MIUs – Sorting out the facts from the party politics

MIUs – Sorting out the facts from the party politics

Sorting out the facts from the party politics: what NHS Kernow really says about the threat to Cornwall’s Minor Injury Units

5th January 2018

By Graham Smith

The war of words over the future of Cornwall’s Minor Injury Units is continuing today (Friday) with claims and counter-claims snowballing into a traditional party political squabble.

Cornwall’s Conservatives and Liberal Democrats, worried that unfavourable publicity will attach to their plans to transfer the National Health Service to a council-led Accountable Care Organisation on 1st April, blamed the Labour Party for “scaremongering.”

NHS Kernow was more measured, saying “no final decisions” had been taken but stopped well short of promising that any of the ten under-threat MIUs will stay open.  The academic whose analysis triggered media interest insisted his presentation of the facts simply spoke for itself.

Dr Peter Levin, whose Social Policy Research for Cornwallwebsite first reported new developments in the NHS decision-making process, said NHS Kernow had not challenged any of his facts and that his assertion that there was now a specific threat to MIUs had been “refuted” were wrong.

Cornwall Reports separately and independently studied the same sources as Dr Levin and came to similar conclusions.  Although a general threat to Minor Injury Units has been known since October 2016, there is now specific new information:

  • The ambition to close Cornwall’s MIUs has now become “a commitment.”

What they said then: “We propose to replace the current Minor Injury Units with a new model of strategically located Urgent Care Centres across the spine of Cornwall.”

What they say now: “Cornwall’s Shaping our Future STP plans include a commitment to replace Minor Injury Units with fewer strategically placed Urgent Treatment Centres. The work to identify the number and location of sites is in an early phase.”

  • What is the timetable for this “early phase?”

A matter of weeks.  NHS Kernow is now developing the specifications for Cornwall-specific Urgent Treatment Centres, proposing to share its latest thinking with Healthwatch Cornwall next month.  The final deadline for a decision is 18th March.

  • What is the significance of 18th March?

This is a deadline set by NHS England, which wants a national network of 150 UTCs.  NHS England is also pressing local NHS bosses to convert to Accountable Care Organisations, in order to execute the STP proposals, by 1stApril.

  • What do we know about the thinking so far?

Penzance is safe.  The most recent NHS Kernow management report says: “We have confirmed that West Cornwall Urgent Care Centre currently meets the standards of the national specification (with some improvement required around digital capabilities) and as such, it will be designated as a UTC.”

Three other sites are “fast followers” and also safe:

Camborne Redruth Community Hospital Primary Care Walk-in Centre

The rationale here is that that the service specification requires the presence of a GP from 08:00 to 22:00 and evening and weekend x-ray cover. The service does not comply with the following aspects of the specification:

  • Point of Care testing facilities
  • Direct booking from NHS 111 or
  • Electronic prescribing
  • Co-located Out of Hours Primary Care treatment centre.
  • To date, the service has focussed on the provision of walk-in primary care as opposed to the more complex fractures and injuries that are seen by the West Cornwall Hospital Urgent Care Centre and make a bigger impact on diverting ambulance journeys from the Emergency Department.

The Minors Department at the Treliske Emergency Department.

 The rationale here is that the service employs GPs on some evenings and weekends to enable front door streaming. There is also round the clock access to x-ray and other diagnostics. Operationally, it is not configured as an Urgent Treatment Centre in the same way that WCH Urgent Care Centre is. The service cannot support direct booking from NHS 111 or offer electronic prescribing. There is no co-located out of hours primary care treatment centre, although this is anticipated in in 2018-19 as part of the new Integrated Urgent Care Service (111 and OOH) operational model which will be provided by RCHT, Kernow CIC and Vocare from the 30th November.

Liskeard Minor Injury Unit (MIU). 

The rationale here is that it offers one day of weekend x-ray (as does Launceston MIU). This factor, combined with its modern infrastructure marginally sets it apart from the remaining Type 3 A&E sites which are the other MIUs in Cornwall. The DOS profile for the service is consequently significantly limited compared to that of the other Type 3 A&E sites selected for designation i.e. West Cornwall Hospital UCC CRCH Primary Care Centre. The service does not comply with the following aspects of the service specification:

  • GP-led or delivered
  • Evening x-ray
  • Provision of point of care test
  • 111 booking
  • Electronic prescribing

The inclusion of Liskeard has the benefit of offering a more evenly geographical spread of designated sites, but should in no way be seen as pre-determining our future model of Urgent Treatment Centre locations.

  • NHS Kernow has promised to consult before any closures.

Saltash, Fowey, Bodmin and St Ives are already closed.  There has been no consultation.

  • So no published “hit list” for closing MIUs?

Correct, and no-one ever said there was.  But there are now ten identifiable MIUs which are not on the “safe list” and unless the business case for the ACO changes, they face a specific threat today which is significantly greater than it was.

NHS and council bosses have always known that as soon as they started to put detail to their plans, public opinion at a local level would become hostile.  The whole STP process has been carefully choreographed to get to the brink of ACO status with the minimum of fuss.

As for the party politics, there seems little doubt that they will continue as usual, regardless of the facts.  The press release above was typical of how the Liberal Democrats – who now accuse Labour of “scaremongering” –  had formerly accused the Conservatives of putting Cornwall’s local hospitals at risk of imminent closure.

3 thoughts on “MIUs – Sorting out the facts from the party politics

  1. Now is definitely not the time to indulge in political point scoring. Here is my latest email to Adam Paynter my Councillor and leader on Cornwall Council.

    “Dear Adam,
    I followed your advice and looked at the STP plans on the Council’s website. The summary of the draft strategic outline case entitled “A Sustainability and Transformation Plan for Cornwall and the Isles of Scilly” says on page 7

    “Examples of potential service changes include …… trading hospital beds in the acute and community sector for more care at home (which may lead to some hospital closures); establishing a tight network of effective Urgent Care Centres in place of a multitude of unsustainable Minor Injury Units;

    It’s says a tight network ( which I think is a euphemism for a smaller number) of effective UCCs in place of a multitude of ( clearer inferring too many) MIUs. Now I cannot see that this can be interpreted as anything other than the closure of MIUs and their replacement with fewer UTC. The paper that the CCG published in December clearly came down in favour of a UTC at Liskeard as opposed to Launceston.

    Surely as people who share a passion for the NHS and local services we should work together. Given you are leader of the Council I’m sure the Chief Accountable Officer at the CCG would take your call. Could you not secure a simple reassurance that Launceston will either become a UTC or maintain its MIU as a minimum? If you cannot secure this reassurance then we can only conclude the hospital/MIU is at risk and that we ought to work together to mobilise public opinion in Launceston against the plan.

    If the document I read has been superseded perhaps you could advise?

    With regards

  2. It’s interesting to note consideration for what becomes a UTC is based on ease of transformation for Kernow CCG, not on accessibility and convenience for local populations, no review of transport links or driving times. Truth is for Launceston Derriford is nearer by car than Liskeard in driving time. By bus although you have to go into Plymouth and then get a bus to Derriford, at least there is a bus. Even if you could get a bus to Liskeard you couldn’t get one home again. So inevitably there will be more demand for ambulances. Our GP surgery has already made it clear there is no way it could pick up demand from the MIU.

    1. From Bude, a UTC in Launceston would be 40 mins by car; Liskeard, 70mins. Both much, much longer by bus and upwards of £50 each way by taxi.

      I bet private ambulance services are salivating at the prospect!

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