4 November 2009

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


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.)


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.


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.