Condition critical in Cornwall – the effect of long-term under-funding in a rural county where demands on the NHS and Social Care are high

Treliske ambulance queue by Stephen C Hick
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Last month a woman in Penzance was forced to wait all night for an emergency ambulance for her husband with suspected stroke, only to be told in the morning that she must drive him the 34-mile, one hour, journey to the county’s only Accident and Emergency Department, in Truro. Fortunately, investigations show this was a transient ischaemic attack, rather than a stroke, but there was no way the South West Ambulance Trust could have known that at the time.

We have sadly heard too many similar stories over the past few months. The Ambulance Trust has the worst record in the UK for the time it takes to respond to urgent calls. It first declared a Critical incident in October 2021 and the situation has not improved. Nor is the problem entirely caused by Covid. Another Keep Our NHS Public member from North Cornwall remembered in 2006 being advised to drive her husband to the nearest hospital, 25 miles away just over the border in Devon, because it would be so much quicker.  

Performance figures from Royal Cornwall Hospitals Trust show unacceptable numbers of people waiting in A&E well before the pandemic, but things are far worse now. Primary care, Maternity and Mental Health services all report increased demand and staff shortages. RCHT, our only NHS Acute Trust, has been at Opel level 4 almost every day since the summer, and the tea trolley now includes the ambulances outside A&E on its regular round. 

The Trust have taken drastic and expensive emergency measures, offering families up to £1,200 to take their relatives home more quickly, and buying hotel beds – but there are still around 180 people trapped in Treliske waiting for a Social Care Assessment, a Domiciliary Care package or a Care Home place. Another 500 people are at home, also waiting for the Social Care they have been assessed to need.

In January, Cornwall Council also declared a Critical Incident for social care [1]. Declaring a Critical Incident does not increase the resources available to Cornwall Council for Social Care. Instead, it tolerates a higher level of risk, not so much for the council as for the people who already rely on its services. For example, the Portfolio holder has said that some people having four visits a day may in future only get two. Support may be taken from younger people and “repurposed” without any evidence that needs have changed.

Cornwall is a beautiful place, but behind the picture postcard views is a very different reality, with real poverty and deprivation; some of the highest house-prices in the UK and some of the lowest wages. Rented property is becoming scarce, and longstanding tenants are evicted, as land-lords discover how much more income can be gained from holiday lets. Young people and many NHS and care/support staff especially are priced out of the housing market, and cannot afford to rent. Funding made available for Primary Care to employ specialist nurses and pharmacists may have to be returned to NHS England as those appointed have to withdraw because of a lack of suitable housing.

A deliberate shift in resources from rural to urban areas has not helped. Across England the funding settlement agreement has been reduced by 20%. This has contributed to crises in council services and Public Health everywhere. For Cornwall the drop was 24%. The NHS funding formula is hugely complex, but is not sensitive to the way poverty presents in rural and coastal areas. Nor does the funding formula reflect the cost of delivering services to a scattered population with a rapidly increasing proportion of older people.

Despite two critical incidents being declared locally, and despite the PM declaring we’re ‘living with covid’, Cornwall’s NHS & social care system is still not functioning [2]. Both the NHS and Social Care are in a Critical state, and so is accountability for those services

Over the last three weeks Councillors have been scrutinising the Conservative Cornwall Council’s budget which includes £55 million of cuts to Cornish services. All departments including social care, public health and children’s services will be affected. Social worker numbers will fall. But the opposition; Labour, Independent, Lib-Dem, and Mebyon Kernow alike are effectively excluded from decision making and from real scrutiny of those decisions, or drawing attention to the human cost.  Opposition councillors have been working together to try to raise the alarm across the scrutiny committees and warn the Conservative Cabinet that the cuts will have drastic impacts on the health, well-being, perhaps even the lives of their constituents. As the Conservatives now have a majority in the Council, they have claimed a majority on every scrutiny committee, making an effective, critical overview of NHS or Council Cabinet decisions impossible. In principle the Committees have that power, in practice they cannot now exercise it. 

Decisions that affect everybody in Cornwall are now made in Cabinet, bypassing full Council as well as scrutiny committees.   The ‘critical incident’ in Social Care was announced – to the press – shortly after the end of January’s full council meeting but not a word was mentioned by the Council leader or the portfolio holder during the meeting [3].  Within a few days Councillors also found out, again after the event, that three care homes run by a Cornish charity were closing, with a significant loss of badly needed places. Again, this had not been mentioned to the Councillors, though Cabinet must have known.  The closure is said to be temporary but it is not clear when, or indeed whether, they will reopen homes after the event.

Every part of England is facing the effects of 12 years of NHS and Local Authority underfunding and staff shortages. In Cornwall the crisis in the NHS, Social Care, and public accountability is extreme, made worse by our location right on the edge of the UK, our housing crisis, and local Conservative politicians who seem unwilling to demand from Government what anyone trying to use the NHS or social care can see so clearly. 

The NHS in Cornwall, needs an urgent increase in funding, in order to improve staffing.  The people of Cornwall must be able to hold local and national Government to account. Nobody voted to have 20 Ambulances waiting outside A&E.  These concerns are broadly shared by Lib-Dem, MK, Green and Independent politicians as well as Labour.

Cornwall KONP are supporting the SOS NHS Day of Action and Petition and have also launched a local petition demanding that Health and Social Care are discussed at Council and that the Council demands the funding for Cornwall’s services that are so badly needed.

Jane Bernal: Chair, Keep Our NHS Public Cornwall




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