The Government’s announcement on 2 April was about historic debts and loans held by NHS providers, rather than commissioners like CCGs. You are right that this debt is being converted in public dividend capital (‘PDC’) instead, a sort of equity in a provider trust balance sheet, which also attracts a payment back to the government each year related to 3.5% of the net value of the trust (but unlike a loan, PDC doesn’t need to be repaid over time). This change does remove the uncertainty that has affected trusts in the past because of the regular cycle of having to rearrange the loans, which often came with changes in interest structures and loan terms each time. When this idea of changing the historic loans to PDC was first put forward during operational planning for 2020/21, there was a concern that the 3.5% rate on the public dividend capital payments could end up leaving some trusts worse off than repaying loans which had lower rates (although it is important to know that they are not calculated in exactly the same way), however, as part of the new announcement the government has been made clear that no provider’s bottom line position will be adversely affected by the change.
Note: It is worth knowing that the second national statement quotes the following draft figures for Royal Cornwall Hospitals NHS Trust (RCHT), University Hospitals Plymouth NHS Trust (UHP) and North Devon Health Care Trust (NDHCT):
In terms of the CCG’s historic deficit, we are awaiting further information to see if there will be revised arrangements for handling this. During the operational planning round, there was a proposal to write-off approximately 50% of this for most CCGs, with plan to be agreed for repayment of the balance. With the change in focus towards the important work of ensuring the NHS is to address the coronavirus pandemic, the Planning process has been suspended, so we will need to wait for further details on how this might be handled in future. It is important to remember that the CCG deficit does not bear interest like the trust loans did.
You asked about actions that might avoid such debts in future. Notwithstanding the current shift to doing whatever is necessary to meet the challenge of the COVID-19 for the people of Cornwall and the Isles of Scilly, in the background it remains as important as ever for the local NHS to get back to living within its means each and every year. That remains a significant challenge given the priorities we all wish to address, but we continue to work together across the whole system to get back towards financial balance, and avoid any further accumulation of debts , and the complications that come with that problem. Financial planning for the future will be an important part of our work when we come out of the COVID-19 response in due course, when we develop the NHS of the future, here in Cornwall.
Traditionally a month of increased pressure on urgent and emergency care services, in December 2019 the readmission rate was lower than in November and lower when compared to December in the previous year in all 3 trusts. This is lower than the national average of 7.4%.
We can reassure you that this is a quality and safety measure that is monitored on a monthly basis.
|Acute trust||Readmission rate within 30 days (December 2019)||Readmission rate within 30 days (November 2019)||Readmission rates within 30 days (December 2018)|
|Royal Cornwall Hospitals NHS Trust||5.50%||6.18%||7.3%|
|Northern Devon Healthcare NHS Trust||4.12%||6.46%||10.9%|
|University Hospitals Plymouth NHS Trust||4.53%||5.76%||5.8%|
Natalie Jones confirmed that colleagues are encouraged to raise any queries or concerns around discharge through the peer improvement tips for care and health (PITCH) system so that individual circumstances can be reviewed and anecdotal learning is applied. Natalie confirmed they would look into discharge and readmission processes at times of escalation and take a report to the quality and performance committee.
Dr White confirmed that GP practices are updated with discharge information daily and reported that practices are reviewing this information regularly. Melissa Mead advised that PITCH and GP awareness of the system was raised at the last joint primary care commissioning committee and a new communication was being prepared for release to GPs in different formats to relaunch the use of the system for those with less familiarity. Dr Garman confirmed that he had been using PITCH. He advised the system was user friendly and more thorough than previous system (STREAM).
The only hospital which is closed in its entirety is Fowey which in the last year that it was open, provided very limited support to its community offering just 6 inpatient beds and treatment to less than 60 people with minor injuries.
We can confirm the contract value with Cornwall Partnership NHS Foundation Trust who run the community hospitals has not been reduced as a consequence of the temporary closures. Where issues such as these arise, the contract gives the Trust flexibility to redirect and redeploy resources (which includes staff) to alternative priorities as highlighted above.
We are undertaking a programme of community engagement in Fowey, Saltash and St Ives and surrounding communities to identify and agree with the local people the type of health and care services they need both now and in the future to inform the long-term role of these facilities.
Both trusts are currently reporting that they are expecting to deliver their financial plans but it should be noted that the NHS Kernow is not planning to meet the required target deficit for the CCG. Whilst NHS England and NHS Improvement (the regulators) have not yet formally approved the CCG plan, they are supportive of the position and recognise that the system as a whole, are targeting a reasonable level of ambition.
The regulators, have recently come together under joint leadership with merged structures, and as such will be taking a more joined up approach to any emerging financial pressures in the system which may begin to indicate we are unable to deliver our collective financial plans. Legal directions and special measures remain an option for regulators in response. However, provided that they system are able to demonstrate that robust financial governance has been maintained, the response from regulators would be expected to be supportive, working with the Cornwall health and care system towards developing and delivering sustainable solutions.
Our health and care system is working with communities to improve our urgent and emergency care system to ensure people get the right care in the right place, whenever they need it. Improving the ways people can get help for serious, but not life-threatening conditions, will make it easier for them, and also take pressure off our busy emergency departments, which should only be used for the most life-threatening of conditions like chest pain, stroke, serious trauma such as a road accident and major cuts, breaks and burns.
What people tell us is informing our plans to create a joined-up and improved health and care system, which works in partnership with our GPs, pharmacies, minor injury services and emergency departments.
We have consulted widely upon the optimal location of urgent treatment centres across the county with 1 of those chosen locations being at Bodmin, where the existing MIU will be enhanced to meet the national specification of an urgent treatment centre. We are aiming for this to be completed by December 2019.
The Bodmin Hospital site was chosen as an urgent treatment centre due to its close proximity to the A30, and because it has room on the site to expand in order to meet future need.
We evaluated the option of locating an urgent treatment centre in Stratton which, from a travel time perspective would make it a key site because it serves a large rural area. As a point of clarity, the PenCHORD modelling and analysis used to inform this decision did not recommend 5 to 9 urgent treatment centres in Cornwall. Rather, it concluded that mathematically between 5 and 9 urgent centres would be required to largely minimise average and maximum travel times.
Our collective evidence, which included other modelling and feedback from clinicians, showed that 3 urgent treatment centres was the optimum number and that there was neither sufficient clinical need nor would it be operationally feasible for more than 3 urgent treatment centres and to prioritise the site as an urgent treatment centre.
We do understand people’s concerns about the temporary overnight closure at Stratton Minor Injury Unit. The service remains open from 8am to 10pm every day when the unit is most in demand.
Cornwall Foundation NHS Partnership Trust has, unsuccessfully, tried to recruit clinical staff since January 2018, including a band 7 MIU sister/charge nurse, and a band 6 MIU practitioner. An interim MIU sister is in post and is shared between Stratton and Launceston hospitals, and 2 nurses have been recruited into developmental roles, but the team has not been able to recruit enough staff to re-open a night time service
We know from historic activity data collected by the service, that last year 9,436 people used the MIU and only 600 people used the service overnight. This is an average of 1.4 per night. Use of the unit from 10pm to 8am is consistent during the winter (October to April) and summer (May to November) months. There were 102 nights with no attendances. We are confident with the accuracy of this data.
We’re having constructive discussions with health and care partners in Stratton to develop a new model of urgent care provision which meets the community’s needs. The NHS, GPs, South Western Ambulance NHS Foundation Trust (SWASFT), community members and the hospital’s League of Friends are working together to understand the local issues and how they can support people in the community.
A multi-agency project group including local councillors and patient representatives has been established to review the model of care within the area. We will also establish a local patient participation focus group with the local PPGs and League of Friends. Council colleagues from Holsworthy will be asked to join the project group to understand the wider local context.
We believe the temporary change to the overnight service will have a minimal impact on safety. People can use other services at night, such as NHS 111, late-night pharmacies and 999 for life-threatening emergencies.
Anyone who has an urgent life-threatening condition, such as a suspected stroke, choking, chest pain, major blood loss, or loss of consciousness should call 999. An MIU is not the right place to be treated, and the temporary overnight closure of Stratton MIU would not change this advice. Anyone in the Bude area who needs emergency medical help will continue to receive this from either the emergency departments at Treliske in Truro, University Hospitals Plymouth or North Devon District Hospital in Barnstaple.