1st February 2018
By Graham Smith
More than two dozen GP surgeries in Cornwall, which provide an “enhanced” service to treat minor injuries, are to be reviewed as part of the process which health chiefs expect to lead to the eventual closure of specialist units.
NHS Kernow is due to unveil its latest thinking to its Citizens Advisory Panel this month. A total of 14 specialist Minor Injury Units (MIUs) are currently offered in Cornwall by NHS 111 call-handlers but they are not expected to survive the radical restructuring of health services, as the two-year-old Sustainability and Transformation Plan develops into an Accountable Care System (ACS.) The STP first suggested closure of MIUs in 2016.
The ACS is due to launch, in “shadow” form, on 1st April and to then become constituted as a new Cornwall Council-led “delivery vehicle” in September. Some senior health chiefs claim that the restructure is a “partnership” and does not amount to a “takeover” – but this view is not shared by everyone at County Hall, where Cornwall Council’s chief executive Kate Kennally will become the overall Strategic Commissioner.
Officials are also struggling to explain the difference between their ACS “delivery vehicle” and a fully-fledged Accountable Care Organisation, which would have controversial powers to commission huge blocks of healthcare from the private sector, and which many people see as hammering home the final nail in the 70-year-old National Health Service’s coffin.
Government plans to introduce ACOs have been put on hold pending a Parliamentary Select Committee investigation and two Judicial Reviews. But health and council bosses in Cornwall are carrying on regardless, claiming the ACS has sufficient “gateways” to prevent any accidental slippage into an ACO. But their insistence that each “partner” will retain their current statutory function accepts that everything could change, once the new “vehicle” hits the road.
County Hall officials have already pencilled in a full council meeting for September, as an all-member vote would be necessary for the constitutional changes required to take over, formally, the strategic commissioning of healthcare and make it a statutory council responsibility.
Now a total of 25 GP surgeries are to be studied to see if they have sufficient capacity to replace the community facilities that will be lost when the MIUs close. Some MIUs could be upgraded to Urgent Treatment Centres (UTCs) but the vast majority are expected to be sacrificed in a bid to achieve £277 million savings. The loss of an MIU could easily threaten the viability of a community hospital, making it easier to close and sell.
“We need to persuade people to think about services, and not bricks-and-mortar,” one senior health executive told Cornwall Reports. “We are not going to leave anywhere without a service. But it will have to be presented in a different format to what they are used to now.
“It could be next year before we finally get there. And there will have to be full public consultation.”
Above: Ten of the MIUs at risk. So far no health chief has suggested upgrading them to an Urgent Treatment Centre, but now executives hope that “enhanced” GP surgeries might fill in the gaps
The health bosses accept that their promises of “full public consultation” are not believed in St Ives, Bodmin, Fowey and Saltash, where some community facilities have been closed on a “temporary” basis for two years, with no consultation at all.
NHS Kernow is meanwhile continuing to develop proposals for a handful of UTCs with only Penzance currently secure. Earlier thinking, which suggested that Camborne, Truro and Liskeard could be “fast follower” locations is now being revised – with the inclusion of Camborne and Liskeard unlikely to make further progress until there is a coherent map of Cornwall which takes into account geography and travel times.
In North Cornwall, that “coherent map” could include parts of North Devon – opening up further complexities over how a single “joined up” health service can operate if much of it is “devolved” to Truro. A report to next week’s Clinical Commissioning Group board meeting says: “Current thinking is that it may indeed be necessary to have a mixed model of out of hospital Urgent Care provision.”
Health chiefs have admitted to Cornwall Reports that they are struggling to find words which do not cause alarm, as they try to persuade people that the closure of a community hospital does not necessarily mean the complete end of a service.
As an example of the difficulties of language, the chairman of NHS Kernow, Dr Iain Chorlton, says in his report to next week’s CCG board meeting: “Urgent Treatment centres are not intended to replace how we provide minor injury services…”
But in December, his chief executive Jackie Pendleton said: “Cornwall’s Shaping our Future STP plans include a commitment to replace Minor Injury Units with fewer strategically placed Urgent Treatment Centres.”
The difference is between “services” and “units” – the latter being housed within an NHS estate which can be sold for capital receipts.