Re-provision of services from Poltair hospital

9th November

Six months after the decision by NHS Kernow to permanently close Poltair hospital and after nearly two years of consultation, we learned last week that its ten community hospital beds will not be re-provided elsewhere; and its clinics, offices and gym will be spread around the area.  In particular, and contrary to expectation, Poltair clinics will not now be relocated to West Cornwall Hospital, but will be moved into GP surgeries; and staff offices to Bellair.

We have been told that NHS Kernow considers there to be sufficient capacity in the county’s community hospitals.  This is despite those hospitals running at dangerously high 95% occupancy levels, unable to accept patients from the acute sector who need re-enablement, and unable to discharge patients due to a lack of nursing home beds and availability of care at home services. The knock-on effect of this is felt at West Cornwall Hospital, where delayed discharges prevent other
patients being admitted; and at Treliske, where frequently there are cancelled operations due to a lack of beds.

West Cornwall HealthWatch continues to have serious concerns about both the process and the replacement provision of Poltair’s services.  Last year NHS Kernow undertook to ‘ensure that there were sufficient community
hospital beds open with sufficient clinical and ancillary services until sustainable alternatives were in place’  (1). However, we can see that the service is almost at breaking point, with no sign of an early improvement.  We are also unsettled about relocation to GP practices including Sainsburys – we don't know the suitability and accessibility of some GP premises and, as rent will be paid by the GP Commissioning Body to some of its GPs, we see a possible conflict of interest here.

We have listened to and understood that health and social provision must be provided in a more integrated way, which includes the aim of fewer people going into hospital and being well supported at home.  However, we see little evidence of such an integrated approach; indeed, we are aware that relationships between the ‘key players’ in healthcare provision in the county - NHS Kernow, RCHT, PCH and Cornwall Council – are strained, to say the least.  We see parallel working, duplication of effort and services, and awkwardness in communications.  This is exactly the opposite of how it should be, which we find most frustrating, and we have grave concerns about their ability to work together.  We rather wish we could ‘bang a few heads together’!

Our concerns have just been reinforced by a report just produced by the NHS Emergency Care Intensive Support Team, investigating persistently poor performance against the four-hour accident and emergency standard at RCHT,
who concluded that “the system was fragmented, with teams from the trust, community provider Peninsula Community
Healthcare and adult social care working in silos….. unhelpful relationships were one of the biggest barriers to improving A&E performance” (2)

In all this, we worry that the needs of the patients are being lost in the system.  We work in West Cornwall HealthWatch because of them.  Anecdotal evidence suggests that many people are being short-changed at the moment, when they are at their most weak and vulnerable – poor care at home, and poor provision of the right care in hospital.  We are close to

 (1) KCCG 2013/008
(2) HSJ 7 Nov 2014