market forces factor reduces Cornwall’s funds against other areas where local costs are higher and will continue to do so. The fairness of this is not a simple issue as my previous post explores.

Secondly, ACRA has looked at the claims of a bias against rural areas in the funding formulas. ACRA has concluded these are “not biased against rural areas” (paragraph 3.41) and has stated that “there is no need for further adjustment for rurality”.

Read the Report of the Advisory Committee on Resource Allocation and scrutinise the ACRA arguments for yourself. I find them persuasive.

Additamentum 20 December 2008

Hansard 17 December 2008 column 917W-919W shows the per capita spending by the 152 primary care trusts (PCTs) in England. Cornwall and Isles of Scilly (CIOS) trust comes in at 84th out of the 152 where 1st position represents the highest per capita spend, ie CIOS is at the 45th percentile rank. The expenditure excludes most pharmaceutical services spending: see the notes to original table in Hansard.

VORSPRUNG CORNWALL 4

I shall post here continuing good news for Cornwall, developments which will positively help the people of Cornwall and the local economy and everyday lives. Everyone who wants the people of Cornwall to succeed in the modern world will welcome them. This post covers the second half of 2008 to December. Vorsprung Cornwall 1 and 2 cover 2007 and Vorsprung Cornwall 3 covers January-June 2008.

* The West Briton reports that Pool, between Camborne and Redruth, is to see a major new development. £40 million will be spent to create a new campus for Cornwall College and £12 million to create a business innovation centre. Eventually and hopefully about two thousand new office jobs will be created at Pool. This is very good news indeed for education and the economy in Cornwall. (11 December 2008)

* A parliamentary answer (Hansard 17 November 2008 column 132W) shows that the number of people sleeping rough in Cornwall has fallen from thirty six in 1998 to zero in 2008. This is progress, especially in Penwith which accounted for half the county’s rough sleepers in 1998. Of course, this does not reveal whether the rough sleepers have moved into accommodation or have simply moved on. (18 November 2008)

* Two lifeguards in Cornwall have been awarded the RNLI silver medal for their courageous rescue of a holiday maker from treacherous seas at Trebarwith in June. After bringing him from the sea, they resuscitated him and kept him alive until the helicopter arrived to take him to hospital. You can read the RNLI account here. They are heroes. (14 November 2008)

* Excellent news for people in Cornwall seeking work. £27 million is available for new projects to help people improve their present skills or develop new skills and thus increase their chances of finding work. The money is from the European Social Fund (ESF) and has just been announced by the UK government. It will support three projects in each of the three areas of Merseryside, South Yorkshire, and Cornwall. Project applicants will have to put up 25 percent match funding in Cornwall but 50 percent in the other two areas.

This is additional to the £100 million from the ESF and British government for improving work skills announced on 15 October 2008 to help people facing redundancy. (6 November 2008)

* The Healthcare Commission has produced an assessment of the urgent and emergency services in areas* covered by primary care trusts in England. There are numerous ratings for numerous aspects of services such as out-of-hours GP services, A and E departments, and ambulance services. Details of the Cornwall and Isles of Scilly area are here. The good news is that the Cornwall area’s overall score is in the top one third of results, the “best performing”. There is also summary file of all the areas’ ratings. (26 September 2008) *The Commission defines the areas as “within 152 localities set by the boundaries of the primary care trusts.”

* A project which has helped a thousand unemployed people in south Kerrier is expanding its catchment area westwards. The project, funded by the government and the EU, offers guidance and also helps job seekers to overcome difficulties with the costs of travel, childcare, and clothes, for example. An excellent, successful project. You can read a report on it here . (25 September 2008)

* Part of the Dobwalls bypass is now opened and it is expected that the new road will be fully open by November. The bypass is costing £42 million and will take traffic away from Dobwalls village on the A38, the Cornwall-Plymouth road. It began in late 2006 and will end congestion in Dobwalls making life there pleasanter and speeding the traffic

* Business Cornwall reports that RAM Gasket Solutions, a Redruth firm employing fourteen people, has won investment grants to expand. Three new jobs will be created. This is good news for the Cornwall economy, the firm, and its workers. Celebrate this success.

* Last March it was announced that the English open golf tournament was coming to St Mellion golf club from 2009 to at least 2013. Now the exact dates for 2009 have been announced . This tournament will attract top golfers and thousands of spectators to St Mellion, near Saltash, and will create scores of new golf-related jobs. The boost to the local economy should be impressive.

RELOCATION OF CANCER SERVICES FROM CORNWALL (2)

(Additamentum 3 December 2008 at the end)

This is about upper gastrointestinal (UGI) cancer. Begin by looking at this post of 24 September. The issue was settled but the rumbles went on. Now the Department of Health has given the figures for survival rates which help make the case for relocation to a centre of excellence. Let it end here. UGI cancer operations should move from the Royal Cornwall hospital and be centralised in a single specialist centre. Exeter should drop any opposition too. It is in the interests of patients that the centre be established soon.

The department gave the figures for survival rates in southwest hospitals involved in this issue.
The figures are percentages for the period January 2003 to March 2006.

Deaths before thirty one days:
Plymouth Hospital NHS Trust 7
Royal Devon and Exeter NHS Foundation Trust 6
Royal Cornwall Hospital NHS Trust 11.

The figures for deaths within one year are 21 percent, 21, and 39.

Source: Hansard 12 November 2008 column 1203W.

Additamentum 3 December 2008

Another question and answer in the Commons, this one about the effectiveness of the government’s national cancer policy: Hansard 26 November 2008 column 2078W. From the statistics given I have worked out the ratio for the 30 day death rate for esophageal cancer in specialist and non-specialist centres: 1999/2000 it was 100:112, in 2005/2006 it was 100:137. The benefit of specialist centres for patient survival is clear.

ROYAL CORNWALL HOSPITALS TRUST ASSESSMENT: HINC ILLAE LACRIMAE

The Healthcare Commission has just published its latest reports on national health trusts, including the Royal Cornwall Hospitals NHS Trust (RCHT) which runs the main hospital in Cornwall at Treliske, Truro. In January it reported that the RCHT maternity services were excellent.

Now the Commission has rated RCHT for quality of services to patients (such matters as cleanliness and patient safety) and for the use of resources (the management of finance) for the year 2007/08.

For use of resources it has been rated as Fair, an improvement on the Weak rating of the two previous years 2005/06 and 2006/07. This is welcome news given concerns about the trust’s finances.

However, for quality of services RCHT was rated as Weak, the lowest rating, as it was in the two previous years. What can I say? This is very depressing though the hospital is responding with an improvement plan. No, I do not have the heart to say anything more but invite you read the Commission’s report for yourself here. Hinc illae lacrimae.

This is my previous post on the Healthcare Commission’s assessment of Cornwall NHS trusts.

And here is my post on the review dated 25 February 2009 (added to this post 21 March 2009).
__________________________________________________

Hinc illae lacrimae (Thus these tears): Terentius Andria, line 126