Introduction:
It has become clear that the Health Services in Cornwall are under immense pressure from record levels of demand, be that emergency or long-term hospital care, GPs, or dentistry. Across Cornwall, residents and communities have been reaching out to their MPs to highlight the difficulty they are having in accessing these vital services.
Historically, Cornwall has been especially vulnerable to increased national pressures on health services. As Cornwall has an older population and because it is at the ‘end of the line’, it is harder to share resources around the NHS so the capacity to deal with a surge in demand is more limited. However, the Pandemic has exacerbated these pre-existing vulnerabilities and created new problems to overcome.
As such, all six Cornish MPs recently met with the Secretary of State for Health, Sajid Javid, to work together to address these concerns. We presented a list of solutions that included requesting more resources in the short-term and more broad strategic-based policy changes in the long term, to support Cornwall's hard-working medical personnel and enable residents to access these vital services.
All statistics are correct as of 01/04/21.
Primary care:
The way in which people accessed general practice services during Covid-19 did have to change and I am sorry to hear that, as a result, you have experienced difficulty accessing a face-to-face appointment or, indeed, even getting through to the practice on the telephone.
Standard Operating Procedures for GP practices set out that, while the expanded use of video, online and telephone consultations can be maintained, this should be done alongside a clear offer of appointments in person. The guidance explicitly says that practices should respect preferences for face-to-face care unless there are good clinical reasons to the contrary. All practice receptions should now be open to patients.
Demand for GP services remains high, and our practices deliver more appointments than many other areas: GPs in Cornwall deliver 0.67 appointments per head of population compared with 0.49 appointments nationally. Cornish GPs are on average delivering 64% of appointments in person, compared with 63% nationally. Finally, our GPs have been doing their best to arrange face-to-face consultations with anyone who needs one all throughout the pandemic and continue to do so.
You may be interested to learn that the KCCG is increasing the availability of digital access solutions, in line with the national strategy which is driven through the digital-first primary care programme, and wider national funding
Supporting RCHT:
In Cornwall, our medical service’s biggest challenges are the flow through our hospitals and getting people home as quickly as possible once they are ready to leave.
Royal Cornwall Hospital Trust (RCHT) and KCCG have a range of support in place to get people home and have put in additional measures that have been agreed by NHS England and Improvement to support discharges.
These include:
- Creating temporary spaces where people can wait while their discharge is completed. By vacating their bed staff can get it ready for someone else who is waiting to be admitted. This would be for a time-limited period each day.
- Working with our ambulance colleagues to take people to another place of care, including our urgent treatment centres and clinical assessment and treatment units, rather than waiting to be seen in the emergency department. This will get our ambulance crews back on the road to care for more people.
- Asking our community teams to increase their caseloads by just a few cases each per day. The impact of this will support timely discharges.
- Working with social care colleagues to increase placements for people who are ready to go home but need some support.
- Working with partner HR leads to supporting the recruitment of domiciliary care workers through the NHS.
All of these actions will support the need to get people home in a timely manner which in turn will enable more flow through the acute hospital. More people coming out will create extra capacity for the ambulance to decant patients, and for those who need a bed.
The Government is committed to upgrading and expanding hospital services in Cornwall, with the £450m in capital funding, on top of £135 million for new facilities and services provided by the Royal Cornwall Hospitals Trust (RCHT) at Treliske, which includes a new women and children’s unit. I am working closely with local NHS leads to develop a plan for the best way to spend this funding.
As we emerge from the pandemic there is inevitably a long backlog of treatments, assessments and procedures that needs to be addressed. Also, hospitals are still having to work in COVID secure ways which limit the amount of space available. To tackle the backlog, the Government is bringing in the biggest catch-up programme in the NHS’s history: We will spend £2 billion this year – double our previous commitment – to start to tackle the backlog. In addition, the Government plans to spend more than £8 billion in the following three years from 2022-23 to 2024-25.
The £9 billion that we are already putting in now, on top of the £1 billion that was included in the 2020 Spending Review, could deliver the equivalent of around nine million more checks, scans and procedures.
Staffing Challenges:
I am very much mindful of the challenges of recruiting and retaining health and care staff and the Government is closely monitoring the situation. The latest workforce statistics for October 2021 show that there are over 1.3 million staff working in the NHS.
Ministers have confirmed to Parliament in answering recent parliamentary questions that we are on track to delivering 50,000 more nurses by the end of this Parliament and to ensure a sustainable long-term workforce supply in the future, we have funded an additional 1,500 undergraduate medical school places each year for domestic students in England - an increase of 25% over three years. This expansion was completed in September 2020 and has delivered five new medical schools across England. The NHS People Plan aims to retain staff by assisting organisations to provide ongoing support to staff to improve their health and wellbeing.
In recent years we have also brought in much-needed reforms to our immigration system to make it easier for NHS to recruit the skills it needs from abroad. The Health and Care Worker Visa has made it significantly easier for doctors and nurses to fill key roles in the NHS. This visa now costs half the usual price and applicants are generated an expedited decision within two weeks.
Adult Social Care:
I have recently received the below response from Ali Bulman, the new Strategic Director for Social Care at Cornwall Council:
“I absolutely recognise that as a system we need a clear plan and narrative to give our residents confidence in the services we provide.
“From a local authority perspective as having a number of strands of work to increase the capacity for ASC. Firstly, for the first time in a number of years, we have a full-time and permanent leadership structure. We have also brought in some additional capacity to support the oversight of the flow in, through and out of the hospital for Adult Social Care. We have additional bedded capacity coming online at the end of this Month including Dementia beds, as well as reprocuring some provisions which have previously been mothballed which was a loss of capacity to the system. We have also agreed a number of actions with steps to increase and optimise their capacity to support people to either prevent admission or support the timely transfer of care home. In addition, we are rapidly developing our technology-enabled independence and care offered.
“Working with Partners across the Health and Care system, we are reviewing every step of the journey of the residents' journey to make sure we are working as one system to deliver the right care at the right time and in the right place. Recognising the workforce challenges across the UK in health and social care, I have started the discussion about a workforce strategy to include the recruitment and retention of staff. We need to do more to promote Health and Social Care as a career opportunity and a job which delivers huge levels of satisfaction. This is very much a work in progress and integral to our recovery plan. Over July we have seen a 10% reduction in people waiting for an assessment from ASC.”
I will continue to work with Ali and the Cabinet of Cornwall Council being led by Linda Tayor to ensure that further progress is made in expanding the social car provision in Cornwall with the goal of reducing backlogs and bed blocking in hospitals.