1. ITV Report

The NHS in Cornwall: how do you save £264 million?

Bed-blocking at the Royal Cornwall Hospital is one of a number of issues faced by the county's health services. Photo: PA Images

A plan to save hundreds of millions of pounds from Cornwall's health budget is up for consultation, and it could mean big changes for local hospitals, GP practices or minor injury units.

It is called the local Sustainability and Transformation Plan. It means all of Cornwall's major health and social care providers have set out their priorities for the next five years.

In it, there is a stark warning about the future if major changes are not made to the way health services operate:

An increasing demand for services, inefficiencies in how we work, variations in practice and a model of care which is heavily reliant on more expensive bed-based forms of care is stretching our resources. It is estimated that there will be a financial deficit of £264m across the system by 2020/21 if we do nothing to transform how we operate.

– Cornwall STP
There are a number of challenges face by Cornwall's health services. Credit: PA Images

The plan identifies a series of challenges facing Cornwall's health services which is putting strain on resources:

of community hospital bed days being used by people who are clinically fit to be discharged
the amount A&E admissions have risen by
the cost of community hospitals per year, described as 'unsustainable'

Plus delayed transfers of care are double the national average - contributing to bed blocking at the Royal Cornwall Hospital and the GP workforce has only increased by 4.75%. There are difficulties in recruiting new GPs and retaining trainees. Over 20% of GPs and 31% of practice nurses are due to reach retirement in 5 years time.

Key proposals to tackle the problems include:

  • A new integrated NHS 111 and primary care out of hours service to commence by 1st December 2017
  • Strategy to tackle childhood obesity, including the potential for local restrictions on promotions for high calorie foods and marketing to children
  • A network of 14 minor injuries units could become three urgent care centres down the spine of Cornwall. They would have more staff, greater clinical expertise and consistent opening hours compared to current MIU's.
  • 13 traditional bed based community hospitals will be reconfigured to become Integrated Community Hubs, which will be nursing and therapy led, enabling people to get back to home as rapidly as possible. They will be located alongside a range of other community resources. People will have access to beds as an alternative to admission to the acute sector where they are medically stable.

Some people say they are concerned older or smaller community hospitals will close as a result of the plans. Edward Hain hospital in St Ives has been closed to inpatients for the last year because of fire safety concerns that will be costly to fix. A decision on its future has been delayed until the Sustainability and Transformation plan is finalised towards the end of the year. Local Health campaigners like Graham Webster are worried it may never reopen and more money saving closures could follow.

Health Watch representatives say Edward Hain hospital is going to be "seriously at risk". Credit: ITV News

We believe all of the community hospitals in Cornwall are at risk. We think the community hospitals are an easy target for making this sort of saving, we know that at the heart of the transformation plan they want to move away from bed based services, towards delivering services in people's own homes. As a result places like Edward Hain and others are going to be seriously at risk.

– Graham Webster, West Cornwall Health Watch

Over the winter a first phase of public consultations were held. 450 people participated in public events across nine locations. They said the key issues were:

  • Too much travel for routine appointments and treatment - cost of time and travel plus support
  • Limited access to mental health services and and support - long waiting lists
  • Lack of investment in prevention and early intervention
  • Local facilities including community hospitals and GP surgeries perceived as under-utilised

2450 people responded to a survey. Their priorities were:

want easy access to services, this is a top priority for people
want staff that are professional, caring and competent
want the right care, in the right place, at the right time
want one contact to coordinate care

Detailed plans will now be developed and there will be further consultations this summer on major changes.