Plans continue to ‘transform’ health and social care in Cornwall!

Posted on: 27th November 2016

Plans continue to ‘transform’ health and social care in Cornwall but I fear they continue to be ‘aspirational’ fine words without adequate funding to back them up.

I have decided not to go to an All Member Briefing last Thursday at Truro and instead sat at home to read a document sent to me on the subject called Cornwall and Isle of Scilly STP Outline Business Case! I suspect I will learn as much. I have no idea whether I am meant to have the document or not. It’s length means that getting through it will take some time!

Below, in quote marks, are what I think are key clues to what the detail might be (italics are my comments).

“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 bedbased 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.” Sounds like Edward Hain might be shut for good but they do not have the bottle to say!

“We need radical change across the entire health and care system in how we provide services and how local people use them, redirecting resources to more prevention, self-care and community-based provision.” Who could not agree with this statement? Trouble is that would need additional money not the cuts this plan is supposed to deliver.

Prevention: An enhanced focus on tackling the wider determinants of health, improving health and wellbeing and building prevention and self-care capacity and capabilities across the system.

Primary Care: Securing the sustainability of General Practice, including delivering at scale through GP ‘clusters’, which is supported by a wider transformation of Primary Care.

Integrated Care Teams: Establishing multi-disciplinary teams of health and care professionals providing short-term and ongoing support in the community.

Integrated Community Hubs: Redesigning current community hospital provision to provide an enhanced offer of support which helps patients to step down to lower support, reducing reliance on care in institutional settings. [I think these are going to be promised to justify closing community beds and it might be brilliant but I think most of us would have more confidence if we saw whatever they are operating effectively first. After all, we would not want to go to old hospitals if something far better was on hand! This link is the best I can find that might give insight, if you watch from the nurse about 8/9 mins in.]

Urgent Care Centres: Establishing strategically located Urgent Care Centres as part of a wider urgent and emergency care network which provide enhanced, consistent and resilient medical cover when it is needed and reduce pressure on acute hospital settings.

Shared back office: Developing and implementing a transformed back office with cross-system shared service arrangements delivering a range of support functions such as Finance, HR and Procurement.”

So obviously the right thing to do that I cannot help asking myself why it is not happening? The community hubs are interesting?

“Over the five year period of the Sustainability and Transformation Plan, we are projecting that the health and care system in Cornwall and the Isles of Scilly will reach financial balance by 2020/21.” ‘Financial balance’ – that’s a nice phrase BUT taken with the notion we are OVERSPENDING rather than, what I believe that we are UNDERFUNDED, then it means cuts!

“An Executive Delivery Group managed progress and alignment of the proposals throughout this phase of work, linked to a Finance Group developing the detailed savings and investment implications of our proposals.” What?

“Finance considerations setting out the anticipated savings and investment projections for our proposals.” Looks as if we are accepting we have been overspending and not seeking proper funding!

“From the local authority perspective, the 2% social care precept has been adopted locally to bolster funding. Subject to democratic process the overall budget for adult social care will increase by 9% in 2017/18, 3% in 2018/19 and 4% in 2019/20 to help keep pace with overall demand. However, the Public Health grant allocated nationally is due to see a 2.9% reduction per year in real terms, at a time when we want to invest more in prevention and wider population health improvement.” The Tory Government are allowing Councils to tax people locally for Social Care BUT, at the same time, they are taking away money they provide for important preventative services.

“This Outline Business Case will be shaped further by engaging with the public –We will continue our conversation with people who use or will use health or care services now and in the future. The draft Outline Business Case will form the basis for engagement with the public during November and December. During this period, our thinking will be further developed and refined. Formal consultation on proposals will take place in summer 2017 providing the public with the opportunity to further influence and shape proposals” As I type today it is 27 November so I think it is OK for you all to see the document I am reading! Here is the Outline Business Case YOU are being consulted on! cornwall-ios-stp-outline-business-case-oct-2016-1

“Intervention: Wider determinants of health

At the broadest population level, we propose to deliver a range of programmes to tackle the wider socio-economic determinants of health to reduce premature illness and improve healthy life.

Intervention: Health and wellbeing improvement

We want to help those people who are currently at low risk whose behaviours or circumstances put them at risk of illness and long-term conditions in the future. A range of more targeted work would seek to enable people to improve their health and wellbeing by making more positive choices.

Intervention: Prevention and self-care

We expect to deliver targeted provision for high risk groups, such as frailty and Long Term Conditions (LTC), which will enable them to better live independently and prevent health issues from escalating in severity.”

This section (above) is all about prevention and encouraging us to make better decisions to stay healthy. Children (and adults) not becoming obese, not smoking, not drinking alcohol to excess, keeping active etc. Now I’d be daft not to agree all that but is there a policy now that says any of these things should not be encouraged? To change things to reduce the increase in type 2 diabetes, heart and stroke problems etc etc will take a generation, at the very least and high levels of investment.


“The number and condition of our community hospital estate is not sustainable, with major health and safety issues at some sites and considerable capital investment required across the entire portfolio to reach an adequate standard. In addition, the small scale of some sites is not economically viable going forward.” No commentary from me necessary and if the community based side of things works then no-one will complain ….. will they? Just in case you need this spelling out:

“We propose to reconfigure the current 13 community hospital sites by developing the new model of Integrated Community Hubs which will support the establishment of a broader service offering in the community and maximises an individual’s wellbeing through joined-up place based care.”

“We propose to replace the current Minor Injury Units with a new model of strategically located Urgent Care Centres across the spine of Cornwall. The Centres will provide enhanced, consistent and resilient clinical cover to meet the urgent care needs of all residents and visitors.” Again, hard to argue against this but it will not happen quickly and will need SIGNIFICANT INVESTMENT … won’t it? I cannot see evidence that the money needed to bring these 5 year plans about is being provided by the current Government.

“Create system changes which better support our ‘High complexity patients’, the top 2% of individual patients that we spent most on, which would improve outcomes and costs. Headline analysis of this ‘high complexity patient’ cohort indicated:
•Total of 1736 individuals costing £32m per year, which is £18k per person per annum.
•Average patient had 8 admissions per year for 3 different conditions
•90% of this cohort had an outpatient attendance per year, with an average of 10 outpatient appointments per year
Ensure that there is capacity in the system to deal with the growth in the increasingly elderly population. Model the changes in disease prevalence to ensure capacity is matched appropriately as well as maximising prevention.” Again, not a lot I can say but as we get older I think, at least for a while, the % of patients in this category and therefore the cost is set to grow and it is a ‘finger in the dyke’ scenario if any Politician believes this can be reversed in 5 years!

“Out of county placements: We have a significant gap in local provision for Mental Health service users, with rates for out of county placements more expensive and carer visits more difficult than if these individuals were supported locally.” I and many others will celebrate this being achieved! I will also celebrate no person with mental health problems ending up in Police Cells as a place of safety – that is so fundamentally wrong.

I have not read every word of the 84 pages but the link provided will enable you to read it more thoroughly than me if you wish. I will keep referring to it, I suspect and I will use it to challenge people that try to fob me off! I will now click ‘publish’ and risk being damned!