16 October 2015

See updates of 7 and 16 October 2015 at the end of this post

ORIGINAL POST 24 September 2015
Another judgement day for our Cornwall Hospitals NHS Trust (RCHT) with three hospitals at Treliske Truro, St Michaels Hayle, and West Cornwall Penzance. The latest Care Quality Commission (CQC) report on the RCHT, published 23 September this year, is here. Incidentally, scroll down that page for the report on the inspection of January 2015, published 27 March 2015.

The trust was inspected on four days in June this year. Do read the report on that inspection and consider what you think. I believe it is a mixed picture though the grim and unsafe have been rightly emphasised by the media. It is a very great concern that the report says the safety of services is “Inadequate.”

A serious issue in the report is shortage at times of suitably qualified staff on duty. I should like to see the CQC well analyse the origins of the shortage at RCHT and other hospitals. Does it consider it is all due to administrative inadequacies by RCHT or are government policies part of the cause? The CQC should consider how far present issues are due to government decisions, especially about cut backs on nurses’ jobs and training places and harsh limits on public sector pay rises; both by the Tory/Libdem coalition. The present Tory government is continuing public sector pay restraint. Is the work load now so onerous that it is damaging nurses’ wellbeing and the NHS?

The RCHT will be inspected again. Let’s hope the managers can engender large improvements. Let’s hope the CQC takes a wider look.

The RCHT ended 2014/15 with a deficit of nearly £7 million. It plans a £5.5 million deficit for 2015/16: see report here.

Further reading
Head of Royal College of Nursing – Nurse shortages are life-threatening: Guardian 2 September 2015

Polly Toynbee on government spending cuts damaging the NHS: Guardian 22 September 2015

Deborah Hopkins, Labour candidate for St Austell and Newquay in May, has an interesting take on this issue on her facebook

End of original post

Update 7 October 2015
Read the telling report by Denis Campbell in the Guardian NHS leadership in crisis as running hospitals becomes near-impossible.

Update 16 October 2015
The Care Quality Commission has just published its latest annual report The state of health care and adult social care in England 2014/15. This is the full report.

In the section dealing with acute hospitals the Commission reports that that two thirds of hospital trusts are in deficit (page 11 full report) and 8 percent of inspected hospitals are judged overall as “inadequate” and 57 percent “require improvement” (page 69). The CQC now says that hospitals are being asked to make significant savings and at the same time deliver an excellent service as work increases in load and complexity.

The latest reports by the Quality Care Commission on the Royal Cornwall Hospitals Trust (RCHT) and its hospitals in Cornwall are mixed: some work requires improvement, some is good; the overall rating for the trust is “Requires improvement”. The March 2014 overall report for the January 2014 inspection is here. Read the reports to see exactly what they say. From that website the reports on the constituent hospitals are accessible.

St Michaels hospital at Hayle and West Cornwall hospital at Penzance are both rated overall as good. Treliske hospital at Truro is rated overall as requires improvement.

Much done, much still to do, but far away from the grimmest of the past.

One interesting aspect is that the main report said staff were positive about the progress that the RCHT was making and their role in it. This report in the West Briton of 5 March 2014 is less upbeat.


20 April 2013

The MHP consultancy has published its survey of the aggregate scores of NHS trust and hospital quality at Quality at a glance (March 2013).

The Royal Cornwall Hospitals Trust (RCHT) comes in at 68th out of 146, on the 54th percentile; that is, as good as or better than 54 percent of the trusts (Annex 3 on page 57). That is an adequate and satisfactory but modest ranking.

However, in the quality index for lung cancer RCHT does very much better. It is placed second of the trusts (page 41). That is an impressive and admirable achievement.

Do read the document to understand the meaning of the scores and the issues around aggregate ratings in hospitals.


3 December 2012

Dr Foster has published its 2012 hospital guide. Read it here.

On the issue of mortality among patients, the Royal Cornwall Hospitals Trust (RCHT) is one of five hospital trusts in England which does well with a death rate (HSMR) that is expected or better for patients who are admitted as an emergency during the week, but which at weekends has an emergency HSMR higher than expected: see page 17 of the guide. This means that if you are admitted as an emergency at the weekend you are more likely to die than if so admitted during the week.

The guide explains that for the five this could be down to “inadequate staffing levels, but, equally, a lack of out-of-hours primary, community or social care services, which means patients are inappropriately admitted to hospital. It could also mean because access to scans and tests are not always readily available at weekends.”

RCHT should now tell us why it has a higher than expected emergency HSMR at weekends and how it is going to bring it down.

Also see AYLIN Paul et al ‘Day of week of procedure and 30 day mortality for elective surgery: retrospective analysis of hospital episode statistics’ in BMJ 28 May 2013

For more about RCHT on Dr Foster begin here.

On general weekend mortality at NHS hospitals also read Hospital patients more at risk at weekends (Guardian 3 February 2012) and Hospital deaths jump at weekend (Daily Telegraph 16 October 2012).

Also see this good news on mortality rates from RCHT in 2009.

This post looks at the intersection of the financial issues of the Royal Cornwall Hospitals Tust (RCHT) and the Tory Libdem government’s localisation of pay which I have explored here several times.

The RCHT is one of the England NHS organisations which are working “in concert” in the Southwest Consortium on Pay and Terms and Conditions of staff. A key aim is to look at how to reduce their pay costs. The government has imposed NHS cuts/savings of £20 billion; the RCHT also has a debt to pay off.

The RCHT has to be financially up to moving to foundation status by 2014 or face merger into another trust. In a debate in the Commons on 16 July 2012 Andrew George, Libdem MP for St Ives, read from a letter to him from the chief executive of the RCHT (Hansard column 740). She appears to have clearly set out the genuine financial issues that the RCHT faces and the savings it needs to make to be financially sound according to Monitor which regulates foundation trusts; and the Consortium/RCHT “is looking at how pay costs may be reduced” while simultaneously keeping staff morale up and patients safe. That balancing strikes me as possible but a very difficult task.

The Tory Libdem government is (or possibly is not) exploring localising pay in the public service; that is, reducing it. This circumstance, along with the demand for hefty spending cuts in the NHS, feeds concerns that the Consortium will lead to pay cuts and worsened work conditions at, inter alia, the RCHT.

Challenged about the possibility of all this leading to cuts in NHS pay and worse work terms and conditions, Andrew Lansley, the health secretary for England, seemed to me to be muddled. He first said the government supported “local flexibilities” in the England NHS national pay framework. Frank Dobson, a former Labour health secretary, observed, “Meaning: pay staff less in the south west”  (Hansard column 748). Lansley then said “we are not proposing any reductions in pay…I do not believe they are necessary or desirable in achieving the efficiency challenge…no proposal for the reduction in pay or the dismissal and re-engagement of staff is, in my view, necessary” (column 748).

The next day Lansley returned to this in answer to an oral question from George:

“…trusts and NHS employers are responsible for the terms and conditions of their staff, and for ensuring, as Agenda for Change intends to, that staff who effectively have the same knowledge and competences have the same pay banding, wherever they happen to be across the country. That is the objective of Agenda for Change. As I said yesterday, and will continue to say, Agenda for Change can be improved — we made that clear to the pay review body — but we think it is possible, if the staff side works with us, to enhance Agenda for Change and increase its flexibilities, so that NHS employers can recruit, retain and motivate their staff, with local flexibility, in a national pay framework” (Hansard 17 July 2012 column 841).

There you have it. The message is: Reducing pay in the NHS is unnecessary and undesirable; the same pay band throughout England for people with the same skills and knowledge; local flexibilities in pay; looking how pay costs may be reduced.

This muddle has perhaps been cleared up a little. A leaked copy of the current thinking of the Consortium is apparently here.

This suggests, for example, exploring an increase in work hours and reviewing annual holiday entitlements which I am sure means reducing holidays not increasing them. I think that both of these are equivalent to reducing pay rates.

It looks as though Dobson is basically right, doesn’t it: “Meaning: pay staff less in the south west”. In any case I reckon that reducing pay costs (about two thirds of RCHT costs) without reducing pay or worsening work terms and conditions or reducing staff numbers or damaging recruitment and pursuing flexible sameness and maintaining patient safety demands first-class dexterity and cooperation from everyone.

It is unrealistic to expect the NHS to be wholly insulated from the financial and economic problems of Britain and the world. The argument is not about bringing down the UK deficit but about the rate at which that is done so as not to damage the economy further; and how far everyone is being required to pay their share of tax and take their share of austerity – and whether the present difficulties are being used to mask the unmandated, scarcely discussed reactionary reshaping of Britain by the Tory Libdem government.

Oh, you might like to turn to the views from the Care Quality Commission about the  Serco out-of-hours GP service in Cornwall and about staffing levels at Wheal Agar ward at the RCHT hospital at Treliske.


23 January 2012

The future of the Royal Cornwall Hospitals Trust (RCHT), which runs the hospitals at Treliske Truro, West Cornwall Penzance, and St Michaels Hayle, became clearer with the publication of the “tripartite agreement” which sets out what the RCHT must do to reach the standard required for foundation status by April 2014.

The tripartite agreement is here.


20 September 2011

In June the Financial Times published research that identified seventeen hospital trusts in challenging financial difficulties. Read the article ‘Hospitals must make deep cuts to survive’ in the Financial Times 3 June 2011: free registration but googling the article title brings it up in full.

The Royal Cornwall Hospitals Trust (RCHT), with hospitals at Truro (Treliske), Penzance (West Cornwall), and Hayle (St Michaels), is one of the seventeen.

I think that the geography of Cornwall will ensure that some of the dire possibilities raised in the article for the seventeen will not apply to Cornwall hospitals though a merger is possible. Last November in the post RCHT again I looked somewhat gloomily at the RCHT; and the article ‘Hospital is facing fines over surgery waiting time failure’ in South West Business for 19 May 2011 adds to that though I hope solid progress is making on waiting times.

This month thinktank Reform published a report by Paul Corrigan and Caroline Mitchell, The hospital is dead, long live the hospital: sustainable English NHS hospitals in the modern world (September 2011). This says, “As things stand, twenty to thirty acute hospital trusts will never become foundation trusts” (page 6).

The report does not identify the thirty trusts but RCHT is probably among them.

In the post Scalpelled I looked at the need to make larger cuts in hospital budgets and wondered what effect this would have on RCHT’s aim of becoming a foundation trust.

However, there is light amid the gloom. The RCHT itself is sounding fairly upbeat about getting foundation trust status and a rescheduling of its debt. Read this upbeat recent report here.

Generally, an uncertain outlook, I think. I very much want the Cornwall hospitals to succeed and I hope the measured confidence of the RCHT is right.

Addendum 22 September 2011
Happily RCHT hospitals are not on this disaster list. Note, however, that PFI first came to Britian under the Tories in 1992 though it was the last Labour governbment that used them for hospital rebuilding projects.