By Graham Smith
The redesign of Cornwall’s health service is set to transfer treatment of existing minor injury units to 25 “enhanced” GP surgeries – posing questions about the viability of community hospitals which currently house that service.
The shake-up will create a Cornwall of “winners” and “losers” as some communities acquire new facilities at the expense of others. Talks take place monthly, in secret, and local health campaigners have little or no opportunity to lobby or make their case.
Officials are about to embark on a programme to “rank” facilities on a Property Asset Scorecard of 1 – 5. Low-scoring properties are unlikely to survive. St Austell is the first to come under the microscope. It is not known if its “score” will be published immediately or if the NHS will wait until every facility is ranked before releasing a league-table.
Confidential minutes obtained by Cornwall Reports using Freedom of Information laws reveal that NHS officials are considering how patients in East Cornwall could be forced to travel to Devon for minor injury treatment. Minor injuries are defined as those which are not urgent, and should not need Accident and Emergency department treatment.
At the same time NHS England is considering the creation of four new Urgent Treatment Centres in Cornwall, intended to help ease pressure on the Accident and Emergency department at the Royal Cornwall hospital, Truro.
So far there has been no public consultation about the changes. But a series of Shaping Our Future “Wave Three” workshops with health professionals has been underway for months and is about to draw to a close. These workshops have fed information to a group of 11 individuals who make up an organisation known as the Shaping Our Future Strategic Estates Group (SEG.)
Quis es? Most people have never heard of the Strategic Estates Group, yet these individuals will rate local hospitals on a “Property Asset Scorecard” which will determine their future
This group does not meet in public and even the identities of most of its members are deemed so confidential that they have been redacted from the FOI answer. It would be quite easy to identify the individuals but Cornwall Reports has chosen to respect the views of the FOI officer who handled the request. The group’s next meeting is on 4th April.
Cornwall Reports has obtained the minutes of the group’s meetings. You can download and read those documents in full here: Shaping our Future Strategic Estates Group minutes and agendas v2 Shaping our Future Strategic Estates Group minutes and agendas v1
NHS Kernow has accepted that the future allocation of minor injury facilities and Urgent Treatment Centres could be “patchy” and that the final provision is likely to be “mixed.” The initial location of proposed UTCs is, as previously reported, at Penzance, Camborne, Truro and Liskeard – but this could change as officials study data on population and transport issues.
NHS Kernow has however provided Cornwall Reports with the full list of 25 enhanced GP surgeries which currently offer minor injury services. The Clinical Commissioning Group is keen to encourage more doctors to offer a walk-in service for the sort of treatment which does not require urgent intervention. Provided the following GP surgeries continue with their existing service, these communities could be described as “winners” –
Bodriggy health centre (Hayle)
Bottreaux surgery (Boscastle)
Cape Cornwall surgery (St Just)
Carnon Downs surgery (near Truro)
Chacewater health centre (near Truro)
Dr Garrod, medical centre (Camelford)
Dr Philip and partners, Stennack (St Ives)
Mullion health centre
Old Bridge surgery (Looe)
Pensilva health centre (Bodmin Moor, between Liskeard and Callington)
Petroc group practice (St Columb)
Port Isaac surgery
Praze an Beeble surgery (Camborne)
Probus surgery (between Truro and St Austell)
Quay lane surgery (Saltash)
St Keverne health centre (near Helston)
St Agnes surgery
Tamar Valley health (Callington)
Rame group practice (Torpoint)
Roseland surgeries (Roseland peninsula: Portscatho, St Mawes and Tregony)
The four Urgent Treatment Centres have previously been described as “super hubs” and officials have suggested they will be “along the spine” of Cornwall – causing consternation to communities which do not live close to either the A30 or A38.
The controversy over 10 specific Minor Injury Units will resurface later this year when formal proposals to close them go out to formal public consultation. The ambition to close Cornwall’s MIUs has been public knowledge for 18 months – described by NHS Kernow recently as “a commitment” to close the MIUs – but the real impact will be on the subsequent viability of the buildings they currently occupy.
St Austell hospital, the first to face the Property Asset Scorecard
The ten MIUs at risk are Bodmin, Falmouth, Fowey (currently “temporarily” closed), Helston, Launceston, Newquay, St Austell, St Ives, Saltash (also “temporarily” closed), and Stratton, near Bude would all close. An 11th MIU, currently managed by the Cornwall and Isles of Scilly NHS Partnership Trust, is at St Mary’s on the Isles of Scilly.
Communities close to these facilities are at risk of becoming “losers” unless alternative provision is arranged within reasonable distance. For example, the St Ives MIU is already housed in the doctors’ surgery and is therefore likely to survive, provided the GPs are happy to continue their existing enhanced service.
The rationalisation of the NHS estate in Cornwall seeks to encourage GPs to relocate into existing NHS properties. But not every GP is able or willing to do this – and the end result, likely to be next year, will be the closure and sale of several NHS buildings in line with the government’s Naylor report.
Older properties, such as Fowey hospital, already closed, appear doomed. But others might survive.
For example, talks have already taken place to develop a business case which would see GPs in Bodmin occupy the town’s NHS Treatment Centre. This modern, purpose-built facility has now been closed for a year, at considerable cost, due to a remarkable contract mismanagement with the private-sector tenant, Ramsay. Ramsay simply moved its operation to its own Duchy hospital, Truro, keeping most of its contract value but causing major inconvenience to NHS patients in North Cornwall.
The confidential minutes of the Strategic Estate Group meeting in November describe how the “Independent Sector Treatment Centre” building at Bodmin building has now been stripped of the equipment which had belonged to Ramsay.
The same minutes also make reference to the controversial, eventually abandoned, attempt to sell hospital land at Launceston. The minutes note “adverse public reaction” to the proposed sale. The future of this land is to be discussed further – but again, because meetings are closed to the public, any future attempt at sale is unlikely to become known until it reaches the auctioneer.
Other facilities, currently open, will survive only if they can make a strong business case. The confidential minutes of the Strategic Estate Group meeting in December 2017 sought to explain the difference between a Minor Injury Unit and an Urgent Treatment Centre:
“UTCs will be open longer hours, be able to undertake X-rays at weekends, be GP-led, ideally have a CT scanner and short-stay observation beds.
“On the assumption that the current MIUs have X-ray equipment, there are 15 MIU/UTC in Cornwall (including St Mary’s and Treliske) and 3 or 4 over the border in Devon, for use by the population residing in East Cornwall.
“The plan is to undertake a desktop review on each possible site to look at building fabric, accessibility, viability etc then enter findings on a report to result in a ranking system from one to five.
“The first desktop review is to take place in St Austell early in 2018.” The Strategic Estates Group is looking to the South West Academic Health Science Network, based in Exeter, for advice on transport issues.
The West Cornwall Hospital, Penzance, is one of those already earmarked as an Urgent Treatment Centre
Cornwall Reports also asked for any SEG background papers which specifically reference the closed St Barnabus hospital, Saltash, Fowey hospital, Bodmin Treatment Centre and Edward Hain hospital, St Ives, and was told that none existed.
NHS Kernow has previously said that no service changes will go ahead without full public consultation. There has been no consultation over the closures at Saltash, Fowey, Bodmin or St Ives. NHS Kernow said the attempted land sale at Launceston did not need public consultation because it did not entail any service change.
Edward Hain hospital: closed “temporarily” for two years with no public consultation
The criteria for “full public consultation” may yet come down to a debate over whether moving a service from one building to another location constitutes a change of service. Much depends on the definition of “a significant commissioning decision.” If it does not constitute a change of service, NHS Property Services may yet be able to sell several of Cornwall’s community facilities without public consultation.