Questions received from members of the public

Questions about agenda items should be submitted in advance. Questions can be submitted via direct message on Facebook or Twitter or emailed to kccg.corporategovernance@nhs.net.
Questions received

August 2021: Long and post COVID questions

Question 1

Could long and post COVID indicators (including case numbers) be added to the Cornwall Council COVID dashboard?

Response

NHS Digital is looking to publish information on long and post COVID later this year and is working with providers to organise the collection of this data. NHS Kernow envisages sharing this information as part of its performance reporting and can work with council colleagues with a view to it being included in their dashboard.

Question 2

What are the risks to Cornwall’s primary care from long and post COVID, bearing in mind the need to complete and boost vaccinations and to catch up with delayed treatments and care?

Response

As per NICE, SIGN and RCGP guidance long COVID is a commonly used term to describe:

  • ongoing symptomatic COVID-19: signs and symptoms of COVID-19 from 4 to 12 weeks
  • post-COVID-19 syndrome: signs and symptoms that develop during or after COVID-19 and continue for more than 12 weeks and are not explained by an alternative diagnosis

Patients, with previously confirmed or suspected COVID-19, may present with a wide range of symptoms including breathlessness, fatigue, chest pains, cognitive impairment or psychological symptoms.

General practice plays a key role in supporting patients, both adults and children, with long term symptoms of COVID-19. This includes assessing, diagnosing, referring where necessary and providing longer term holistic support of patients, which are part of the core contractual responsibilities of GP practices. However as this is a new and sometimes complex condition NHS England and NHS Improvement have developed an enhanced service specifically to support general practice in:

  • professional education
  • consistent coding of patients
  • planning of practice clinical pathways to assess and support patients
  • consideration of measures to reduce the risk of inequity of access to support

Under the enhanced service practices will receive £0.371 per registered patient (75% of payment) upon sign up to this enhanced service. This will be paid via monthly instalments.

The remaining £0.124 per registered patient (25%) will be paid upon commissioner confirmation that the self-assessment set out above has been completed by 31 March 2022.

It is important to note that long COVID is also having an effect on staff within general practice and there are several clinicians who are currently on long term sick due to long COVID. Within general practice funding has been provided via the general practice COVID expansion fund to support backfill for staff on long term sick and the national statement of financial entitlements provides funding for locum cover for GPs on sick leave for up to 52 weeks.

There continues to be significant pressure across general practice both in terms of business as usual and urgent demand. This is not specifically related to long COVID but has been impacted by the need of staff to self-isolate and so on. In addition to this the ongoing need for practices to ensure appropriate infection control prevention means that general practice has not returned to normal unlike other areas of society and this has impacted on the availability of appointments and so on.

Practice resilience has been tested and additional support has been provided by NHS Kernow in relation to allowing practices to flex their capacity to meet demand, flexibility of the utilisation of e-consult by supporting practices to turn this off as necessary, additional staffing has been made available via the Kernow Health staff bank and increased funding provided to support increasing capacity, delivering health checks for patients with severe mental illness and learning disabilities and the increase in support with patient communications.

The primary care team are working on the development of an escalation process which will enable practices to identify when they are having issues and put in place a range of mitigations to support them.

The COVID pandemic may be levelling out but primary care does continue to experience issues relating to this, but NHS Kernow and general practice are working together to ensure access to primary care provision is not impacted significantly.

August 2021: Contracting arrangements for minor injury units

Question 1

Does NHS Kernow pay Cornwall Partnership NHS Foundation Trust to run minor injury units in Cornwall’s community hospitals?

Response

The minor injury units are commissioned by NHS Kernow through Royal Cornwall Hospitals NHS Trust and have been since 2017/18.

Question 2

What are the terms of contract for these services?

Response

Currently NHS providers are paid under the emergency provisions for COVID issued by the government.

Question 3

Are there penalties for not providing these services?

Response

There are no penalties under the current arrangements.

June 2021: Transfer of general practice data to NHS Digital

Question 1

On 12 May 2021 Rose Curling in her evidence to the people COVID inquiry advised that as of 1 July 2021 GP patient data will be transferred to NHS Digital, unless patients opted out.

Can you confirm that Cornwall’s GP practices were sent the data provision notice on 12 May?

Response

We can confirm NHS Digital (NHSD) sent out the data provision notice (DPN) to all practices notifying them of the rollout of GP data for planning and research (GPDPR).

Question 2

What will NHS Kernow and GP practices do, in response to this directive, to make sure that the public are informed and have the opportunity to opt out if they so wish?

Response

NHS Kernow has a privacy notice in place directing patients to the national data opt out webpage.

As data controllers NHS Digital and general practices have a legal duty to be lawful, fair and transparent and to provide patients with accessible information under GDPR about the data they are sharing. General practices will need to update their own privacy information before this collection commences.

NHS Digital has produced an additional general practice privacy notice for this collection, which GPs can easily link to for this purpose. This privacy notice provides important information to patients about their rights to opt out, including their right to exercise a type 1 opt-out to stop their identifiable data being shared with NHS Digital for purposes beyond their direct care.

Although NHS Digital is collecting data that is pseudonymised, it has agreed with the British Medical Association and the Royal College of GPs, it will not collect data about patients who have registered a type 1 opt-out.

The privacy notice provides a link to a type 1 opt-out form which patients can complete either online or download a copy and sending it to their GP practice by post or email or to NHS Digital direct. When the form is received, GP practices must action this promptly by registering the type 1 opt-out on the patient’s record using the codes set out in the NHS Digital form by no later than the 30 June 2021.

Patients may however exercise this right by using other forms available, or by simply asking at the GP practice.

NHS Digital has published its own NHS Digital transparency notice for this collection which provides more information about how NHS Digital will process the data collected from general practice and also sets out all of the legal bases under GDPR which apply to NHS Digital’s subsequent sharing of any GP data with other organisations. This also contains full information about opting out and provides a link to the type 1 opt-out form.

The general practice privacy notice also contains a link to this NHS Digital transparency notice so that if patients would like more information, they can click through to the NHS Digital notice.

Kernow LMC is also aware of this requirement and have included useful information for GPs in their June GP bulletin.

June 2021: Accessibility to NHS premises

Question 1

Why after a quarter of a century are so many NHS facilities in Cornwall inaccessible?

Response

Without more detail it is difficult to respond to this question.

Organisations have a responsibility to meet the requirements set out in the Equality Act 2010. Under the Act organisations need to make reasonable adjustments if someone is placed at a substantial disadvantage because of their disability compared with non-disabled people or people who don’t share their disability.

These adjustments could include:

  • changing the way things are done
  • changing a physical feature
  • providing extra aids or services

We are not aware of which NHS organisations have been approached or the response those organisations have given to requests to make reasonable adjustments.

Question 2

Who or which department in the integrated care system is or will be responsible for making sure NHS facilities are accessible to all, and therefore comply with the law?

Response

There is no one department within the integrated care system (ICS) for making sure NHS facilities are accessible to all. Each individual NHS organisation is responsible for complying with the requirements of the Equality Act 2010 for their premises.

Should anyone have an accessibility issue, we would ask that they approach the relevant organisation in the first instance so that they can consider what reasonable adjustments can be made.

As we move towards establishing the new ICS in April 2022, NHS Kernow will ensure we continue to abide by our public sector equalities duties in terms of our policies and our decision making responsibilities.

Question 3

Why has the public sector equality duty been ignored for accessible car parking and, has Royal Cornwall Hospitals NHS Trust (RCHT), their primary stakeholder, really got a grip on the access requirements for disabled people in the new builds and reorganisation?

Response

This question was redirected to RCHT for them to provide a response.

RCHT’s response is as follows:

The public sector equality duty has not been ignored in respect of accessible car parking at RCHT. As a member of the RCHT accessible parking group, previously representing Disability Cornwall, you will be aware that a significant amount of work has been undertaken over the last 5 months to understand the impact on accessible, and regular, parking spaces as a result of recent (and planned) hospital reconfiguration work.

At a meeting held on Friday 26 March 2021, you were part of a group who were presented with the initial findings of a car parking and traffic management survey being undertaken by Arup Limited (who are independent planning experts). Since that date, the full survey of car parking and traffic management arrangements has been presented to the RCHT senior leadership team, and work is now underway to develop the case for an accessible parking hub at the Treliske hospital site. A business case is being drafted for an accessible parking hub which will aim to comprise up to 60 British Standards compliant accessible parking spaces, and a free transfer shuttle service to the hospital entrances (supported by Age UK) for all patients and visitors with disabilities and/or impairments who require support in reaching the hospital from the accessible parking hub. The RCHT executive board are, at present, identifying funding to deliver these changes. The timeline for action will be confirmed in the next few weeks, and the aim will be to have the accessible parking hub in place and operational by early 2022. It will not be an immediate solution as planning permission and construction work is required. We will ensure that we provide information updates on our website, and via our usual communication routes.

Finally, I would like to assure you that the designs for all new buildings, created as part of the hospital reconfiguration programme, are fully compliant with NHS health building notes and health technical memoranda which take full account of legal accessibility requirements. The designs are, in turn, scrutinised by NHS England and NHS Improvement estates advisors and estates experts from the Department of Health and Social Care, before any funding to commence construction is released.

February 2021: Social prescribing

Question

I am the chair of directors of Camelford Leisure Centre, a community benefit society, set up to run the leisure centre in 2012 when Cornwall Council decided they could no longer afford to run it. We have always offered concessionary memberships to people referred by the local GPs and these have become increasingly popular. We currently have 93 single and 12 couples concessionary members at a monthly cost of £1,713. There is no contribution to this by our GPs. There is ample evidence to show the benefit of social prescribing both in terms of increased health and decreased cost of medicines. I would like to ask NHS Kernow why they are not actively promoting social prescribing and paying for it.

This begs the question why NHS Kernow and its practices are not prepared to support social prescribing financially and expect local businesses and charities such as ourselves to foot the bill for helping patients to get better. The evidence is clear that social prescribing improves patient outcomes and is cheaper than medication and so why is NHS Kernow not prepared to support it financially?

Response

NHS Kernow supports the national programme for social prescribing and is committed to ensuring all areas have access to social prescribing. Across Cornwall this is being lead by the public health team and Volunteer Cornwall on our collective behalf. Primary care networks, which are groups of GP practices working together with community-based health, care and volunteer groups, are now able to access funding for recruiting social prescribing link workers. Whilst this helps fund the social prescriber themselves, this does not fund or contribute towards the costs of the services referred to. The 2 Camelford GP practices are not yet in a primary care network, so have not yet been able to access this national funding stream. Despite this, the 2 practices are keen to start to provide such services and see the value of social prescribing. NHS Kernow will therefore be working closely with them to establish a local arrangement which will enable them to gain access to funding as soon as they are in a position to employ a social prescribing link worker.

I think it is helpful to clarify what social prescribing is, it is intended to be a link between statutory services and other community groups and charities, it is not prescribed in the same sense that a medication would be from a local pharmacy. NHS England provides a wide array of information relating to social prescribing which you may find useful. As you can see from the website, social prescribing isn’t about funding or commissioning a service it is about linking people who would benefit to existing services. Whilst NHS Kernow recognises the positive impact many of these alternative services have on individuals, they are not clinical services which we would fund. This is because the NHS is bound by national regulations when it comes to commissioning or funding decisions. As the service offered by Camelford Leisure Centre would be considered to be lifestyle and prevention, these are matters which rest with the individual and, in some instances, the local authority. As members of the local community we value the input that community organisations, such as yourselves, make to the community and the positive contribution such discounts can offer to individuals. However, the discounts mentioned in your question are not a requirement of social prescribing and NHS Kernow is therefore unable to fund them.

February 2021: New care home in the west of Cornwall and re-provision of community hospital

Question

In the report to the board at your last meeting when it resolved to confirm the closure of Edward Hain Hospital the report on which that decision was based had repeated references to NHS commissioned beds in the community and assured the board that “a purpose-built new care home will be open to receive its first residents in Penzance in January 2021. This will provide 28 beds and these have been commissioned as discharge to assess beds (D2A) which by their nature have a focus on reablement. This will increase bedded reablement capacity in the west of Cornwall, and addresses some of the [scrutiny] committee’s concerns.” (page 3 – Agenda item: community hospital engagement).

How is this going? Has the presumably now up and running commissioned beds helped to meet the needs they are intended for? If not, why not? If NHS Kernow has discovered (as we suspect) that no such beds exist or can be commissioned, what alternative arrangements does it plan to meet this identified need? Which organisation or company had the NHS intended to commission from to deliver the reablement beds; what is its clinical experience, success and outcomes in providing such services? What is the proposed period of the contract and what plans are there for provision of the service at the end of the contract?

Would NHS Kernow staff meet myself and other community representatives who are looking at a project to deliver a newly-provided, purpose-built community hospital with 20+ beds in the Penwith area and to advise on potential avenues this project could usefully take to meet the unmet need for reablement, end of life care and other community hospital services in the west Cornwall area and in response to the closures of Poltair and Edward Hain Hospitals?

In order to keep options open for the re-provision of community hospital services in the Penwith area, will NHS Kernow ensure that it, the Royal Cornwall Hospitals NHS Trust and others in the NHS community do not dispose of any land or building assets, especially those at West Cornwall and St Michael’s Hospitals, until these options have been fully explored? This may require maintenance/non-disposal of land and buildings for at least another 24-month period while options are exhaustively investigated.

Response

It is Cornwall Council, not NHS Kernow, who is commissioning the additional care home beds. Colleagues from the adult social care team at the council will therefore respond to your questions directly.

NHS Kernow, as well as health and care partners across the system, is clear our strategic commissioning intention is for new models of care which reduce the reliance on bedded care. At this stage there is no perceived requirement for another community hospital facility. There are already several forums in place in the Penwith area that enable local engagement and input into the design of the new models of care work. Should you require contact details please let us know.

As noted above, there is no intention to re-provide a community hospital service in the Penwith area.

February 2021: New care home in west of Cornwall, discharge to assess and reablement

Question

At its meeting on 1 December 2020, the Governing Body of NHS Kernow was told, in support of its proposal to close Edward Hain Community Hospital: “[We] have received confirmation that a purpose-built new care home will be open to receive its first residents in Penzance in January 2021. This is the first time a new care home has been built in Cornwall for over a decade. This will provide 28 beds and these have been commissioned as discharge to assess (D2A) beds which by their nature have a focus on reablement. The intended length of stay for individuals will be up to 6 weeks. Some beds will be for people with dementia and complex care needs. This will increase bedded reablement capacity in the west of Cornwall. The beds are due to open mid-January 2021. (GB2021/071)”.

We now discover that the new care home will not be purpose-built but a conversion of a former nursery school, the rooms and facilities in the converted building are designed for long-term residential care for dementia patients, and it will apparently have no specialist rooms or facilities for D2A or reablement. Planning permission has not yet been granted and it seems that the beds are unlikely to be available for several months at least.

  1. What steps has NHS Kernow taken, or plans to take, to confirm the date when the building at Polwithen House will actually be ready to receive patients?
  2. What steps has NHS Kernow taken, or plans to take, to ensure that the building and its staffing will meet the requirements of the discharge to assess scheme (pathways 2 and 3)?
  3. What steps has NHS Kernow taken, or plans to take, to ensure that Polwithen House is equipped with rooms, staff and equipment to provide for the reablement needs of individuals admitted?
  4. How will NHS Kernow operate the D2A system for patients from west Cornwall in the short-term, given the lack of planned provision?
  5. Will NHS Kernow consider the implications of this situation for its decision on Edward Hain Community Hospital and particularly for pathways for rehabilitation and reablement, as described in the previous report to the Governing Body, community hospital engagement (GB2021/071)?

Response

As previously confirmed, commissioning of the new care home beds is the responsibility of Cornwall Council, not NHS Kernow. Colleagues from the council will therefore respond more fully to the first 3 questions.

In accordance with national guidance, the D2A arrangements have been in place for many months and continue to be co-ordinated by health and care system partners. The beds referred to above are additional beds which will supplement those already in place.

The additional 28 care home beds in Penzance are not a direct replacement for Edward Hain Community Hospital beds, but will provide additional bed capacity for the area. The beds in the new care home will help meet a commissioning need identified in Cornwall Council’s market position statement published in 2019. NHS Kernow Governing Body made its decision on Edward Hain Community Hospital based on an 18-month long piece of engagement and a multi-agency formal evaluation process. This included considering 21 different criteria such as safety, workforce, environment and finance. The evaluation process, criteria and scoring were agreed by the people on our community stakeholder group. The minimum score was not met for safety, financial, affordability or sustainability. The evaluation process determined that the option to re-open 12 Edward Hain Community Hospital beds and the continuation of existing podiatry and mental health community clinics in a fire safety compliant and refurbished hospital is not viable or safe. As a consequence, the December 2020 Governing Body decision stands and any further questions relating to the care home beds should be re-directed to the adult social care team at Cornwall Council.

February 2021: Discharge to assess and reablement

Question

There’s a lot of emphasis on increased use of discharge to assess and reablement to move people out of hospital and to free up acute beds. The definitions of discharge to assess (NHS England) and reablement (National Audit of Intermediate Care) are both rather vague. What definitions are being used in Cornwall to commission these services? Against a current background of staff shortages and financial pressures, which providers and which staff will be involved?

Response

The national guidance is used to commission these services. However, commissioners continue to work with NHS England and NHS Improvement colleagues with the expectation that future iterations of the guidance takes account of feedback and learning provided.

System health and care partners are working collectively to support each other and optimise the resources available, whether that is for funding, beds or staffing.

December 2020: Edward Hain Community Hospital

Question

In April 2020, the council published a draft market development strategy as part of the process of onboarding care homes to a new joint contractual agreement between the council and NHS Kernow. This strategy included profiles for 4 priority development areas, 1 of which was west Penwith. This was intended to give an initial indication to care home providers about the areas of immediate priority and future demand for care homes services. The former Bolitho School site was acquired by Porthia Group (majority shareholder of Cornwallis care services limited) in 2015 with the intention of continuing to provide a local community service. The nursery element of the site was identified as a building that could rapidly be developed into a specialist care service.

In March 2020, the Government mandated the discharge to assess (D2A) model in its hospital discharge requirements and as a policy response to the COVID-19 pandemic. To ensure the local health and social care system was able to rapidly respond to these requirements, commissioners agreed with Cornwallis that the building could be temporarily used to support this approach until the end of March 2021. This will allow the service time to establish itself before converting to a specialist dementia care home, which is expected to include both discharge to assess pathway 2 and 3 support for people with dementia and long-term complex care requirements. The design of the ongoing service is currently in progress and will be codesigned with key stakeholders. Although the new service will initially support people who are in the discharge to assess pathway 2 and 3, it will be registered as a care home and is intended to be provided as such longer term. The wider discharge to assess arrangements also includes additional capacity to ensure people are supported home through pathway 0 (home with voluntary and community sector support) and pathway 1 (home with some short-term support).

The discharge to assess care home beds have been jointly commissioned by Cornwall Council and NHS Kernow. As with any new care home which requires building work there is likely to be some slippage around the start date but at the time of commissioning the provider was confident that the works would be complete in time for a January 2021 start. The provider is confident that they can achieve this and will only be paid from the start of the service.

Where is the new building situated? Is it within a local community?
Who owns the new building?
What are the terms of the contract between NHS Kernow, Cornwall Council and the owner of the building?
Who will manage the new building, how will it be staffed, and how will the staff be paid?
How will the new building be equipped, and who will pay for the equipment and its installation?

The conventional idea of a care home is a ‘home from home’, a place providing a sheltered environment where elderly people can pass their remaining days and enjoy the benefits of a communal life with some degree of continuity. This is not consistent with a perpetual rapid turnover of occupants, all looking forward to returning to their own homes. Is the new building intended to provide a home for long-term residents? If so, has any thought been given to how to accommodate short-term and long-term residents together?

There is also a conflict between D2A and provision for reablement. With D2A the emphasis is very much on speed, on rapid turnover. Patients are to be removed from hospital at the earliest possible moment, kept in beds while their needs are assessed, and then hastened on their way as quickly as possible. While in transit in the care home they have to be provided with care, a nursing function. This may not necessarily be good for them. A study published by the Local Government Association found that, unfortunately, ward-based staff such as nurses were predisposed to argue that patients should move on to a short or long-term residential placement rather than return home. This despite lacking knowledge of the full range of alternatives that were available to support patients at home. Reablement, on the other hand, is a process of reskilling. Over a period of up to 6 weeks, those on a reablement programme will need to be provided with a training, they will need to be kept out of beds, and they will need to be in the charge of, chiefly, physiotherapists and occupational therapists, aided by healthcare assistants. Has any thought been given to the problems inherent in catering for these 2 quite different groups in the same building?

There will be workforce issues too. The revised report to NHS Kernow’s Governing Body notes that staffing Edward Hain Hospital’s 12-bed unit required a nursing force of 29. What consideration has been given to the make-up of the workforce necessitated by the functions that the new care home establishment is expected to perform?

While welcoming the various initiatives undertaken by members of the medical and other professions under the NHS, and during the COVID-19 pandemic being profoundly grateful for everything they have done and continue to do, they are not above question. The era of the deferential patient is over, and members of the public are keenly aware of ‘never events’, things that go wrong and changing fashions. We do not want to be patted on the head and told that you know what is best for us. Will you take our questions seriously?

Response

The new care home is situated on the Bolitho School site at Polwithen Road. The building is currently a nursery, which has been relocated to the Rosamunde Pilcher building on the same site in October 2020.

The building is owned by Porthia Group Ltd, who are the landlord and the service will be provided by Cornwallis Care Service Ltd, who hold the Care Quality Commission (CQC) registration. There will be a lease between Porthia and Cornwallis for this.

The service will be contracted via the council’s standard care home contract for 2020 to 2021 as a block contracted arrangement and will then as part of the new joint council and NHS contract for 2021 to 2022 onwards. This will be a 3-year contract with an option to extend for a further 2 years.

The service will be managed by Cornwallis Care Service Ltd and staffed as a care home. The staff will be paid by Cornwallis as the employer at not less than the living wage foundation rate.

The service will be equipped by Cornwallis Care Service Ltd in the first instance with equipment required by individual residents provided by Cornwall equipment loan service (CELS) in accordance with the care home equipment policy.

The discharge to assess service is the commissioned service at the moment. Any future contract would take into account the mix of residents but it’s not unusual for a care home to offer both short-term and permanent services.

The provider has a track record in delivering the right workforce for their provision.

The process and continued response to your questions demonstrates we take you seriously.

October 2020: Edward Hain Community Hospital

Questions received from Dr Peter Levin, on behalf of West Cornwall HealthWatch. Read the questions and our response (PDF, 573 KB).

October 2020: Earwax removal service

Question

Please can you confirm the commissioning arrangements for earwax removal in GP practices in Cornwall? We understand that the NICE guidance recommends earwax removal by micro suction or electronic ear irrigation rather than traditional syringing; but we have been advised that not all practices have the equipment and deliver these services. What are you doing to ensure that earwax removal remains an NHS-funded service for the many patients in Cornwall who require this treatment at their local practice?

Response

GPs across Cornwall and the Isles of Scilly have historically provided ear wax removal via ear irrigation, sometimes called syringing by mistake. None of our practices perform manual syringing as it is contraindicated and only a handful have ever provided micro-suction.

In terms of commissioning arrangements it is not explicit in the national GP contract that GPs need to provide this to their practice population. Early in the year we identified that 48 practices were still providing some wax removal services, but as this is classed as an ‘aerosol inducing procedure’, many more are now not performing because of the associated COVID-19 risk.

Feedback has suggested that people with earwax tend to seek treatment in the form of a procedure. For example ear irrigation or micro-suction. Having not given sufficient time for first line treatment with ear softeners. Wax softeners take anywhere between 4 and 6 weeks to work. We have therefore been working with the ENT consultants and GP leads to finalise a patient/GP information leaflet that gives consistent information to patients about treatment with softeners. The majority of people with ear wax removal should never need a procedure to remove it.

  • Our plan therefore it is share a more consistent approach with primary care and the public about the first line treatment of routine ear wax using ear softeners; a patient leaflet is to be distributed within the next 4 to 6 weeks.
  • Work is taking place between planned care and primary care commissioners about potential options for a GP service to be considered; however, funding any potential new service will require savings to be made in other commissioned services, and any future investments will need to be prioritised.

Regarding the supplementary question raised about the secondary care service, NHS Kernow commissions the Royal Cornwall Hospitals NHS Trust (RCHT) to provide an aural care service within the ear, nose and throat (ENT) speciality. This nurse led service is not only designed to see people needing complex ear wax removal via micro-suction but supports our ENT consultants by seeing people with ear conditions such as active infection and disease which often cause significant complications such as infection in and around the brain, dizziness and permanent irreversible hearing loss if not managed regularly.

To ensure that we utilise this resource appropriately, there is a longstanding agreement in place that certain criteria must be met for referrals to be accepted in to the service. Read the current commissioning policy criteria for troublesome ear wax.

Some people may only need to attend 1 appointment for micro-suction but others may have a number of appointments over a longer period of time. A clinical assessment on when a person can be discharged is applied to all patients based on criteria set by the ENT department. Whilst an average appointment time slot for aural care is about 15 minutes per patient, there are currently around 2,000 awaiting follow-up appointments within the aural care department.

Some patients have been contacted recently to advise that they no longer need to be seen by the aural care team. This is because the department is currently reviewing their waiting list/follow up lists and applying discharge criteria. Such reviews are essential in light of the recent events of COVID-19 which means that social distancing measures reduce the number of appointments available in clinic and therefore the amount of people that can be treated. NHS Kernow is fully supportive of RCHT conducting these clinically led reviews and applying the access and discharge criteria that has been previously agreed.

NHS Kernow and RCHT would like to reassure everyone that every person who has been discharged has had a clinical evaluation of their medical records against the clinical criteria for discharge. Each individual has been given detailed advice on self- management of their condition from home without the need to attend for a further hospital appointment.

NHS Kernow confirms that this is not a withdrawal of a service nor is it based upon any financial cut backs. It is however paramount if we are going to have enough resource across Cornwall and the Isles of Scilly in treating those with the most pressing clinical need. If a patient’s condition changes and they subsequently meet the access criteria for the service, they can be re-referred by their GP.

6 October 2020: Brexit – future supply of medicines and equipment

Question

Could the Governing Body please advise their concerns about the future supply and cost of medicines and medical equipment following Brexit and how these can be addressed generally and particularly within Cornwall? This is a particular concern given the well-publicised problems arising from the Government’s insistence on nationally organised COVID pillar 2 testing rather than local NHS and public health organisation.

Response

Governing Body concerns about the future supply and cost of medicines and medical equipment following Brexit would include:

  • sufficient buffer stock by companies in local warehouses, note that there are no warehouses of the major suppliers in Cornwall, the nearest being Plymouth, then Exeter
  • public stockpiling by patients fearful of running out of medication will aggravate any potential shortages in advance of BREXIT, we saw this effect in the early months of COVID-19
  • concern that companies may find it more advantageous to market products in the EU as more profitable

How these can be addressed generally and particularly within Cornwall?

  • the Department of Health and Social Care (DHSC) has advised pharmacies to have at least 6 months of stock and to avoid the bottlenecks of Dover and Felixstowe as they consider transporting goods from EU to UK
  • GP practices have been advised not to increase prescription quantities which is advice often given to manage the Christmas and New Year bank holiday closures
  • we will need to work with the communications team to begin to deliver a consistent message to the public around ordering of prescriptions and not to over order
  • any over ordering will aggravate the fragility of the supply chain
  • encourage practices to consider eRD to manage stock issues
  • DHSC has listed a number of products that are not to be exported from UK to EU

More generally the medicines optimisation team, has supported during COVID and continues to support the provision of information and advice on how to manage an interruption in supply.
DHSC has also indicated that it will continue to ask healthcare providers to avoid local stockpiling over and above business as usual ahead of 31 December as it is unnecessary and could cause shortages in other areas. This includes advising patients that they do not need to stockpile medicines either

August 2020: Mental health budget

Question

How will NHS Kernow ensure that the mental health budget is protected in the event of a merger between Royal Cornwall Hospitals NHS Trust (RCHT) and Cornwall Partnership NHS Foundation Trust (CFT)?

Response

The Cornwall and Isle of Scilly Health and Care Partnership maintains it commitment to parity of esteem between physical and mental health service provision and the strategic intentions set out in the adult mental health strategy: Futures in Mind. We are also committed to meeting the annual Mental Health Investment Standard (MHIS) to ensure that service development and transformation keeps pace with national expectation and meets the needs of the local population.

NHS Kernow shall be consulted on RCHT and CFT’s planned integration as part of the strategic and full business case process which shall be managed by NHS England and NHS Improvement (NHSEI). As part of this process, we expect NHSEI will also seek assurance of both organisations continued commitment to national MHIS expectations.

May 2020: NHS debts

Question

It has been reported that the Government has now written off all NHS bodies debts. However, the position is far from clear since it was subsequently reported that these debts have been transferred into public dividend capital which would seemingly involve higher interest charges. Could you please clarify the position and the implications for the CCG and NHS providers in Cornwall? Could you also please advise if there have been any statements or actions which would help avoid future accumulation of such debts?

Response

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):

  • RCHT revenue: £36,818,000
  • RCHT capital: £5,776,000
  • RCHT total: £42,594,000
  • UHP total (all revenue): £141,984,000
  • NDHCT total (all revenue): £20,003,000

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.

May 2020: Isles of Scilly Council - accountable officer (AO) role

Question

There is no reference to the Isles of Scilly Council in the AO paper. Is this due to the council not being supportive of the role or if had they not been involved in the process?

Response

Dr Chorlton confirmed that the Isles of Scilly (IoS) Council were part of early discussions on strategic commissioning and had been consulted and involved. The IoS Council would be part of the assurance panel and ongoing evaluation of proof of concept. However due to their separate authority with a specific role on the Isles of Scilly, the council opted not to be a part of the process indicating that, from a director of public health perspective, the AO role could link across to the island as they have a separate adult social care. Mrs Pendleton highlighted that a risk may be that this process may marginalise the IoS Council, and even though they were not formally part of the process, it was imperative that they continued to be consulted.

May 2020: Accountable officer (AO) role

Question

How does the new strategic AO role fit in with the recently announced Cornwall Council arm for adult social care?

Response

Mrs Charlesworth-May advised that Cornwall Council (CC) had set up a new Corcare homes company which would sit in a discrete reporting Council cost code, under the highways organisation. Historically, Cormac Ltd had delivered a suite of services which were not picked up by other companies and this existing suit of services would now be covered by the new care homes company.

3 May 2020: Year end deficits

Question

In terms of finance, will the year-end deficit would be rolled over?

Response

Mrs Bryan informed that there had been recent changes to the way clinical commissioning group monies are managed and the new financial year would have a new budget allocation. The historical deficit of £27 million would need to be repaid at a point in time in the future however this would not be included in the new budget allocation for 2020/21 financial year. Mrs Bryan confirmed that the accumulated debt would always be stated in the financial reports.

May 2020: North Devon acute hospital activity

Question

Why are north Devon figures were not reported within the acute hospital activity of the month 10 finance report and commented that there was an identified gap of £52 million?

Response

Mrs Bryan advised that once activity figures fell below a certain amount, with north Devon being the smallest, the detail is not included. Mrs Bryan confirmed that the report would include Devon, Exeter and any Cornish residents that attend elsewhere in the country for non-contracted activity. A list of contracts over a certain value is available on the NHS Kernow website. Mrs Bryan confirmed that this list included several hundred contracts for which analysis is included within the annual report.

May 2020: COVID-19 plans

Question

How will plans around COVID-19 would be communicated to the public?”

Response

Mrs Jones confirmed that NHS Kernow had received clear public health instructions and were following the national communications pathway. All communications were being released to the public nationally via NHS England, public health, disseminated via television, radio and social media outlets, and not updated locally to ensure uniformity of messaging. Members of the public are directed to seek advice from www.111.nhs.uk before calling 111 to assist with the volume of enquiries. Any changes to the current protocol would be under the directive of public health. Mrs Pendleton confirmed a national action plan had been released to support the developing situation.

May 2020: NHS plan and staffing

Question

What plans are in place around local issues of staffing which would be needed to supplement the national plan?

Response

Mrs Charlesworth-May advised county wide planning rules would be initiated if that critical point was reached, which are tightly controlled and signed off at each level and a local workforce strategy would be included within this. Communications in that context would be closely managed, with national messages circulated locally alongside agreed local messages.

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