Calls for more support and less criticism for Cornwall's NHS staff amid watchdog report
The CQC says 'significant work' is needed to reduce pressure on urgent care in Cornwall
There are calls for Cornwall's NHS staff to be given more praise and less criticism following the publication of a health watchdog report.
The Care Quality Commission (CQC) been looking at how services respond to challenges within the new Cornwall and Isles of Scilly Integrated Care System and carried out a series of inspections in April.
It found a lack of joined up communication resulted in long waits for assessment and treatment for patients.
The report, which has been released today (27th May), highlighted issues such as delays in 999 responses, bed-blocking, a shortage of district nurses and exhausted staff.
We are told there needs to be closer working between organisations to ensure no patients are at risk of harm and that their needs are met.
Bosses say there has been "unprecedented strain" on services over the past two years. Since the inspections were carried out our health system has come out of operating at a 'critical incident' level, which was first declared last October.
Chair of campaign group Save our NHS Cornwall, member of Cornwall's Health Scrutiny Committee and former MP, Andrew George claims the issues come down to failed policy and says our NHS staff deserve more support.
He told us: "The fundamental reason why there are 20 or more ambulances queued outside the emergency department at Treliske, and the consequences throughout the whole health system which is clearly at breaking point and failing, is in fact policy failures from above.
"What that has resulted in is intolerable pressure for frontline health care staff, doctors and nurses on the frontline, failure to retain valuable staff because of the pressure they are put under and the consequences that we can see before us today, you know, those are the issues that need to be addressed.
"We have stood on our doorsteps and applauded them, as have government ministers, but they haven't really backed staff up to give them the support that they need. The pressure that they have been under has been intolerable, of course mistakes are made when the pressure is intense as it is in the frontline here in Cornwall, and indeed the rest of the country, but in Cornwall in particular the difficulties are very, very significant."
What did the report find?
The Care Quality Commission says across the board inspectors found:
• There were significant delays to people’s treatment across GP care, urgent care, 999 and hospital services which put people at risk of harm.
• GP practices reported concerns about significant delays in 999 responses for patients who were seriously unwell, resulting in GPs needing to provide emergency treatment or extended care while waiting for an ambulance.
• GPs also reported a shortage of district nurses in Cornwall and a lack of availability in mental health services, which resulted in people’s needs not being suitably met.
• Other services were only available in specific geographical areas and during particular times, making it challenging for front line ambulance crews to know what services they could access and when. In addition, ambulance staff were not always allowed to make referrals to alternative services. The complexity of these pathways often resulted in patients being conveyed to the emergency department.
• Urgent care services were available in the community, including urgent treatment centres and minor illness and injury units and these services were promoted across Cornwall. These services adapted where possible to the change in pressures across the county. When services experienced staffing issues, some units would be closed.
• When a decision was made to close a minor injury unit (MIU) the trust diverted patients to the nearest alternative MIU and updated the systems directory of services to reflect this. However, this carried a potential risk of increased waiting times in other minor injury units and of more people attending emergency departments to access treatment. This had been highlighted on the trust’s risk register.
• Hospital wards were frequently being adapted to meet changes in demand and due to the impact of COVID-19. There was a significant number of people who were medically fit for discharge but remaining in the hospital impacting on the care delivered to other patients. The hospital had created additional space to accommodate patients who were fit for discharge but were awaiting care packages in the community; however, staff were stretched to care for these patients.
• A care hotel has been established in Cornwall providing very short-term care for people with very low levels of care needs; this is working well for those who meet the criteria for staying in the hotel, however this is a relatively small number of people.
What do health bosses say?
Speaking on behalf of Cornwall and Isles of Scilly’s integrated care system, Chief Executive Officer Kate Shields said: "As CQC has recognised, health and care staff working across our system have worked incredibly hard and under challenging circumstances during the past two years to make sure people get the care they need, when they need it.
"There has been high demand for primary and secondary care, mental health services and adult social care. Alongside this we have delivered our successful vaccination programme, and responded to the peak in COVID-19 infections which affected both patients and our staff, at the same time as our usual winter pressures.
"This placed unprecedented strain across our services, and together we have worked to stretch and expand our services to support those needing our care. The pressure is most clearly seen in longer waits for ambulances and for patients to be admitted to hospital.
"I am pleased that since CQC’s visit we have been able to come out of our critical incident, which we achieved by working as 1 system and will continue to do so over coming months.
"The CQC clearly recognises our biggest challenge as an integrated care system is creating a sustainable workforce, with a particular focus on encouraging people to work in domiciliary and adult social care to support those want to be in their own homes.
"It is so rewarding to be able to help people to maintain their independence in familiar surroundings and I would encourage anyone who is looking to start a career, for a change in direction, or the next step on their career ladder to visit our proud to care website to find out more about the varied, flexible and secure jobs we can offer".