mudhook

Post offices

Forty nine of the 277 post offices in Cornwall have been listed for compulsory closure by Royal Mail. These are throughout Cornwall and in both rural and urban areas.

These forty nine are part of the national program to close 2500 of the current 14 000 branch post offices in Britain. The reasons for closure are fewer customers and pressure about competition and subsidies. Changes in the way we live mean that the post offices have lost many services: television licences are no longer sold in them, benefits and pensions are paid directly into bank accounts, car tax can be paid online. The government sees the financial losses and fewer customers – for which its own policies such as benefits payments are partly responsible - and its simple response is to cut back the service to try to stem the losses, a policy that might lead to even fewer customers and more and more closures. This simple response is what happened in the 1960s to branch railway lines.

People can tell Royal Mail what they think of the proposed closures: the consultation for Cornwall ends on September 1st.

Opposition to closures has to face economic realities. At present the post office in Britain makes a loss of £3.5 million a week. Does anyone think that can continue unabated? Can the present losses be borne? Can the losses be eradicated without closures? Can the number of users be increased significantly? Can the services available at the post office be increased? There is an important social question too: What will happen to those who cannot easily get to other post offices for their benefits and other cash, despite the Royal Mail’s assurances about the nearness of the alternative open post offices? Can the present services be provided conveniently and satisfactorily for present customers elsewhere as is done through Royal Mail’s “outreach” system? Indeed, is there a longterm future for discrete post offices at all?

An additional issue in branch closures is that many of the post offices are part of a shop: the loss of the post office part might mean the loss of its customers to the shop and the consequent closure of the shop.

Opposition has to come up with a coherent response and plan rather than plaintive wails, parochial complaints, and attempts at party political blame - and in the end closure.

You can read about the closures at the royalmail.com site here ; scroll down to Cornwall. The overall plan is given, along with some details of each branch listed for closure, including the local population and the weekly customer use which is challenging information.

Relocation of cancer surgery

At the same time as branch post offices closures in Cornwall are debated, the proposed move of some surgery from the RCHT hospital at Treliske, Truro to Derriford Hospital, Plymouth is under debate. The county council has called for further public consultation on the Cornwall primary care trust’s proposal to move surgery for upper gastrointestinal cancer (stomach and gullet cancer) to Derriford: treatment before and after surgery would continue at Treliske. The reason for the move is, in line with national guidelines, to improve outcomes for patients, that is to increase the survival chances of patients and reduce incidents of complications. In order to maintain their skills surgeons need sufficient patients to operate on and in the RCHT part of Cornwall only around twenty five patients a year have an operation to remove their tumour: note that only those twenty five would be affected by the proposed relocation. The arguments for the consolidation at Derriford are set out fully by Cornwall primary care trust here .

Although the move sounds reasonable on these grounds, Derriford is eighty miles from Penzance and that is a long, stressful – and expensive - journey for patients and their families: that is a reasonable caveat and objection and should be explored fully. We should hear from the patients who would be affected by the relocation.

The present reality is that nearly three in ten people in Cornwall - those in the eastern parts of the county - already look to Exeter or Plymouth for their hospital care. Health care should have no inappropriate county borders.

Change

Panta chorei said Heraclitus, according to Plato, but change is difficult for people, even change for the better and it is not certain to everyone in Cornwall that the post office and cancer surgery changes are for the better. There are no easy solutions to these two issues neither of which is about dismembering Cornwall. What is needed is neither sentimentalism nor parochialism but hard thinking about what is the best to help and serve people.

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Panta chorei (everything changes, moves): Plato in his book Cratylus, referring to a saying of Heraclitus.

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 2008 from January onwards. Vorsprung Cornwall 1 and 2 cover 2007.

* For several months people have been fund raising for a proposed children’s hospice in Cornwall: the nearest one at present is in north Devon. Now Howard and Shirley Rosevear have given land near St Austell as a site for the hospice. This will be for children from Cornwall and Plymouth.

You can read this heart-warming story here in the Western Morning News for 25 June. There are good people in Cornwall.

* June 2008. The government is contributing £34 million as part of transport improvements for the regeneration of the Redruth-Pool-Camborne area. In all the regeneration project is intended to produce 2300 new jobs and six hundred homes.
(Source: egov monitor Rosie Winterton announces £34 million transport improvements for Cornish regeneration area)

* May 2008. The Office for National Statistics (ONS) has published data for individual institutions about MRSA and C difficile deaths. The data comes with caveats. For the period 2002-06 the Royal Cornwall Hospitals Trust performed creditably in this difficult sphere: better than average for the listed institutions for C difficile and average for MRSA.

* 13 April 2008. There’s an upbeat article in the Observer describing Penzance as now the premier art place in Cornwall and a place to visit and enjoy. Perhaps Penzance is beginning to see a cultural and economic resurgence and outshine St Ives. (Source: Observer 13 April 2008 Penzance turns regeneration into a fine art)

* April. The county record office at Truro has begun to put its parish tithe maps and their accompanying apportionment/survey books onto compact disks. This will save the original printed maps from wear and tear, will make them available in a more user-friendly format than microfiche, and make the survey books more easily searched. Additionally, the record office is selling the disks (map and survey book) for £20. This is excellent news for everyone interested in local and family history in Cornwall.

* In Cornwall in 2007/08 £3.362 million was spent on warm front measures for vulnerable households. The details are here , look for DEP 2008-0881.xls for 17 March 2008.

* March 2008. Caradon district council is receiving £5.95 million for affordable housing from the first round of the national affordable housing program 2008/09. This will build ninety six houses in the district and create a care village for the elderly out of the the Passmore Edwards hospital in Liskeard. This is capital news and a significant help to people there in need of affordable housing. Rejoice. Read more here . (NOTE. The original article is no longer available online but the cached version is still available: type “caradon £6m affordable housing” into google and open the cached version.)

* There has been a significant improvement in waiting times for NHS hospital patients in Cornwall. The figures are subject to caveats and fluctuations but the waiting time for all specialties for patients still waiting for hospital admission in the period ending March 2007 in Cornwall and Isle of Scilly primary care trust (CIOSPCT) was 7 weeks; March 1997 in the corresponding Cornwall and Isles of Scilly health authority (CIOSHA) it was 12.9 weeks.

Examples of reductions in the specialties are cardiology with 4.6 weeks at March 2007 and with 14.6 weeks at March 1997; gynecology 7.2 weeks and 13 weeks; and ophthalmology 7.2 and 17.7 weeks.

With all the caveats these are impressive reductions.

You can read the details and the data explanations and caveats in Hansard 27 February 2008, columns 1754W-1756W.

* The figures for breast and cervical cancer screening show that in the area of the present Cornwall and Isles of Scilly primary care trust the screening program is being well used and is reaching a high proportion of women. We are slightly higher in percentage reach than the average for England in cervical screening. In breast screening the proportion of eligible women who have attended screening here was higher than the England average in the last given year, 2005-2006, a very large improvement over two years previously when Cornwall was way below the England average. The lives of women in Cornwall are being saved through timely screening. (Hansard 31 January 2008, columns 596W-602W and 618W-624W.)

* 30 January 2008. The EU investment program, called by the unromantic name of the Convergence program, now begins in Cornwall and will make available about £300 million over the years 2008-2013, plus £140 million from the British government.This is in effect a ‘continuation’ of the 2000-2007 Objective One program which made about £350 million available to Cornwall.

* 25 January 2008. The Healthcare Commission has published the results of its assessment of 148 maternity units. The assessment stressed women’s reported experiences. The maternity unit at Treliske Hospital, Truro (Royal Cornwall Hospitals NHS Trust) has been assessed as among the “Best performing,” a category in which 26 percent of the units fall. In fact it is seventh best of the units. That is an excellent performance.

The unit at Plymouth Hospitals NHS Trust, which serves some women in east Cornwall, is in the “Least well performing” category. That is unacceptable but the assessment has been influenced by incomplete information from the trust.

The complete details are here.

* 8 January 2008. Cornwall county council is considering, through consultants, the development of a park-and-ride for seven hundred cars at St Erth railway station. This, along with longer trains, would be to improve the service for people on the St Ives branch line, which is much used in summer, and to reduce congestion in St Ives.

Such a development has long been advocated by locals.

Read the details at Transport briefing here.

The Association of Public Health Observatories (APHO) have published the 2008 health profiles today. You can read the report for Cornwall and for each of its six districts here .

For Cornwall as a whole the APHO report is generally good news. For example, in five of the districts there is a smaller proportion of people living in the most deprived fifth of areas of England than the average for England; and in every district men and women have a higher life expectancy at birth than the average for England.

The APHO report gives information for each district too and although here the news is generally good of course there are difficult spheres where it is less rosy compared to the averages for England. For example, look at the figures in Penwith for index-of-multiple-deprivation, child poverty, and educational achievement.

There is much here to be pleased about. Not complacent, but recognising a record of progress. Cornwall, again, isn’t at the bottom.

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Source: Association of Public Health Observatories website article Welcome to health profiles

Once more the financial inequalities between the countries of Britain are exposed. The office of national statistics (ONS) has issued United Kingdom health statistics 2008 and these statistics in Table 8.5, page 114 give the spending per head on health and personal social care for 2006/07:

Scotland £2313

Wales £2109

N Ireland £2096

England £1915.

Thus someone in England - and that includes Cornwall - has nearly £400 less spent on him than someone in Scotland. Concern about public spending inequalities like these will not go away. They are part of the perceived unfairness that is, I think, slowly dissolving the United Kingdom, an unfairness that the Labour government appears indifferent to.

Will the Liberal Democrat MPs for the Cornwall constituencies cry foul? I doubt it.

Will Cornish nationalists complain of inequality and injustice? I’m not holding my breath.

Will Labour and the Conservatives in Cornwall complain? I’m still not holding my breath.

Come on, surprise me.

More data, this time about the provision from primary care trusts in England (Hansard 15 May 2008, columns 1673W-1677W). The data is (or “are” if you prefer) based on social aspects like life expectancy and deprivation and on administrative aspects like the proportion of patients seen within forty eight hours and the proportion able to see a specific GP.

Each trust is ranked against the average for all trusts in England. Average is undefined but presumably is the mean average.

Here comes the teaser. There are 152 trusts in the published Hansard table in rank order. If 1 is best and 152 is worst, whereabouts is Cornwall and Isles of Scilly primary care trust (CIOSPCT)? Near the best or the worst? 32nd, 99th, 151st?

I’m sure you’ve guessed right, having read my previous posts.

Yes, it’s 32nd.

Of course I repeat my comment on all Cornwall data: to look at aggregated data for the whole county, or an entire trust, is not particularly helpful. What counts is the position on the ground for individuals and parcels within those areas. For people who live here Cornwall is not one place but many places and the circumstances of life vary vastly.

Let me end with another teaser. Do you think this favourable trust data will figure on any nationalist or Libdem Cornwall website?

Here’s a disturbing report about people, including cancer and HIV patients, not getting everything on their prescription because they cannot afford the prescription charges.

Citizens Advice say that about 800 000 people are affected. I think that pro rata in Cornwall that suggests about eight thousand patients.

This is uncivilised. The government gets about £430 million a year from prescription charges and four-fifths of people aged eighteen to fifty nine are required to pay them. There are schemes to help people pay for prescriptions (and other health needs) but they are, like many means-tested schemes, byzantine and thus inefficient.

The government should drop prescription charges. They deter people from getting their medicines. Added to other NHS charges such as dental treatment and hospital parking they are a serious cost to people on modest incomes. The founding principle of the NHS was a collective pooling of resources and service free at the point of need. We should get back to that.

It will be interesting to see if Cornish nationalists take any contemporary interest in those eight thousand people here who are voiding items on their prescriptions because of insufficient income.

Cast your mind back to the post on the market forces factor in the NHS and my criticism of the simplicity of the grievance agenda in damning the funding of the NHS in Cornwall.

The Centre for Economic Performance (CEP) has published this month a report on NHS nursing pay, Can pay regulation kill performance? Panel data evidence on the effect of labour markets on hospital performance.

Pay in the private sector, outside the NHS, varies from area to area. Nurses’ pay, which is nationally fixed, has some regional differences but nurses’ pay in areas with high pay outside the NHS does not match that outside pay.

The CEP report says that hospitals in areas with higher outside pay have problems in the recruitment and retention of nurses and have worse hospital performance and productivity than hospitals in low-outside-pay areas.

Productivity is defined on page 61 of the report.

Disturbingly, on performance or quality the report suggests that hospitals in higher-pay areas have higher death rates for heart attack patients, that is the death rate for deaths in acute hospitals from heart attack within thirty days of emergency admission for patients of fifty five and over; and offers explanations linked in part to uncompetitive pay.

Cornwall is a low-pay area and so the problems identified in the report do not, or should not, apply here. Indeed, the somewhat dated maps in figure 5 on page 54 of the report show Cornwall as an area of low wages, low rate of use of agency nurses, and low rates of defined heart attack deaths.

The report is a powerful argument for effective regional differences in NHS pay to reflect outside wages: it explicitly says on page 39 that productivity will improve and lives will be saved if this is done. I have previously posted about arguments for meeting regional realities in the minimum wage.

In the light of this report and the arguments for the market forces factor, just saying Cornwall unfairly gets less than other areas in NHS funding is a simplistic approach which fails to recognise the need to provide a good NHS service everywhere whatever the local circumstances; and getting fair NHS funding between different areas is problematic.

It is folly to fail to recognise local outside influences on the public services in Britain. Sloganising about “fair funding for Cornwall” is an inadequate response to the problems and does nothing to encourage understanding of the funding of public services. The hard question that all the political parties and people in Cornwall must answer is, Do you accept that pay and funding in the NHS must recognise outside pay realities and must therefore vary from area to area – and that some areas should receive more than Cornwall, a low-pay area?

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 2007 from July onwards. Vorsprung Cornwall 1 covers February-June 2007 onwards.

*December 2007: Newquay Airport continues to expand its services. Ryanair are increasing their flights to London Stanstead and flights to Spain, from March 2008 Skybus will be operating two additional routes, and in summer 2008 Flybe will be operating five new routes.

These expansions will help the airport, create jobs, and help the Cornwall economy. Welcome them.

* 26 November 2007: A parliamentary answer has revealed that the proportion of 16-18 year olds in Cornwall who are not in education, employment, or training (NEETS) is 6.1 percent of the Cornwall age group. This is much lower than in many places; for example the figure for Hackney is 13.1 percent, for Liverpool 13.2, for Birmingham 11.4, and for Plymouth 7.4. Cornwall is in the bottom third of the figures, where bottom is best. This is good news about young people in Cornwall though 6.1 is still too high.

Read the details in Hansard 26 November 2007, columns 141W-144W. Similar information is given in Hansard 21 November 2007, columns 958W-964W.

Addendum February 2008: Hansard 25 February 2008, columns 1284W-1290W gives NEETS figures for 16 and 17 year olds. At December 2007 the figure for Cornwall was 5.5 percent of the age group; this puts Cornwall at the 64th percentile of the 149 local authorities.

* 7 November 2007: Starting in September next year Cornwall, along with thirteen other local authorities, will begin to offer fifteen hours of free early education to all three and four year olds for thirty eight weeks of the year. This is to help to give every child a good start in life and to help parents work out a life/work balance. The scheme will be funded by the government. Details are in Hansard for 7 November 2007, columns 3WS-4WS.

* 2 November 2007: today is the official opening of the new heart centre at Derriford Hospital, Pymouth. There’s an account of it in the Western Morning News.

Yes, I know Plymouth isn’t Cornwall but patients from east Cornwall use the hospital and the heart centre will be used by people from all over Cornwall. This cardiothoracic unit is very good news for people in Cornwall who no longer have to travel as far as London for treatment such as a heart bypass.

* 25 October 2007: the future of Newquay airport is assured after investment of around £44 million has been agreed to change it from an RAF to a wholly civil airport. This involves money from the EU, British government, and the regional development agency. The airport is important to Cornwall’s economic development. Read more here.

* 10 September 2007: Kerrier district council has deservedly been named by the government as a champion for homelessness. It will share with other councils its expertise and good, successful practice in reducing the use of temporary accommodation and in helping people to avoid homelessness. See here for more details.

*From September 8-22 St Ives, Cornwall is holding its annual festival. Music, poetry, painting, film, talks, everything to enjoy in the arts from Cornwall and the wider world. Not a time to be gloomy about this place.

* From 6th to 12th August Newquay is hosting its annual rip curl boardmasters (RCB) surf contest. Okay, Cornwall isn’t Hawaii but one estimate is that surfing brings £40 million into the Cornwall economy and this RCB contest attracts thousands of visitors each day. The rip curl boardmasters is actually a surfing, skateboarding, and music festival/competition. See here for vigorous details. Oh, and there is a bikini competition too.

Cornwall: a fun, energetic place for talented people and great for unenergetic spectators.

* August 2007- a regeneration of the centre of St Austell is going ahead. The cost will be £75 million, of which £31.5 million will be from the south west of England regional development agency (SWRDA) and the rest from the developers, David McLean Developers.

The regeneration will be mainly retail and includes new shops, cafes, a cinema, and an underground car park, but also seventy flats.

For several years now St Austell has been the forgotten town of Cornwall with an uninspiring town centre. Things can only get better.

Details are here and here.

* July 2007 - A group restoring the Steeple nature reserve on Worvas Hill, St Ives was given £36 000 by the heritage lottery fund. The money will help to fund restoration, improvements, tree planting, and educational work.

* An architecturally impressive new art gallery has opened in Penzance in July. St Ives has its Tate and now Penzance has its Exchange. See details and pictures here in the Daily Telegraph for 21 July.

* Marks and Spencer opened a new store on 19 July at the shopping site by the roundabout on the eastern outskirts of Hayle. As well as shirts and skirts and the usual M and S things, it will sell food and has a cafe, and has created nearly a hundred jobs. This is very good news for Hayle and western Cornwall. There are other shops on the site (Next, Boots) though I’m not sure if there’s enough car parking there. On the adjacent site there are other shops selling fabric, tiles, cars, etc; it’s all a good shopping area now.

* July 2007 - A fast computer network which links all the hospitals and doctors’ surgeries in Cornwall and Scillies has been launched.
This enables information to be shared among medicos speedily; for example, doctors will be able to see patients’ xrays from hospitals in their surgeries.

This technology is clearly a beneficial way of meeting the medical difficulties of a spread-out rural county.

See here for details from PublicTechnology.net.

Here are some recent data which show Cornwall is getting a fair share of national funding and resources. Probably not what you will read on Cornish nationalist and Libdem web pages.

Funding for primary care trusts 2008/09
Cornwall and Isles of Scilly £710 827 000 (recurrent revenue allocation)

Cornwall is in money terms 24th out of 152 trusts, that is twenty three trusts have more money than Cornwall, the other 128 have less.

Hansard 13 December 2007, column 58WS-63WS

GPs per 100 000 of population
Cornwall and Isles of Scilly 76.2

11 primary care trusts have a higher, better proportion than Cornwall, 140 have a lower, worse proportion.

Hansard 28 November 2007 column 546W-555W

The House of Commons health committee has this month received a deal of information from the Department of Health about NHS spending. The News of the world has put some of the various data together and produced a league table of percapita spending on cancer patients by the primary care trusts.

For Cornwall the news appears appalling according to these figures.

The average percapita spending on cancer patients for England is £8 437 per year for 2006/07.

For Cornwall it is £5 749, one of the very lowest amounts, 149th out of 152 trusts.

The highest spend is £17 028 in Nottingham, the city not the county.

I don’t suppose there is a simple correlation between percapita spending and outcome, that is survival, but it is reasonable to ask whether the level of spending affects the nature of one’s access to drugs and treatment and one’s survival. I think Cornwall and Isles of Scilly NHS primary care trust should explain their spending level.

The figures are here. The bottom internet reference gives the spend per patient.

This 2006 paper from the King’s Fund, Local variations in NHS spending priorities, gives an informative background and analysis to this and related issues.