RCHT JUDGED: UPDATED

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
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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.

ANOTHER YEAR, ANOTHER RCHT REPORT

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.

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RCHT QUALITY MEASURED

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.

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RCHT AND WEEKEND MORTALITY

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.

Notes
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.

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NHS PAY AND WORK ARRANGEMENTS IN CORNWALL

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.

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RCHT FUTURE

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.

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RCHT FUTURE

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.

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SCALPELLED

Before the general election David Cameron promised that the NHS would be safe in Tory hands. Yes, I know, a politician’s promise is like snow in summer. Turn your back and it’s gone.

And gone this one has.

Along with the proposed Tory Libdem changes to the organisation of the NHS, are cuts – governments tend to call them efficiency savings but they usually turn out to be buying fewer paperclips, employing fewer workers, and ending or reducing services.

Last year the Tory Libdem government looked for annual cuts of 4 percent from hospitals in England. The other day Monitor, the foundation hospital regulator set up by the last Labour government, wrote to foundation and would-be foundation hospital trusts. The letter is here.

It has increased the suggested savings/cuts from 4 percent to 6-7 percent a year which compounded over five years total 37 percent; the letter explains why. I do not believe a hospital can make savings of that level without eating into jobs and patient services.

Additionally, this is the figure that Monitor will be using from May 1st when assessing an NHS hospital application to become a foundation trust. There are adverse changes to the tariff and readmission fines too.

What are the implications for the Royal Cornwall Hospitals Trust (RCHT) which aspires to foundation status? The RCHT should tell us now candidly how it sees its position and future in the light of these latest and large changes. Can it make these new savings/cuts? What will be the impact upon services, on paying off the debt, on investing in improvements, on securing foundation status?

I hope my gloom can be solidly confounded.
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RCHT AGAIN

A survey for the Association of laparoscopic surgeons of Great Britain and Ireland (ALSGBI) of theatre equipment used in laparoscopic (keyhole) surgery in 474 UK hospitals has put Cornwall’s major hospital, Treliske hospital, Truro, in the bottom of the three grades. The survey found it was using out of date equipment.

Here are the ALSGBI survey tables: National audit of theatre equipment 2010 . This is a local report: Royal Cornwall Hospital Trust reprimanded for use of ageing surgery tools.

The survey found only 11 percent of hospitals were of top, ‘gold’ standard – including Derriford at Plymouth – and 61 percent of second, ‘silver’ standard. About 28 percent were in the bottom, ‘bronze’ standard and ALSGBI said that they were “operating with obsolete and, in some cases, potentially unsafe equipment.”

Note that the RCHT says that the survey results do not reflect the current situation.

This ALSGBI finding is disappointing. I have in the past recorded some dismal adverse reports on RCHT and it was vastly encouraging to report in Vorsprung 8 excellent news from RCHT: see the entries for 10 July and 24 September.

Additamentum 12 November 2010
Read this report and this which give very good news from the RCHT and Treliske hospital.
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RCHT: Royal Cornwall Hospitals Trust with the hospitals Treliske, Truro; West Cornwall, Penzance; and St Michaels, Hayle
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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.

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