Can you please provide me with your guidelines or treatment pathway for the pharmacological management of chronic kidney disease (CKD)?
The guideline for the management of CKD can be found on the Royal Cornwall Hospitals NHS Trust document library.
NHS Kernow is currently updating the renal resources pack, once approved this will be uploaded to our formulary website and will replace the 2016 version shown.
Please provide the following information you have pertaining to care provision for adults (aged 18 to 64).
Our response to this request was provided as an attachment. Please email our FOI team for a copy of the response.
In response to question 1, NHS Kernow can neither confirm nor deny whether information is held under section 31(3) of the Freedom of Information Act (FOIA). Section 31(3) of the FOIA allows a public authority to neither confirm nor deny whether it holds information where such confirmation would be likely to prejudice any of the matters outlined in section 31(1). This includes information the disclosure of which would or would be likely to prejudice the prevention or detection of crime.
As section 31(3) is a qualified exemption, it is subject to a public interest test for determining whether the public interest lies in confirming whether the information is held or not.
NHS Kernow considers that to confirm or deny whether the requested information is held would indicate the prevalence of cyber-attacks against our information and communications technology (ICT) infrastructure. It could also reveal details about our information security systems. NHS Kernow recognises that answering the request would promote openness and transparency regarding the organisations ICT security.
Cyber-attacks, which may amount to criminal offences for example under the Computer Misuse Act 1990 or the Data Protection Act 2018, are rated as a tier 1 threat by the UK Government. NHS Kernow, like any organisation, may be subject to cyber-attacks. Since it holds large amounts of sensitive, personal and confidential information, maintaining the security of this information is extremely important.
In this context, we consider that confirming or denying whether the requested information is held would provide information about our information security systems and resilience to cyber-attacks. There is a very strong public interest in preventing the NHS Kernow’s information systems from being subject to cyber-attacks. Confirming or denying the type of information requested would be likely to prejudice the prevention of cybercrime, and this is not in the public interest.
If NHS Kernow were ether to confirm or deny the existence of the requested information, the disclosure would be likely to prejudice the effective conduct of public affairs for the organisation, the NHS or any other government department. As such, this conflicts with section 36(2c) of the FOIA.
NHS Kernow has considered that if it were to confirm or deny whether it holds the requested information, it would enable potential cyber attackers to ascertain how and to what extent we are able to detect and deal with security attacks. NHS Kernow’s position is that complying with the duty to confirm or deny whether the information is held would be likely to prejudice the prevention or detection of crime, as the information would assist those who want to attack NHS Kernow’s ICT systems. Disclosure of the information would assist a hacker in gaining valuable information as to the nature of NHS Kernow’s systems, defences and possible vulnerabilities. This information would enter the public domain and set a precedent for other similar requests. Which would, in principle, result in NHS Kernow being a position where it would be more difficult to refuse information in similar requests. To confirm or deny whether the information is held is likely to enable hackers to obtain information in mosaic form combined with other information to enable hackers to gain greater insight than they would ordinarily have, which would facilitate the commissioning of crime such as hacking itself and also fraud. This would impact on NHS Kernow’s operations including its front line services. The prejudice in complying with section 1(1)(a) FOIA is real and significant as to confirm or deny would allow valuable insight into the perceived strengths and weaknesses of NHS Kernow’s ICT systems.
For question 2, NHS Kernow have started the process of adopting the NHS Digital backed N365 (a variant of Office 365). It is currently in deployment and set up phase and not our primary source of data storage. Backup solutions are being assessed.
Our response to question 3 is below:
Question 4: Single.
Question 5: No.
Question 6: None.
Can you please provide both the number of inpatients sent out-of-area and the average cost per day (or week if daily information is not available) for the following areas:
I would like the information provided for financial years 2018 to 2019, 2019 to 2020 and 2020 to 21.
NHS Kernow does not hold all the information requested as our system does not record the conditions as described in your request.
Services provided by NHS Trusts are commissioned on a block contract basis and not on a tariff basis. Therefore we do not hold this information and you may wish to contact Royal Cornwall Hospitals NHS Trust and Cornwall Partnership NHS Foundation Trust.
For some of the services due to the case numbers being less than 5, the information cannot be disclosed as it could potentially identify the individuals involved, especially if combined with other data, this would constitute a breach of the Data Protection Act 2018. Therefore, this information is exempt from disclosure under section 40(2) of the Freedom of Information Act 2000 on the grounds that it is personal information.
Rehabilitation and recovery independent sector providers:
NHS Kernow is a clinical commissioning group responsible for the planning and commissioning of health care services. NHS Kernow does not hold the information. This may be available from the service provider Royal Cornwall Hospitals NHS Trust.
Please provide the following information for 2018 to 2019, 2019 to 20 and 2020 to 21.
The payments made to charities and third sector organisations relate to the following only:
NHS Kernow has not made any grants, loans or payments to any of the organisations listed.
NHS Kernow is a clinical commissioning group responsible for the planning and commissioning of health care services. Agency doctors and nurses are not used by NHS Kernow. Royal Cornwall Hospitals NHS Trust and Cornwall Partnership NHS Foundation Trust may be able to provide the information requested.
Please provide me with:
Please provide the name of the individual and their ICS job title. In cases where there are multiple leads, please include the names of all individuals.
Cornwall and Isles of Scilly integrated care system (ICS) is in development. The timeline is dependent on legislation but is expected to be formed by April 2021. Therefore, not all roles have been appointed to.
ICS lead: Kate Shields, accountable officer for NHS Kernow from 16 August 2021
Chair: John Govett, designate chair
Lead for workforce: Not yet confirmed
Lead for finance: Not yet confirmed, job title will be chief finance officer
Medical lead: Not yet confirmed, job title will be chief medical officer
Nursing lead: Not yet confirmed, job title will be chief nursing officer
Lead for continuing healthcare: Not yet confirmed
Chief operating officer: Not known
IT, technology or digital lead: Not yet confirmed
Procurement lead: Not known
Transformation lead: Carolyn Andrews, ICS transformation and programme director
Portfolio and programme lead: Carolyn Andrews, ICS transformation and programme director
Local workforce action board chair: Now the people board. Carolyn Andrews, interim people board chair
Can I ask how many dedicated dementia beds that there are in Cornwall Care Homes?
NHS Kernow does not hold the information requested because care home beds are commissioned on an individual care needed basis.
Further information about dementia beds in Cornwall care homes can be found on the Care Quality Commission website.
Please can you confirm if all B12 deficient patients in Cornwall across your 59 GP practices were stopped from receiving their vitamin B12 injections? Can I ask if this position still stands in Cornwall? Are new patients being given B12 injections or are all being given oral tablets now?
The British Society for Haematology released guidance on vitamin B12 replacement during the COVID-19 pandemic. This may be helpful as it gives guidance on when oral cyanocobalamin tablets may be an appropriate alternative due to the pandemic. There is also further guidance from the Specialist Pharmacy Service on prescribing considerations and formulations of oral vitamin B12.
From open prescribing figures, it can be seen that hydroxocobalamin 1mg/ml solution for injection has been prescribed throughout the pandemic for patients at practices in NHS Kernow, 29,962 items have been issued in the last 12 months.
From further review of figures at clinical commissioning group level, data from open prescribing shows NHS Kernow prescribed 3,523 hydroxocobalamin 1mg/ml injections in January 2020, before the pandemic. Compared to 1,772 prescriptions in May 2020, which was during the first lockdown.
For information, a longer-term comparison of data over the last 3 years shows 3,118 hydroxocobalamin 1mg/ml injections were prescribed in NHS Kernow in June 2019, 2,246 in June 2020 and 2,914 in June 2021.
Data for cyanocobalamin 1mg tablets shows no prescribing in June 2019, 157 items in June 2020 and 114 items in June 2021. There are other strengths of cyanocobalamin available dependent on the indication for treatment, for example, cyanocobalamin 50microgram tablets. Data for cyanocobalamin 50microgram tablets shows NHS Kernow prescribed 401 items in June 2019, 1,014 in June 2020 and 1,078 in June 2021.
This data demonstrates that some patients were switched from hydroxocobalamin injections to cyanocobalamin tablets during the pandemic, which was in line with the guidance linked above and to reduce need for patients to visit their GP practice during the pandemic.
Although prescribing of hydroxocobalamin injection reduced during the pandemic and some patients changed to cyanocobalamin tablets, some patients continued injections. Oral vitamin B12 replacement may not have been suitable for all patients depending on indication for treatment. Data also demonstrates patients are still being prescribed injections currently.