36. Cornwall and the Isles of Scilly
What does the STP mean for your area?
Campaigners are concerned about the future for the community hospitals and a reduction in bed numbers. In January 2017 at a public meeting, NHS managers refused to guarantee the long-term future of Falmouth Hospital. Other concerns include changes to the workforce, cuts to services, cuts to acute bed numbers and continued pressure on social care.
Caroline Court, the interim director of public health at Cornwall Council, who represents the council on the STP project board, raised concerns in a report published ahead of a meeting of the council Health and Adult Social Care Overview and Scrutiny Committee.
Cornwall Council has suffered a cut of £4 million due to cuts from central government and has already scaled down staff in the core and health promotion teams, reduced the value of contracts for drug, alcohol and sexual health services, and cut the budget for NHS health checks in primary care. The council report warns that the council will need to now make savings from important NHS contracts including health visiting, school nursing, sexual health and drug and alcohol services.
The STP contains an “ambitious” prevention plan, with areas including a domestic violence referral plan, improving immunisation uptake, a whole-system strategy to tackle childhood obesity, measures to identify patients engaging in harmful smoking and drinking, and a self-management and self-care programme. However, the report notes that £20 million will be needed to deliver these plans.
- Longer waiting times for elective care,
- Closure of wards and theatres
- Staffing cuts
- Ending funding for some treatments and prescriptions
- Delaying or avoiding funding newly approved treatments
For more information, see below.
What are the proposed aims of the STP
- Elimination of a projected 2020/21 deficit of £264 million;
- To increase the focus on preventative care and self-care;
- Transformation of primary care;
- Development of integrated community hubs;
- Development of urgent care centres;
- Consolidation of back-office functions.
- The overall aim of the STP is to move care away from the acute sector and into the community and primary care sector.
The STP does not contain exact details of how the aims are going to be achieved with the level of funding available.
The STP states that the 13 community hospitals in the area with a total capacity of 314 beds are not used effectively, not fit for purpose and are not sustainable. It also states that 35% of community hospital bed days are being used by people who are clinically fit to be discharged. The plan aims to reconfigure the community hospitals as "integrated community hubs."
A reduction in numbers of acute beds is discussed in the STP as a review: "Review of acute medicine beds to examine our overall requirement and distribution, including the impact of planned improvements to community based care for admission avoidance and step down and a subsequent review of required acute medical resources from all providers, including mental health support."
The STP outlines the development of integrated community care hubs, which focuses primarily on care of the elderly. The STP outlines that these hubs will "be one stop assessment centres for the frail elderly (replacing outpatient clinics), focusing on: comprehensive geriatric assessment; re-ablement and rehabilitation; prevention (co-opting third sector and community resource) and admission avoidance such as falls assessments."
The Integrated Community Hubs will be co-located with Urgent Care Centres to ensure workforce and financial viability, working in partnership with the acute trusts.
The STP plans for integration of care and health teams and notes that the development of an integrated single provider/commissioner model is possible.
As well as a series of Urgent Care Centres across the region the STP also outlines that the emergency care system will be reconfigured, with the commissioning of an integrated NHS 111 and out-of-hours service.
Changes across the area
In June 2017 the HSJ reported on discussions between NHS Improvement and NHS England on what certain STP areas will be required to do to enable them to spend less money and remain within a budget known as a 'control total' for 2017/18. The target areas include Cornwall. The measures under discussion include the following:
- Limiting the number of operations carried out by non-NHS providers so the funding stays within the NHS. Considerations differ between areas but include both limiting patients’ choice of providers, and reducing work which is outsourced by NHS trusts. In some cases it would require the NHS to find the capacity to carry out more operations.
- Systematically drawing out waiting times for planned care, including explicit consideration of breaching NHS constitution standards. Some plan to target delays at specialties/areas where waits are currently lower than average.
- Stopping NHS funding for some treatments, including extending limits on IVF, adding to lists of “low value” treatments, and seeking to delay or avoid funding some treatments newly approved by the National Institute of Health and Care Excellence.
- Closing wards and theatres and reducing staffing, while seeking to maintain enough emergency care capacity to deal with winter pressures.
- Closing or downgrading services, with some considering changes to flagship departments like emergency and maternity - though these would normally take too long to deliver savings this year.
- Selling estate and other “property related transactions”.
- Stopping prescriptions for some items, as suggested by NHS Clinical Commissioners earlier this year.
The commissioners in the area told the HSJ that they have been told to examine “difficult decisions” and “think the unthinkable”, including modelling changes which are normally avoided as they are too unpleasant, unpopular or controversial.