Cornwall redesigns services for isolated communities
The NHS in Cornwall has a small population spread over a large area, so is piloting new ways of delivering care outside of hospital
What’s the issue?
The NHS in Cornwall has been searching for ways to deliver care closer to people’s homes, despite the fact the county’s population of 500,000 is sparsely spread over 1,376 square miles.
A pilot urgent care model launched at the previously underused West Cornwall Hospital in June, alongside an expansion of elective services, is creating much interest. There are ambitions to replicate the model in varying degrees at other community hospitals in the county.
How did they bring in change?
West Cornwall Hospital is run by Royal Cornwall Hospitals Trust and has been the subject of local controversy for the past two decades; much of the local population was convinced Royal Cornwall and commissioners wanted to close it down. Local GPs from Kernow Clinical Commissioning Group - which covers the whole of Cornwall - got together with the trust’s emergency department lead, representatives from South West Ambulance Service Foundation Trust and the lead sister from West Cornwall to develop a plan. They sought considerable public input into their work.
What is the West Cornwall model?
Emergency medicine physicians and GPs now staff the hospital: two doctors are on duty during from noon to 5pm and at least one at other times. The hospital also has two medical wards, a surgical ward, operating suite, dialysis, outpatient department, diagnostics and a treatment centre. Most of the surgery is day case, with only about 4 per cent of patients staying overnight. In July, 843 elective patients were treated at the hospital, the largest number in any month for the past three years and a 20 per cent increase on July 2011.
Could the model be used elsewhere?
Bodmin, St Austell and Camborne and Redruth community hospitals have been identified as potential sites to replicate all or some of the West Cornwall model. All three are run by Peninsula Community Health and have minor injury units open from 8am-10pm and x-ray provision from 9am-5pm.
If the model was extended to the sites, the new services would likely be operated by Royal Cornwall. This plan has the benefit of improving patient experience by reducing travel times. Providing such services at other community hospitals, particularly Bodmin, fits in with Royal Cornwall’s ambition of increasing its market share by attracting patients in the east of the county who might otherwise have gone to Plymouth.
However, there is a local expectation that there will need to be changes to the tariff to make the model affordable in the long term. It will require cooperation from the Department of Health, which is usually reluctant to make radical changes to the tariff, or agreement by the CCG to reinvest savings released by the service in a way to make it sustainable.
What does the future hold?
There is a lot of enthusiasm, particularly from the provider side. The key difference is that while West Cornwall already had or was supposed to have a lot of the infrastructure needed to provide the services, the other community hospitals would need more investment.
Bodmin is likely to be the test case, with commissioners and providers taking the learning from West Cornwall Hospital, not least the importance of involving the public early on in the development of plans, to develop appropriate services.
- Which other South West hospital trust is interested in the model
- The role of the local clinical commissioning group in turning West Cornwall Hospital around
- The benefits to the ambulance service