Letter from health leaders as hospitals in Cornwall at breaking point

It's as the NHS 111 service received 2,000 calls at the weekend alone, 27 people are in hospital with Covid-19 – five in intensive care – 24 care homes are closed and 400 people visited A&E in two days.

It comes just a day after Dr Allister Grant, medical director at the Royal Cornwall Hospitals Trust, said it was "like New Year every day", adding that staff were "the busiest we have ever been."

And just hours later, actress Stacie Guthrie, who plays Liz Stewart in the BAFTA-winning Bait, posted on Twitter about the situation she found when taking her son to the A&E department at Truro's Royal Cornwall Hospital, saying: "People sitting on the pavement because it’s so busy inside. Eldest was told if he needs admitting it’ll be 22 hours before there’s a bed available."

I’m at Treliske A&E with the eldest. People sitting on the pavement because it’s so busy inside. Eldest was told if he needs admitting it’ll be 22 hrs before there’s a bed available. @thisischerilyn where’s that new hospital we were promised?

— Stacey Guthrie 〓〓 (@stacey_guthrie) August 17, 2021

Now a letter has been sent out, signed by Kate Shields, chief executive of the Integrated Care System, Suzanne Wixey, director of adult social care at Cornwall Council, Dr Paul Cook, chairman of NHS Kernow Clinical Commissioning Group, Dr Rob White, system and urgent and elective care clinical lead at NHS Kernow Governing Body, a GP and clinical director for Coastal Primary Care Network, Kim O'Keeffe, deputy chief executive Royal Cornwall Hospitals NHS Trust, Matthew Patrick, interim chief executive at Cornwall Partnership NHS Foundation Trust, and Paul Masters, chief executive of the Council of the Isles of Scilly.

In it they say that the health and care system in Cornwall and the Isles of Scilly is experiencing an "ongoing extreme surge in demand."

They said: "There’s no single reason for this – it’s a complex mix of factors affecting the whole health and care system.

"These factors include the impact of Covid-19, providing care for our elderly and vulnerable citizens outside of hospital, and an increase in the numbers of people visiting our county for a holiday.

"The emergency department in Truro had another busy weekend with more than 400 people seeking help. Inside the hospital there were more than 100 patients well enough to go home but waiting for care to be provided from elsewhere within our health and care system or for someone to collect them. That's the equivalent of five wards.

"We are urging anyone who is called to collect a loved one to come to do so as quickly as possible so the bed can be given to someone else who really needs it."

The leaders add that additionally there are more than 700 people needing care and support that is currently unavailable in Cornwall and the Isles of Scilly. Support and one-off grants are available to help care for people when they are at home.

"We have 27 people in hospital with Covid-19, including five on the intensive care unit. More than 24 care homes in Cornwall are closed due to Covid-19.

"Our NHS 111 service experienced huge pressure this weekend, with more than 2,000 calls made.

"Our minor injury units had one of their busiest weekends. This was exacerbated by short-notice staff sickness, supporting Boardmasters, and the sheer volume of people seeking urgent treatment, particularly at Camborne and Redruth Community Hospital minor injury unit on Sunday."

At the same time, they said the level of demand for GP services shows no sign of abating. In Cornwall and the Isles of Scilly, GPs undertook 337,097 appointments during June. NHS Kernow Clinical Commissioning Group represents 0.88% of the English NHS registered population, but its June data totals 1.26% of overall appointments – far higher than the national average.

"This sheer volume of calls has resulted in GPs and nurses working through long lists of requests to call people back. More and more people are contacting their GP surgery for home visits or if they need help for their mental health.

"While GPs have continued to provide face-to-face appointments throughout the pandemic for anyone who needs to be seen in person, the increase in requests have added significant pressure to primary care.

"As health and care leaders in Cornwall and the Isles of Scilly we are faced with challenging choices to maintain important services for both staff and the communities we serve.

"This letter is designed to help you understand what we are doing, why we are doing it, and what you may be able to do to help," the leaders added.

The A&E department at Treliske is 'like New Year every day' Picture: GP/Google Maps

Covid-19

"The impact of Covid-19 continues to be seen across our acute and community hospitals. Whilst infection prevention and control measures are already part of business as usual, the ongoing additional measures that are required in response to Covid-19 can result in delays in patients being seen in our admitting areas and delays in transfers from admitting areas to base wards.

"The additional measures that have been introduced (which are not expected to change soon) include enhanced cleaning of areas where Covid-19 positive or suspected Covid-19 patients have been cared for; the need to maintain 2 metres social distancing which impacts on additional space being created on a temporary basis and; depending on the acuity of the patient, enhanced personal protective equipment has to be worn by staff which takes additional time to put on and take off safely. Our priority remains patient safety.

"Please help us to keep infection rates low by getting vaccinated. Call 119 or visit nhs.uk to book your appointment, or visit one of our walk-in centres, the details of which can be found online at kernowccg.nhs.uk"

Staffing

"Health and care organisations are seeing higher levels of sickness in line with the national picture. This does not include other sickness absence and maternity leave.

"We are in the peak of supporting much needed staff summer leave, plus, there are vacancies. There are significant issues county wide to source affordable accommodation in either the short or long term. This has compounded availability issues.

"We are working hard to source additional staff and make it easy for them to come and join our teams, including sourcing accommodation for them."

Urgent and emergency care

"Coverage of ambulances queueing outside the emergency department has become the visual representation of the pressures being faced across health and social care.

"During July, the emergency department at Truro had an average of 51 patients in the department at any one time and a peak of 81. This compares to an average of 24 people and a peak of 58 in July 2020.

"We are asking the public to use other healthcare options, such as minor injury units if the situation isn’t life-threatening, and to use 111 online for advice and guidance."

Primary care

"Across Cornwall in June, GPs provided 337,097 appointments.

"GPs provided 60% of appointments in person compared to 56% nationally. People will continue to be seen in person when it’s clinically necessary.

"Our GPs are also supporting our vaccination programme.

"They are working extremely hard to cope with the demands placed on them, so please treat staff considerately.

"We are asking people to consider treating minor ailments such as coughs and colds, at home, using NHS 111 online, or their local pharmacy to seek help before booking a GP appointment. If people are visiting us during the summer, to contact their local GP back at home where their medical records are held."

Kate Shields, chief executive of the Integrated Care System, is among the letter signatories Picture: RCHT/Hugh Hastings

Mental health

"The Covid-19 pandemic has affected us all differently, but demand for mental health services is a key concern. More people are seeking mental health support and more people are presenting with acute or advanced issues.

"Our community mental health services are prioritising care to the most seriously unwell people. This in turn can put pressure on other emergency services, including the police.

"Our acute psychiatric units are at 100% occupancy.

"As a result, we sometimes struggle to avoid placing people out of county and then to bring them back home.

"Dementia beds are also at 100% occupancy. This means some people with dementia and severe behavioural issues are receiving treatment in locations which were not designed to deal with their very specialist needs.

"Referrals to help children and young people with their mental health continue to grow and the waiting time for treatment is growing beyond recommended timescales.

"We now have a 24/7 mental health support line in place, having brought forward plans to help people cope during the pandemic. The number - 0800 038 5300 - is available to anyone of any age who is worried about their own or someone else’s mental health."

Social care

"Demand for adult social care services has increased by more than a third in the last month, causing unprecedented demand on all adult social service care services.

"At the end of July, the care of 102 people was handed back to Cornwall Council from care home providers. Using the average care package of 13.5 hours this equates to over 1,300 hours of care. Care providers, including care homes cite staff taking up alternative employment (ie in hospitality or cleaning/maintenance) and the ‘ping-demic’ as key factors.

"There is also continued pressure on the care homes due to COVID and staffing issues with 24 care homes now closed.

"We have relaunched the Proud to Care campaign to attract more people to join or re-join the care sector at this vital time.

"We are maximising our capacity across the voluntary sector and reablement services to get people home

"We are working with public health to mitigate and manage the risk of COVID with care homes and with providers."

Summer pressures

"According to figures from Visit Cornwall, up to 210,000 people a day are visiting Cornwall this summer, an increase of 15% on previous years as a result of vaccine confidence and uncertainty over foreign holidays.

"The boom in staycations means demand for property in Cornwall is very high with people converting long term rentals to Air B&Bs, making people homeless and driving up prices to a point where they are unaffordable to people on even decent wages, which exacerbates our recruitment challenges.

"The extra summer traffic also adds to congestion on our roads. As a result, it takes longer for staff working in the community to visit people at home as well as increasing the demand on health services.

"We are asking people to come on holiday well-stocked with their regular prescription medication and any useful first-aid supplies they may need while here. We are explaining which common illnesses and conditions they can go to a pharmacy for help and advice with. We are asking people to contact their local GP rather than arriving at the emergency department, or trying to get an appointment with a Cornish GP. We are recommending 111 online or by phone to direct people to where they can get assistance and advice."

There are issues in staffing in Cornwall File picture: Getty Images

Other actions we are taking

Elective cancellations

"Although a last resort, we have had to cancel some elective operations and procedures, at a time when we are trying reduce waiting lists."

Stroke care

"Both Cornwall Partnership NHS Foundation Trust and Royal Cornwall Hospitals NHS Trust clinicians risk-assessed the provision of the service and with senior management support took the decision to consolidate the specialist stroke rehabilitation service onto the Woodfield stroke unit in Bodmin Hospital. Clinicians consider this is the best way to provide safe and consistent care to patients who need rehabilitative stroke care.

"We will increase the capacity on the Woodfield unit to 21 beds, which will be an overall reduction of eight beds. This will allow us to make best use of our specialist stroke team which is currently struggling to maintain a full complement of therapy specialists."

One-off discharge grant

"We are asking people who can care for their relatives to come and take them home and we are providing a one-off financial grant to enable them to do so."

Forward look

"We know that severe pressures are being felt across the entirety of health and social care in Cornwall, the Isles of Scilly and in other parts of the country, so a whole-system approach is required to meet these challenges so we can provide the care and treatment needed.

"With no evidence to suggest the pressures will reduce during the coming months, we are taking a series of steps to cope with demand. For example:

• Actively recruiting to vacancies and bringing additional staff into Cornwall and the Isles of Scilly.
• Supporting them with accommodation so they can start work quickly.
• Deploying clinicians from corporate services back to frontline patient care.
• Focussing resources to where we know they will be needed, for example diverting staff from small minor injury units to the larger and busier ones.
• Preparing for a further surge at the end of August, in babies and children with respiratory syncytial virus or RSV. This is a common respiratory virus that usually causes mild, cold-like symptoms. While most children recover in a week or 2, RSV can be serious for babies and children. We expect to see significant numbers of children and babies with this condition through until November.
• Putting in place arrangements for the Covid-19 booster and flu vaccination programme to protect our population.
• Supporting a national drive to reach holidaymakers before they leave home for Cornwall, so they bring the right medicines and know what NHS help is available if needed on their staycation.

"Our staff are working harder than ever, while managing the additional measures which are now part of our everyday approach to Covid-19. These include wearing and changing personal protective equipment, maintaining social distancing, and the enhanced cleaning of areas where Covid-19 or suspected Covid-19 patients have been treated.

"People in Cornwall and the Isles of Scilly have given incredible support to the NHS during 2020/21 and the advent of the pandemic and its lockdowns. We need you again to help us to help you and your loved ones."

The Royal Cornwall Hospital is 'the busiest is has ever been' File picture: Getty Images

How you can help

• Encourage visitors and residents to make use of pharmacies. GPs are routinely being contacted for advice and treatment of urinary infections, back pain which has flared up during the journey to Cornwall, gout and insect bites – all of which can be treated by phone or by a pharmacist.
• Encourage residents and visitors to contact their GP as usual. Your own GP can speak to you by telephone or online, wherever you are. People may need to wait for an appointment.
• Go online to NHS 111 or call 111.
• Encourage parents to download the free NHS HandiApp which provides advice about common childhood conditions. Most fevers, and coughs can be treated with Calpol, drinking water, and will improve within a week. Call your GP or 111 if your child does not get better, or their condition worsens.
• Protect our ambulance service and the NHS by only calling 999 in a genuine, life-threatening emergency, and do not call back for an arrival time.
• Encourage families to take their relatives home when they are ready for discharge. Financial support is available in the form of a one-off discharge grant for people who are ready to leave hospital but need a bit of extra care and support to return home. Part of the national hospital and community support discharge policy the grant will help ease the current challenges around access to regulated care across Cornwall and Isles of Scilly and support discharge from hospital.

"We promise that we are doing all we can to strengthen the position of the health and care system in response to the pressures. We are grateful for your support."