Frequently asked questions

Questions raised during the conversations:

  1. Volunteer drivers are needed. Could this be subsidised?
  2. Could more clinics be run by nurses, and could St Barnabas be used for this?
  3. Is there money in the system to open St Barnabas to inpatients now?
  4. Could a hub for activities be a new use for St Barnabas?
  5. Can St Barnabas be sold?
  6. Can the hospital be knocked down or extensions added at the back?
  7. Can the use of the hospital be changed?
  8. If St Barnabas is sold can the money be ring-fenced for Saltash?
  9. Could we have a 16 bed hospital?
  10. What are the waiting times for people in Derriford waiting to come back to Saltash?
  11. What impact has the temporary closure of St Barnabas inpatient beds had on the wait times for people at Derriford?
  12. Can delays from Derriford be lowered?
  13. Who controls where section 106 money is spent?
  14. Could they bring the Derriford consultants to St Barnabas and run the outpatient clinics there?
  15. Could we have a purpose-built facility which could accommodate GPs, health and social care and provide convalescent beds?
  16. Could GP surgeries offer more services so people have more things done in the community before going to see the consultant in Derriford?
  17. Can we provide a community service for people who are frail entirely without hospital beds?
  18. Is there any sort of restrictive covenant on St Barnabas?
  19. Is there different funding available for improvement?
  20. Is the upkeep being done?
  21. Can we get figures prior to 2015 when it was an out of hours rather than just 8am to 3pm to show a better picture of the usage?
  22. Why wouldn’t the MIU at the GPs treat my son’s leg recently? 
  23. When is the transfusion/infusion unit going to start?
  24. Is adult social care involved with current discussions?
  25. What is extra care housing?
  26. Who owns extra care facilities?
  27. Who runs extra care housing? Is it NHS or private?
  28. Do residents pay to live in extra care housing or is it funded?
  29. How do we know what MIU services the GPs provide or where we should go for what services?

1. Volunteer drivers are needed. Could this be subsidised?

There is a patient transport service available for people who are unable to get to their NHS appointments or treatments because they have a medical need for special transport. To be eligible for the service, people must need support or assistance during the journey to their healthcare appointment. People who think they may qualify for NHS transport should telephone 01872 252211 (Monday to Friday 8am to 8pm, weekends and bank holidays 9.30am to 5pm).

Volunteer Cornwall also runs a community transport scheme. If someone cannot drive, or cannot use public transport, Volunteer Cornwall will always try to find a volunteer willing to help in the local area. The cost is 42p per mile, plus a £2 administration fee. Bookings are via telephone: 01872 265300, or email: bookings@volunteercornwall.org.uk

Community Enterprises PL12 also hire out Hopper buses, run a regular link service on a Wednesday connecting people from Saltash with the stores in Fore Street and at Carkeel, and they also run day trips to local attractions. If you have any questions about any of the Hopper services please call 01752 848348 or pop in to the Hub at 4 Fore Street, Saltash, our email the transport team at transport@cepl12.co.uk

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2. Could more clinics be run by nurses, and could St Barnabas be used for this?

St Barnabas already runs a number of clinics. These are provided by staff from Cornwall Partnership NHS Foundation Trust (CFT) and consultants from University Hospitals Plymouth (UHP, formerly known as Derriford). The CFT clinics include nurse and therapy led clinics covering specialisms such as physiotherapy and memory clinics. The consultant-led clinics are supported by CFT healthcare assistants. In the 12 months from February 2017 to March 2018 there were approximately 3,000 clinic attendances - most of these for physiotherapy.

Use of the hospital for ongoing provision of clinics will be included in part of this review if the local stakeholders wish to explore this as part of developing options.

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3. Is there money in the system to open St Barnabas to inpatients now?

St Barnabas is temporarily closed to inpatients. The nine beds within St Barnabas are split over two floors, separated by a mezzanine. For safety reasons, this restricts the type of people who could be treated as an inpatient. The doorways and lift also do not allow for transfer of people in a bed which presents a safety concern from a fire evacuation point.

Staff from St Barnabas hospital were transferred to Liskeard hospital to support the provision of safe staffing levels for the larger number of inpatient beds. This was due to staff recruitment challenges in Liskeard.

The backlog maintenance costs to address some of the above environmental building concerns was estimated to be at a minimum of £1.3million in 2016 and even completion of these may not guarantee the site is fit for inpatient use.

NHS Property Services (NHS PS) owns the building, and is responsible for the backlog maintenance. NHS PS is unable to commit to investing large sums of money into an estate where there is lack of clarity on its role and future. This engagement process will determine the future role of St Barnabas Hospital.

In addition, all backlog maintenance requests for any local asset will be subject to a prioritisation process.

In view of this, all potential options for the future use of St Barnabas will be explored as part of this engagement process. Each option will then be evaluated against a list of agreed evaluation criteria.

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4. Could a hub for activities be a new use for St Barnabas?

All potential options for the future use of St Barnabas will be explored as part of this process. Each option will then be evaluated against a list of agreed evaluation criteria.

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5. Can St Barnabas be sold?

The hospital is owned by NHS Property Services (NHS PS) and leased to CFT which is the main provider of services in the hospital. The hospital can be sold if it is no longer required for the local health system and is therefore declared surplus to local NHS requirements. 

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6. Can the hospital be knocked down or extensions added at the back?

In theory yes, subject to planning permission, a requirement by the local health system to the proposal and sufficient funding.

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7. Can the use of the hospital be changed?

Initial legal searches show there are minimal constraints or restrictions on the hospital (such as covenants and listings). A full and more detailed assessment will be undertaken on any preferred option. The use can therefore be changed subject to planning permission, a requirement by the local health system to the proposal and sufficient funding.

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8. If St Barnabas is sold can the money be ring-fenced for Saltash?

Initial queries suggest the site is marketable. Monies generated from a sale are recirculated into the health economy on a needs basis assessed nationally. The presumption is that any funds received by NHS PS as sale proceeds are invested back in to the NHS via the Department of Health and Social Care, unless there is a persuasive business case to invest the sale proceeds in Cornwall. This business case will be submitted through the local Sustainability and Transformation Partnership. For Cornwall and the Isles of Scilly this is the Shaping our Future Programme. The outcome will be determined nationally.

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9. Could we have a 16 bed hospital?

All potential options for local services will be explored as part of this process. Each option will then be evaluated against an agreed list of evaluation criteria.

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10. What are the waiting times for people in Derriford waiting to come back to Saltash?

We have requested data for this and will include this as soon as possible.

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11. What impact has the temporary closure of St Barnabas inpatient beds had on the wait times for people at Derriford?

We are awaiting data to show what the waiting time is for people in Derriford who live in the Saltash area.

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12. Can delays from Derriford be lowered?

Operational and managerial teams from Saltash and Plymouth communicate on a daily basis to ensure every available opportunity is made to improve the current processes in place. The daily conversations include reviewing each individual’s unique circumstances and providing solutions to allowing that person to be discharged in as timely a way as possible. Reducing delays remains, and will continue to be a priority.

CFT staff are now based in UHP, which aids these discussions. The focus from the CFT team working within UHP is to discharge people to their home with relevant support as the preferred option rather than to a community hospital bed.

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13. Who controls where section 106 money is spent?

There has been a slight disconnect between health, planning, housing and development of accommodation with care needs. We expect that to now change. Cornwall Council has recruited an experienced strategic commissioner for accommodation with care, and NHS Kernow and Cornwall Council have jointly funded a new post to determine how section 106 monies can be spent most effectively to support social care and health needs. Conversations are already taking place about the Broadmoor housing development.

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14. Could they bring the Derriford consultants to St Barnabas and run the outpatient clinics there?

There are already four Consultant led clinics with consultants from UHP. The clinics are colorectal surgery, ear, nose and throat (ENT), gastroenterology, ophthalmology and urology. In 2018, approximately 500 people were seen. Healthcare assistants support the consultant clinics. Increasing the consultant-led clinics would require the support of more staff. All potential options for local services will be explored as part of this process. Each option will then be evaluated against an agreed list of evaluation criteria.

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15. Could we have a purpose-built facility which could accommodate GPs, health and social care and provide convalescent beds?

All potential options for local services will be explored as part of this process. Each option will then be evaluated against an agreed list of evaluation criteria.

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16. Could GP surgeries offer more services so people have more things done in the community before going to see the consultant in Derriford?

GPs are part of this engagement process. All potential options for local services will be explored as part of this process. Each option will then be evaluated against an agreed list of evaluation criteria.

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17. Can we provide a community service for people who are frail entirely without hospital beds?

There are models around the country where people who are frail are managed in the community by multi-agency teams. The closest such model to us is Torbay and our local community teams have already undertaken a learning visit to determine what can be implemented in Cornwall.

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18. Is there any sort of restrictive covenant on St Barnabas?

The initial legal search indicates there aren’t any covenants. We would have to create a business case to put to the health and social care system, which would then be decided nationally. 

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19. Is there different funding available for improvement?

The level of investment would depend on use – i.e. an inpatient unit would need very high investment. The use as it is now (clinics) is not as much, due to there being no overnight stays. It is the same principle in terms of a single pot of money.

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20. Is the upkeep being done?

There is 75 staff there running clinics and the building is currently fit for that purpose.

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21. Can we get figures prior to 2015 when it was an out of hours rather than just 8am to 3pm to show a better picture of the usage?

It isn’t comparable. A different service was run out of St Barnabas than the one in Liskeard. The proportion of people that went to Liskeard stayed the same.

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22. Why wouldn’t the MIU at the GPs treat my son’s leg recently? 

There are limitations, especially if an X-ray is needed. In the case of a child they would almost certainly send on to Liskeard. It would be a clinical decision. 

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23. When is the transfusion/infusion unit going to start?

We need to have the right sort of patients for this (not too complicated) and also staff. It is early days so no date can be set. It wouldn’t be seven days a week and it might not be cost effective anyway. Acute care at home can do IV fluids/antibiotics and some meds. We are trying to expand that in care homes to keep people out of Derriford. We are asking Derriford to identify who they would like to handover. We are also looking at intermediate care and support services. Embrace Care are currently investigating all the resources we currently have. They have worked in other areas of the UK and are able to restructure what intermediate care in Cornwall might look like and how it can best work. 

There are reservations concerning the transfusion unit as it would be spending eight hours in a chair and not many patients would be fit for that. The room could also then not be used for anything else. The lift doesn’t take beds so no upstairs rooms would be suitable for patients. The benchmark has to be clinical need and patient safety. 
 
There are long delays in getting people home when they need specialised housing or adaptations to existing housing, e.g. for wheelchairs.
 
Moving activity from St Barnabas to Liskeard made it much easier for staffing. The average length of stay reduced from 21 to 14 days. Productivity in the locality improved. There was a reduced referral rate to manage the increased input in Liskeard. This also reduced pressure on Derriford.
 
The Home First Service with generic support workers (GSWs) meant many more people were seen for reablement at home - 93 per month in addition to baseline reablement. There are eight GSWs for each area.

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24. Is adult social care involved with current discussions?

Yes - ASC representatives are on the project group and distribution list. They are also working with Embrace Care. 

The discharge team is excellent. They are getting community workers in at Derriford to try and get people straight home rather than to community hospitals. Delays in Derriford are split between health and social care. 

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25. What is extra care housing?

Extra care housing combines accommodation with care and support services. The care is similar to that provided by care at home services and can flex according to people’s needs. There are many different types of extra care housing, from small communities of flats and bungalows to retirement villages.

The facilities and care provided will vary, but extra care housing schemes usually include:

  • Self-contained adapted flats or bungalows.
  • On-site care and support staff, providing personal care and domestic services.
  • Emergency alarms throughout the scheme, with 24-hour help available.
  • Communal facilities and services, such as a lounge, dining area and garden.

For more information, please visit Cornwall Council’s website.

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26. Who owns extra care facilities?

It depends on the delivery of care. There can either be two providers-one providing the housing and one the care provision, or one provider delivering both care and housing.

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27. Who runs extra care housing? Is it NHS or private?

Extra care housing is not an NHS facility. It is the provision of housing with care.

Cornwall Council is in the process of establishing a strategic partnership to deliver extra care housing in Cornwall.

For more information on the strategic partnership, please visit Cornwall Council’s website.

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28. Do residents pay to live in extra care housing or is it funded? 

 There are three elements to the cost of extra care housing:

  1. The cost of buying or renting your own home including utility bills.
  2. The service charges associated with your home for maintenance and any communal facilities.
  3. The cost of your personal care, lifestyle support and domestic support.

The amount you pay will vary depending on your individual situation and your income. You may have to pay for all of the costs, or you may be entitled to benefits to meet some or all of them. The intention is that both the rented units and the shared ownership units will be affordable models.

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29. How do we know what MIU services the GPs provide or where we should go for what services?

NHS Kernow’s Choose Well leaflet can be really helpful when people are deciding where to attend. You can also find out more in our Choose Well web pages.

The following list gives guidance on the types of injuries and circumstances that a GP minor injuries service can help with, although it is not completely comprehensive:

  • Cuts, lacerations, abrasions.
  • Simple local infections.
  • Cellulitis within five days of an injury.
  • Simple fractures.
  • Animal and human bites.
  • Insect bites and stings.
  • Removal of foreign bodies.
  • Soft tissue injuries.
  • Epistaxis.
  • Minor head injuries.
  • Burns.
  • Bruises due to trauma.
  • Eye injuries.

A GP minor injuries service cannot help with the following: 

  • 999 call (unless attending crew speak directly to the doctor).
  • Any person who cannot be discharged home after treatment.
  • Any person with airway, breathing, circulatory or neurological compromise.
  • Actual or suspected overdose.
  • Accidental ingestion, poisoning, fume or smoke inhalation.
  • Blows to the head with loss of consciousness.
  • Sudden collapse or fall in a public place.
  • Penetrating eye injury.
  • Chemical, biological, or radioactive contamination injured patients.
  • Full thickness burns.
  • Burns caused by electric shock.
  • Partial thickness burns over 3cm diameter.
  • New or unexpected bleeding from any body orifice if profuse.
  • Foreign bodies impacted in bodily orifices, especially in children.
  • Foreign bodies deeply embedded in tissues.
  • Trauma to hands, limbs or feet substantially affecting function.
  • Penetrating injuries to the head, to lacerating/penetrating injuries involving nerve, artery or tendon damage.

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