Operations to be offered in Wales to take pressure off Cornwall hospitals
It comes after the Royal Cornwall Hospitals Trust declared the highest alert level
Cornish patients on long waiting lists will be offered operations elsewhere in the UK, including in Wales, in a bid to ease pressure on hospitals in Truro and Plymouth, both of which are currently on the highest alert level for pressure and patient safety.
A meeting of Cornwall Council’s health and adult social care overview and scrutiny committee heard about plans to improve patient care at the Royal Cornwall Hospital, Treliske, Truro in a bid to ease pressure on the emergency department (ED), queuing ambulances and over-stretched waiting lists for operations.
This would include offering patients earlier operations out of county including in Wales, Somerset and Devon.
The presentation by Kate Maynard, interim chief operating officer at NHS Cornwall and Isles of Scilly, comes as both Treliske and Derriford Hospital in Plymouth were placed at Operations Pressure Escalation Levels (Opel) 4 alert level.
Opel is a method used by the NHS to measure the stress, demand and pressure a hospital is under, with Opel 4 representing the highest escalation level. Opel 4 is declared when a hospital is “unable to deliver comprehensive care” and patient safety is at risk.
Both hospitals said the pressure had gradually built up over the course of the past week or so and had now reached almost unmanageable levels. The Royal Cornwall Hospitals Trust (RCHT) declared it was at Opel 4 on October 3.
Presenting the results of a health performance metric to councillors on the scrutiny committee, Ms Maynard said: "The system as a whole is continuing to struggle.
"We’ve got very high levels of ED occupancy; lots of patients attending. It’s overcrowded in there and ambulances are waiting frequently on the forecourts – it’s not good.
"There are high levels of bed occupancy within the Treliske site and high levels of delay for patients needing to leave hospital if they need support, either in their own bed, their own home or in a care home.
"All of that brings a higher risk of harm, which is what we’re really concerned about. The plans for winter are very much an intermediate care strategy, so it’s focusing on keeping people well and safe at home, avoiding admissions wherever we can to the acute hospital and particularly for the frail and elderly."
She added: "We’re planning increased provision of alternatives to going into hospital, so at home or support in the community assessment treatment units (CATUs).
"We’re also focusing on patients that do have to be admitted and have the same opportunity to be turned around and cared for at home. Very often that doesn’t happen and they become an automatic admission.
"For those who are acutely unwell and need to be in hospital, we want to ensure that they have a rapid admission through ED and get to the right specialist in a timely way and we would like to minimise the delay that currently exists when they need to go home. We all want to have a much better winter than previously."
Ms Maynard pointed out that the metric shows that Cornwall still has a number of patients waiting for 104 weeks (two years) for an operation.
She said: "These are primarily at Plymouth and they’re primarily neurosurgery spinal patients. These are complex procedures and the numbers are reducing. Nobody should be waiting over 65 weeks by March next year, which follows the previous aims that no one should be waiting for 104 weeks.
"There remain a significant number of patients waiting over 78 weeks as well, which of course should be zero. Again, a large proportion are at Plymouth and that would be to do with the complexity, but nearly two-thirds are at RCHT and the majority are orthopaedics.
"It’s fair to say that RCHT has been struggling to get on top of the orthopaedic waiting list which has increased significantly since pre-pandemic for a number of reasons; not only the direct impact which the whole country felt with waiting lists going up, but a change in operating model of moving services to St Michael’s (hospital in Hayle) and winter pressures.
"That’s all resulted in the last couple of years in a much lower capacity as the waiting lists have gone up. There’s lots of support going in to help RCHT; there’s regional overview and national support as well. A new model of productivity and efficiency includes longer operating sessions through the week and weekends."
She added: "That is still a work in progress and a large number of patients are waiting at 65 weeks at the end of the year, so we’re also exploring some independent sector capacity outside Cornwall – Devon, Somerset, some in Wales actually. That’s available and we have to see if patients would be happy to travel to take that opportunity up."
There is a new faster diagnosis standard for cancer treatment, which means an appointment to see a specialist and resultant diagnosis should be made within 28 days. Cornwall is slightly under the 75 per cent standard with a 74.2 per cent success rate.
Ms Maynard said the focus now is on the specialities which are “not quite achieving that so well”, including skin, lower gastrointestinal and gynaecological cancers.
The other key metric is where 85 per cent of patients should see their cancer treatment start within 62 days of referral. Cornwall Integrated Care Board’s (ICB) performance is currently around 63 per cent. "It’s improving but our focus is on the numbers of patients who are waiting over 62 days, which is 294 at the moment and we need to get that down to around 50 by the end of March," she stressed.
Following her presentation, Cllr Armand Toms said: "Just this weekend Derriford had 33 ambulances waiting outside with over 100 patients waiting inside. They’re on Opel 4 as is Treliske.
"I’m a layperson and my thing with all of this is we have been told for years and years and years that Derriford is 71 beds short of what it should be and Treliske is also, with a number I can’t remember. It must be a capacity issue – there is an insufficient number of beds for people who live in the area.
"The increase in population and the number of houses that are being built in Cornwall is going to bring a lot more people in, with 30 per cent of people who are retired. When can we see some of these situations changing because if you’re going to get a lot more older people and not have that capacity in both Treliske and Derriford, how are we going to cope in the next five to ten years? I can’t see with what we’ve got how things are going to get markedly better."
Ms Maynard responded: "You’d be absolutely right if we were going to stick with the same model of care which we’ve had for a long, long time, but the new model of care which is essentially this intermediate care strategy is about recognising that the acute hospital is not the best place always for frail elderly patients and what we need to be providing is alternatives to that.
"Many argue, and I would agree with this, that the acute hospital bed is often the worst place for a frail elderly patient to be because of the harm associated with that, so the plan is to provide those alternatives so a number of patients each day don’t go automatically into ED and then get caught up in that acute system. Instead they’re cared for at home under a GP and the community teams or in one of the community hospital beds.
"The work we’ve done around all of that shows that there would be enough acute beds for those acutely unwell patients that do need that bed. You wouldn’t get that degree of overcrowding in ED and ambulances waiting on the forecourts, because that is no good for anybody whatsoever."
Ms Maynard said that Cornwall is in the highest tier in the country, meaning it’s one of the areas struggling the most, as is Plymouth.
She said the problems faced by Treliske and Derriford were “absolutely recognised nationally” and additional support has been forthcoming on a national level.
Cllr Nicky Chopak said: "I have a long-term frustration – the old adage of moving the chairs around on the Titanic. The everyday resident of Cornwall isn’t really interested if we’re in Tier 1 or 2, it’s how that affects them as a patient whether trying to get a GP appointment or accessing A&E. How long do we have to be in Tier 1 before we see an improvement?"
The interim boss of the NHS in Cornwall replied: "Six million dollar question there. I believe in our plans for winter, but I think we’ll be in Tier 1 into next year."