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Healthcare in
Cornwall Cornwall (; kw, Kernow ) is a historic county and ceremonial county in South West England. It is recognised as one of the Celtic nations, and is the homeland of the Cornish people. Cornwall is bordered to the north and west by the Atlantic ...
, United Kingdom, was, until July 2022, the responsibility of Kernow
clinical commissioning group Clinical commissioning groups (CCGs) were NHS organisations set up by the Health and Social Care Act 2012 to organise the delivery of NHS services in each of their local areas in England. On 1 July 2022 they were abolished and replaced by Integra ...
, a
National Health Service The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom (UK). Since 1948, they have been funded out of general taxation. There are three systems which are referred to using the " ...
(NHS) organisation set up by the
Health and Social Care Act 2012 The Health and Social Care Act 2012c 7 is an act of the Parliament of the United Kingdom. It provided for the most extensive reorganisation of the structure of the National Health Service in England to date.''BMJ'', 2011; 342:d408Dr Lansley's Mon ...
to organise the delivery of NHS services in England. As far as the NHS is concerned, Cornwall includes the
Isles of Scilly The Isles of Scilly (; kw, Syllan, ', or ) is an archipelago off the southwestern tip of Cornwall, England. One of the islands, St Agnes, is the most southerly point in Britain, being over further south than the most southerly point of the ...
.


History

From 1947 to 1974, NHS services in Cornwall were managed by the South-Western
Regional Hospital Board In geography, regions, otherwise referred to as zones, lands or territories, are areas that are broadly divided by physical characteristics (physical geography), human impact characteristics (human geography), and the interaction of humanity and t ...
. In 1974 the boards were abolished and replaced by regional health authorities. Cornwall came under the South West RHA. Regions were reorganised in 1996 and
Devon Devon ( , historically known as Devonshire , ) is a ceremonial and non-metropolitan county in South West England. The most populous settlement in Devon is the city of Plymouth, followed by Devon's county town, the city of Exeter. Devon is ...
came under the South and West (Wessex and South Western) Regional Health Authority. Cornwall and Isles of Scilly constituted a
district health authority A district health authority was an administrative territorial entity of the National Health Service in England and Wales introduced by the National Health Service Reorganisation Act 1973. District health authorities existed in Britain from 1974 t ...
from 1974 until 2002 when Cornwall and Isles of Scilly
Primary Care Trust Primary care trusts (PCTs) were part of the National Health Service in England from 2001 to 2013. PCTs were largely administrative bodies, responsible for commissioning primary, community and secondary health services from providers. Until 31 May ...
was established. This was managed by the South West Peninsula
Strategic Health Authority Strategic health authorities (SHA) were part of the structure of the National Health Service in England between 2002 and 2013. Each SHA was responsible for managing performance, enacting directives and implementing health policy as required by the ...
from 2002 until 2006 when that was merged into NHS South West. The PCT and the strategic health authority were abolished in 2012. A report by the
Care Quality Commission The Care Quality Commission (CQC) is an executive non-departmental public body of the Department of Health and Social Care of the United Kingdom. It was established in 2009 to regulate and inspect health and social care services in England. I ...
in October 2017 found that the county's health and social care system ‘is not working well together’, that different parts of the system are not working together to ensure people can move between services as they need them, and that too many people were stuck in hospital waiting for a social care package or a place in a residential establishment.


Sustainability and transformation plans

In July 2015 a devolution deal, the Deal for Cornwall, was announced by the
government A government is the system or group of people governing an organized community, generally a state. In the case of its broad associative definition, government normally consists of legislature, executive, and judiciary. Government is a ...
under which
Cornwall Council Cornwall Council ( kw, Konsel Kernow) is the unitary authority for Cornwall in the United Kingdom, not including the Isles of Scilly, which has its own unitary council. The council, and its predecessor Cornwall County Council, has a tradition o ...
and the Council of the
Isles of Scilly The Isles of Scilly (; kw, Syllan, ', or ) is an archipelago off the southwestern tip of Cornwall, England. One of the islands, St Agnes, is the most southerly point in Britain, being over further south than the most southerly point of the ...
are to create a plan to bring health and social care services together under local control. The Sustainability and transformation plan says that the 13 community hospitals in the area with a total capacity of 314 beds are not used effectively, not fit for purpose and are not sustainable. It proposes to develop integrated community care hubs primarily for care of the elderly and to integrate
NHS 111 111 is a free-to-call single non-emergency number medical helpline operating in England, Scotland and parts of Wales. The 111 phone service has replaced the various non-geographic 0845 rate numbers and is part of each country's National Health S ...
and the
out-of-hours service Out-of-hours services are the arrangements to provide access to healthcare at times when General Practitioner surgeries are closed; in the United Kingdom this is normally between 6.30pm and 8am, at weekends, at Bank Holidays and sometimes if the ...
. The CCG’s savings target for 2017/8 is £29.6 million but it has "no viable plan" to achieve this.
Royal Cornwall Hospitals NHS Trust The Royal Cornwall Hospitals NHS Trust is an NHS trust which runs West Cornwall Hospital, St Michael's Hospital, Royal Cornwall Hospital, and St Austell Hospital - Penrice Birthing Unit, in Cornwall, England. History The trust was established ...
and
Cornwall Partnership NHS Foundation Trust Cornwall Partnership NHS Foundation Trust provides community health services to children and young people and mental health and learning disability services to people of all ages across Cornwall, England. It runs Longreach House in Redruth, and B ...
established a joint board in July 2017 to “gradually unite clinical and non-clinical services" - a step towards the creation of an
accountable care system An accountable care system is a system of healthcare provision which is intended to be integrated, and in particular to merge the funding of primary care with that for hospital care, therefore providing incentives to keep people healthy and out of ...
. In March 2018, after protests,
Cornwall Council Cornwall Council ( kw, Konsel Kernow) is the unitary authority for Cornwall in the United Kingdom, not including the Isles of Scilly, which has its own unitary council. The council, and its predecessor Cornwall County Council, has a tradition o ...
announced that it was abandoning proposals to establish an Accountable Care System but they would continue to support the integration of health and care services. They said they would strengthen the existing Health and Wellbeing Board to become a more effective decision making body. Cllr Andy Virr, the Conservative health spokesperson, said that kind words regarding working together were vacuous without a commitment to integrate and combine budgets.


Commissioning

Kernow
Clinical Commissioning Group Clinical commissioning groups (CCGs) were NHS organisations set up by the Health and Social Care Act 2012 to organise the delivery of NHS services in each of their local areas in England. On 1 July 2022 they were abolished and replaced by Integra ...
was placed under legal directions by
NHS England NHS England, officially the NHS Commissioning Board, is an executive non-departmental public body of the Department of Health and Social Care. It oversees the budget, planning, delivery and day-to-day operation of the commissioning side of the ...
in December 2015. It has a budget of £728.7 million and expects a deficit of £14 million for 2015/16. It is required to have a turnaround director in place. Keith Pringle, who had previously worked with CCGs in Hampshire and at
Gloucestershire Hospitals NHS Foundation Trust Gloucestershire Hospitals NHS Foundation Trust runs Gloucestershire Royal Hospital, an NHS district general hospital in Great Western Road, Gloucester, England. It serves western and southern Gloucestershire and parts of Herefordshire. It also ru ...
was employed at a cost of £396,000 in 2015/6 including agency fees. Cornwall was one of the four areas chosen to trial the integration of specialised commissioning, previously run by
NHS England NHS England, officially the NHS Commissioning Board, is an executive non-departmental public body of the Department of Health and Social Care. It oversees the budget, planning, delivery and day-to-day operation of the commissioning side of the ...
centrally, in September 2016. In September 2017 it was forecasting a £37 million deficit and had “no viable plan” to hit its control total, a £19.9 million deficit on its allocated £765 million, in the financial year. The clinical commissioning group proposed in October 2017 that it would no longer pay for non-emergency patient transport to hospital patients who frequently travel to hospital. The policy would particularly impact kidney dialysis patients, who typically have to visit hospital three times a week. The service has been supplied by E-zec Medical Transport Services Ltd. since summer 2016. In December 2017 it was announced that
Cornwall Council Cornwall Council ( kw, Konsel Kernow) is the unitary authority for Cornwall in the United Kingdom, not including the Isles of Scilly, which has its own unitary council. The council, and its predecessor Cornwall County Council, has a tradition o ...
was to take over the functions of Kernow Clinical Commissioning Group as part of the development of an
accountable care system An accountable care system is a system of healthcare provision which is intended to be integrated, and in particular to merge the funding of primary care with that for hospital care, therefore providing incentives to keep people healthy and out of ...
for the county. Services are to be provided by one or more “accountable care partnerships” led by the existing NHS providers. According to Cllr Rotchell “Cornwall Council will ultimately become the strategic commissioner for all healthcare for Cornwall that is commissioned by the CCG. The longer term plan is that the CCG becomes a department within Cornwall Council and we will buy services from the providers.”


Primary and Community Care

There are 69 GP practices in the county. St Mary’s hospital on the Isles of Scilly is a small community hospital with a Minor Injuries Unit run by
Peninsula Community Health Peninsula Community Health was a community interest company created in October 2011 as not-for-profit service provider by Cornwall and Isles of Scilly Primary Care Trust. It ran 14 community hospitals in Cornwall: Bodmin Hospital, Camborne Redr ...
which also runs community hospitals all over Cornwall. The
Out-of-hours service Out-of-hours services are the arrangements to provide access to healthcare at times when General Practitioner surgeries are closed; in the United Kingdom this is normally between 6.30pm and 8am, at weekends, at Bank Holidays and sometimes if the ...
contract, worth £8m a year, from 2015 was awarded to Devon Doctors, a GP led social enterprise, and Kernow Health CIC, a community interest company run by member practices. The consortium will operate under the name Cornwall Health. In 2017 it was announced that a £48m contract for
Out-of-hours service Out-of-hours services are the arrangements to provide access to healthcare at times when General Practitioner surgeries are closed; in the United Kingdom this is normally between 6.30pm and 8am, at weekends, at Bank Holidays and sometimes if the ...
GP and 111 services had been awarded to a consortium of
Royal Cornwall Hospitals NHS Trust The Royal Cornwall Hospitals NHS Trust is an NHS trust which runs West Cornwall Hospital, St Michael's Hospital, Royal Cornwall Hospital, and St Austell Hospital - Penrice Birthing Unit, in Cornwall, England. History The trust was established ...
, Kernow Health
Community Interest Company A community interest company (CIC, colloquially pronounced "kick") is a type of company introduced by the United Kingdom government in 2005 under the Companies (Audit, Investigations and Community Enterprise) Act 2004, designed for social ente ...
and
Vocare Vocare is a provider of Out-of-hours services to the NHS in England based in Newcastle upon Tyne. The firm started in 1996 as Northern Doctors Urgent Care GP co-operative, run by family doctors in Northumberland who were then responsible for 24 hou ...
. Palliative care is provided by
Cornwall Hospice Care Cornwall Hospice Care is a charity-funded hospice based in Cornwall, England, established in 1980 providing palliative care. It operates Mount Edgcumbe Hospice in St Austell and St Julia's Hospice in Hayle. From 1999 until 2006 the two hospices w ...
. During 2015 there was a programme funded with £44.5m from the Better Care Fund intended to ensure care packages were available for patients leaving hospitals in Cornwall but between July and September a total of 3,815 hospital bed days were lost because of problems with social care packages, compared with 2,255 days for the same period in 2014, meaning that there were 69% more delays in discharging people from hospital. Community services were provided by
Peninsula Community Health Peninsula Community Health was a community interest company created in October 2011 as not-for-profit service provider by Cornwall and Isles of Scilly Primary Care Trust. It ran 14 community hospitals in Cornwall: Bodmin Hospital, Camborne Redr ...
from 2011 but from April 2016 will be taken over by a consortium of Royal Cornwall Hospitals NHS Trust, Cornwall Partnership NHS Foundation Trust and Kernow Health CIC. In May 2017 there was a backlog of 14,000 people unable to register with an NHS dentist in the county. Waiting times for routine appointments were up to eighteen months.
Cornwall Council Cornwall Council ( kw, Konsel Kernow) is the unitary authority for Cornwall in the United Kingdom, not including the Isles of Scilly, which has its own unitary council. The council, and its predecessor Cornwall County Council, has a tradition o ...
confirmed
Mears Group Mears Group plc is a housing and social care provider. It repairs and maintains over 700,000 social homes across the UK. History The company was founded in 1988 in Gloucestershire, where it is still based, and floated on the Alternative Invest ...
as lead strategic partner for the delivery of extra care in Cornwall with a seven year agreement for 750 extra care housing units worth £150 million.


Healthwatch

Healthwatch HealthWatch is a UK charity which promotes evidence-based medicine. Its formal aims are: # The assessment and testing of treatments, whether “orthodox” or “alternative”; # Consumer protection of all forms of health care, both by thorou ...
was set up under the
Health and Social Care Act 2012 The Health and Social Care Act 2012c 7 is an act of the Parliament of the United Kingdom. It provided for the most extensive reorganisation of the structure of the National Health Service in England to date.''BMJ'', 2011; 342:d408Dr Lansley's Mon ...
to act as a voice for patients. There is one Healthwatch for Cornwall and a separate Healthwatch for the
Isles of Scilly The Isles of Scilly (; kw, Syllan, ', or ) is an archipelago off the southwestern tip of Cornwall, England. One of the islands, St Agnes, is the most southerly point in Britain, being over further south than the most southerly point of the ...
.


Mental health

NHS mental health services in the county are largely provided by
Cornwall Partnership NHS Foundation Trust Cornwall Partnership NHS Foundation Trust provides community health services to children and young people and mental health and learning disability services to people of all ages across Cornwall, England. It runs Longreach House in Redruth, and B ...
. According to the trust between 8 and 12 patients a month have to be sent out of Cornwall, because there is an "inadequate provision" of beds.


Hospital and acute care

Royal Cornwall Hospitals NHS Trust The Royal Cornwall Hospitals NHS Trust is an NHS trust which runs West Cornwall Hospital, St Michael's Hospital, Royal Cornwall Hospital, and St Austell Hospital - Penrice Birthing Unit, in Cornwall, England. History The trust was established ...
provides hospital care in the west of the county.
University Hospitals Plymouth NHS Trust University Hospitals Plymouth NHS Trust, formerly known as Plymouth Hospitals NHS Trust is the organisation which runs Derriford Hospital, and the co-located Royal Eye Infirmary (REI), as well as the Child Development Centre in Plymouth, Devon. ...
serves the east. Specialised services are provided from other trusts outside the area.
Cornwall Air Ambulance The Cornwall Air Ambulance Trust is a charity that provides a dedicated helicopter emergency medical service (HEMS) for Cornwall and the Isles of Scilly. The service also has two critical care cars that operate when the helicopter is unable ...
was the first dedicated helicopter emergency medical service operational in the United Kingdom. The Duchy Hospital in Truro run by
Ramsay Health Care UK Ramsay Health Care UK is a healthcare company based in the United Kingdom. It was founded by Australian businessman Paul Ramsay, who established its parent company: Ramsay Health Care, in Sydney, Australia, in 1964 and has grown to become a global ...
is the only private hospital in the County. It has 27 in-patient beds. In May 2015 it was reported that
Cornwall Partnership NHS Foundation Trust Cornwall Partnership NHS Foundation Trust provides community health services to children and young people and mental health and learning disability services to people of all ages across Cornwall, England. It runs Longreach House in Redruth, and B ...
and
Royal Cornwall Hospitals NHS Trust The Royal Cornwall Hospitals NHS Trust is an NHS trust which runs West Cornwall Hospital, St Michael's Hospital, Royal Cornwall Hospital, and St Austell Hospital - Penrice Birthing Unit, in Cornwall, England. History The trust was established ...
were considering a merger. In March 2022 it was announced, after prolonged and repeated delays, that the merger would not be going ahead. Cornwall had 134 patients, the second-highest number in England, waiting more than 12 months for treatment in November 2018 Staff at South Western Ambulance Service NHS Foundation Trust reported 29 serious incidents in Cornwall between October and December 2021 during an inspection by the
Care Quality Commission The Care Quality Commission (CQC) is an executive non-departmental public body of the Department of Health and Social Care of the United Kingdom. It was established in 2009 to regulate and inspect health and social care services in England. I ...
. The inspectors reported that exhaustion was leading to “high levels of staff sickness and staff resignations” with high vacancy rates for nursing staff in adult social care services. They also found a “lack of joined up communication across the system has resulted in people facing lengthy delays as they wait for assessment and treatment”. In August 2022 the average waiting time for category 2 calls was “hovering around 200 minutes when the national target response time is 18 minutes. Nearly half of the trust’s community beds were occupied by patients who were medically fit to leave but waiting to be placed in their next care setting.


See also

*
Healthcare in the United Kingdom Healthcare in the United Kingdom is a devolved matter, with England, Northern Ireland, Scotland and Wales each having their own systems of publicly funded healthcare, funded by and accountable to separate governments and parliaments, together wit ...


References

{{reflist


External links


Cornwall Mental Health

Kernow clinical commissioning group
Cornwall Cornwall (; kw, Kernow ) is a historic county and ceremonial county in South West England. It is recognised as one of the Celtic nations, and is the homeland of the Cornish people. Cornwall is bordered to the north and west by the Atlantic ...
Isles of Scilly