THE PEOPLE’S OPTION
ON THE FUTURE OF
WEST CORNWALL HOSPITAL
Prepared by West Cornwall Healthwatch March 2001
Section 1 STATEMENT BY
WEST CORNWALL HEALTHWATCH page 3
Section 2 IN THE BEGINNING … page 4
Section 3 THE PEOPLE’S OPTION page 8
Section 4 WHAT THE PEOPLE OF WEST CORNWALL
WERE PROMISED IN THE NHS PLAN page 10
Section 5 WHY WE BELIEVE THAT WEST CORNWALL
IS UNIQUE page 13
Section 6 UNDERLYING FACTORS page 16
Section 7 CASE HISTORIES & CONCLUSIONS page 18
Section 8 CENTRALISATION AND ITS CONCERNS page 21
Section 9 A POSTCODE LOTTERY ? page 27
Section 10 SUMMARY page 28
Section 11 ACKNOWLEDGEMENTS AND
LETTERS OF SUPPORT page 30
Section 12 WEST CORNWALL HEALTHWATCH
AIMS AND OBJECTIVES page 33
Section 13 DISTRIBUTION page 34
STATEMENT BY WEST CORNWALL HEALTHWATCH
The Government originally stated that its top priority was – education – education – education.
The result of a national survey into the key
concerns of the British Public, announced in early
December 2000, showed that
42% mentioned Health as their top priority
and only 27% mentioned education.
Without a first class truly NATIONAL health service, then public monies put into the education of
the country and job creation will be of no avail.
If people do not have the provision of
quality health care they cannot take full
advantage of what life has to offer.
It is this committee's view that the top priority of
the Government has to be
HEALTH – HEALTH – HEALTH
IN THE BEGINNING …
In recent years West Cornwall Healthwatch has become increasingly concerned about the way in which the provision of health care in West Cornwall is being planned and implemented. It was because of this, Healthwatch became involved, and played a major rôle in saving our community hospitals and services at West Cornwall Hospital more than three years ago.
More recently we have welcomed the opportunity to take part in, what appeared to be, the drawing up of a comprehensive, bottom-up Health Improvement Plan for our area. However, it became clear that not only were we, the general public, not being involved in future plans, but late in 2000 we learned that there were plans afoot for a 'clinically led' review with regard to the future rôle of West Cornwall Hospital.
Therefore, at the request of the local MP, Andrew George, we called a Public Meeting at the Queens Hotel Penzance on Tuesday 10th October 2000. Despite bad weather, over 300 people attended, indicating the level of concern felt about this matter.
On the platform were: Jack Aitken, Mayor of Penzance; Marna Blundy, Co-ordinator of
West Cornwall Healthwatch; Peter Cox, Clinical Director of, and Consultant Surgeon at
West Cornwall Hospital; Rosemary Harker, GP; Malcolm Jones, GP and Chairman of
the West of Cornwall Primary Care Group; David Levine, Consultant Physician at West
Cornwall Hospital; Rob Pitcher, Assistant Medical Director of the Royal Cornwall
Hospitals Trust; Neil Walden, GP and Glyn White, Chairman of the League of Friends of
West Cornwall Hospital.
The key points we heard that night were:
; That local Consultants and GP's were being "open, honest and brave" to highlight the
need to change and improve local Clinical Care. Malcolm Jones
； West Cornwall Healthwatch felt that no evidence had been presented to show
that the changes, whatever they were, would improve clinical care.
; "Your best chance, in cases which are complicated or unpredictable, is by going to a
larger hospital with a much bigger range of Specialists" David Levine
； No evidence was presented to support that statement and indeed we have
since learned that medical opinion is divided on this issue.
; "If medical emergency admissions are stopped at West Cornwall Hospital, then
surgical emergency admissions will have to go too." Peter Cox
； Due to the common support services that are required by both medical and
surgical teams, if we lose one, we lose both. The resulting domino effect would
bring about the end of West Cornwall Hospital as we know it.
; “We couldn't find a Cardiologist with the right skills who would work here"
； We understand that the post was never advertised. Not surprising therefore,
that no one applied!
; "This isn't about planning health services behind closed doors and coming up with a
plan that is presented to you the people once it's formulated giving you no
opportunity to amend or alter that plan". Malcolm Jones
； To date, the ordinary person in the street has not seen any options. We fear
that at the end of the day we will be faced, not with a choice - but a conclusion.
; "Medicine's changed so much over the years that we cannot sensibly carry on
admitting all the usual medical emergencies to West Cornwall Hospital." ; "West Cornwall Hospital simply cannot offer the right facilities for many emergencies
which would be life threatening."
; "West Cornwall Hospital services have not, as has been reported, been steadily
eroded" David Levine
； More services have been taken away from our Hospital than have been given,
and that by any standards is erosion. The implication of the first two
statements is that MORE will be taken away in future, and that West Cornwall
Hospital will become a 9.00 to 5.00 hospital.
The following is just one of the statements made that night by a medical practitioner.
; "…. we have real concerns about the plans that are being thought about and the fact
that these plans are being rushed and not properly thought through. We know that
Treliske is under pressure and cannot at present cope with all emergencies.
For example, if you have a heart attack you should see a Cardiologist. Current
waiting times in Cornwall to see a Cardiologist are 35 to 93 weeks, this is just not a
practical option." Rosemary Harker
； This statement gives an insight into the fact that not all of the medical
profession is happy with some of the possible changes.
; "We are absolutely committed to consider all the options" Malcolm Jones
； Our question becomes repetitive. What options?
; "First of all let's just be clear about what I said, a range of medical emergencies
would be better treated somewhere else" David Levine
； This is yet another statement made by a senior member of the medical
profession which highlights that they may be clear about what THEY WANT,
but that is not necessarily what WE NEED!
West Cornwall Healthwatch raised five key points through their Co-ordinator:-
； "Where was the evidence that patients will do better if they go to Treliske
instead of West Cornwall Hospital?"
； "How can we be assured that Treliske would be able to cope with all
； "What about other options for the future, besides that statement that we
cannot apparently keep what we currently have?"
； "How are we all supposed to get up to Treliske and how many more
ambulances will it take to get us there?"
； “David Levine said, ‘We are living on a legacy of a mistake that was made all
those years ago, where Cornwall should have more than one major hospital.’
What I would like to know is why on earth do we have to carry on perpetuating
a mistake? When is someone going to have the courage to put it right?"
None of these five points were answered in any detail!
In July 1999, a paper was prepared by the Joint Consultants‟ Committee about the role
of hospitals. This document referred to the threat to alter, downgrade or close a hospital or deprive it of any of the services that it had customarily provided, as being a politically sensitive matter that evokes strong public reaction, namely:
"Attempts to change the function of a hospital therefore need to be
handled with care and will probably be more easily accepted by the
public IF THEY ARE PRESENTED FOR CLINICAL REASONS
(our capital letters) by or with clinicians taking a lead in the public
The following is an extract from a letter signed by Professor Sir George Alberti, President of the Royal College of Physicians dated 31st July 2000 and sent to Dr David Levine, Consultant at West Cornwall Hospital:
"Thank you for your letter of 17 July . . . .Based on what you have
written I agree with you that it will be very difficult to sustain acute
medicine safely at West Cornwall … In the meantime you might
consider asking the Trust to ask the College Review Team to come
to look at Acute Medicine in West Cornwall … A report from us
might then take the pressure off the local doctors"
In a nutshell, the above two extracts recommend:
; If as a medical practitioner you feel that changes are necessary, present
them as being clinically led.
； This is exactly what happened in the case of WCH!
; Ask a team of more senior practitioners to come down, knowing that the
outcome will be in your favour.
； This is exactly what happened in the case of WCH!
Therefore we begin to see that whatever changes are being proposed will be changes that the health service personnel feel THEY WANT and not necessarily those that meet THE NEEDS OF THE PUBLIC.
In the light of the foregoing, West Cornwall Healthwatch decided that as the public had made its views quite clear and had clearly identified THEIR NEEDS, we, as an elected committee, and representing the views of the public, would collate them into this document.
THE PEOPLE’S OPTION
； A FULLY MANNED 24 HOUR ACCIDENT & EMERGENCY DEPARTMENT.
"We will create a new Modernisation Agency to help local clinicians and managers
redesign local services around the needs and convenience of the patients."
NHS Plan page 60 6.15
； 24 HOUR MEDICAL AND SURGICAL EMERGENCY ADMISSIONS UNDER THE
CARE OF CONSULTANTS AND APPROPRIATE JUNIOR/TRUST DOCTOR
"The NHS has been too slow to change its ways of working to meet the modern
patient expectations for fast, convenient, 24hr, personalised care."
NHS Plan page 26 2.11
； A WIDER RANGE OF VISITING SPECIALISTS FOR OUTPATIENT AND IN-
PATIENT TREATMENTS, PARTICULARLY PAEDIATRICS.
"No injustice is greater than the inequalities in health which scar our nation."
NHS Plan page 106 13.1
； INCREASED DIAGNOSTIC TESTS AND THERAPIES WITH SUFFICIENT BACK
UP RESOURCES SUCH AS, A CT SCANNER, ACCESS TO 24HR RADIOLOGY
OPINION AND IMPROVED LABORATORY FACILITIES, PLUS MANY OTHERS
THAT COULD/SHOULD BE CONSIDERED.
"Patients should have fair access and high standards of care wherever they live."
NHS Plan page 58 6.10
； IMPROVED USAGE OF THE MORTUARY FACILITIES FOR POST-MORTEMS
(a stressful and costly occasion for relatives without the added need for
transfer to Truro and back).
"People are concerned that too much of what the NHS does is dictated by the needs
of the system rather than the needs of the patient.” NHS Plan page135 A1.6
； GUARANTEED, PUNCTUAL, APPROPRIATE TRANSFER OF PATIENTS TO A
MORE APPROPRIATE CENTRE WHEN REQUIRED.
"Services will be available when people require them, tailored to their individual
needs." [Introduction by Alan Milburn, Secretary of State for Health]
NHS Plan page 15
； A GROWTH IN THE SERVICES OFFERED BY WEST CORNWALL HOSPITAL
MAY NECESSITATE A PHYSICAL EXPANSION OF PREMISES.
"The decline in the condition of the NHS estate has been halted. The biggest ever
hospital building programme is underway." NHS Plan page 1 1.24
The NHS Plan states " The NHS must also be responsive to the needs of different populations in the devolved nations and throughout the regions and localities".
NHS Plan page 4.4
； ONLY BY IMPLEMENTING THE ABOVE IN
FULL, WILL THE NATIONAL PLAN FOR THE
NHS BE ACHIEVED IN WEST CORNWALL
BRINGING US, AT LONG LAST, INTO LINE
WITH THE REST OF THE COUNTRY.
WHAT THE PEOPLE OF WEST CORNWALL
WERE PROMISED IN THE NHS PLAN
In his foreword to the NHS Plan, presented to Parliament in July 2000, the Prime Minister personally wrote the following key message:
"It is in a very real sense our chance to prove to my generation
and that of my children that a universal public service can deliver
what the people expect in today's world. For all of us it is a
challenge. But it is one we intend to meet."
； West Cornwall Healthwatch identified the following key promises, made to the
people of Britain, which specifically relate to the needs of West Cornwall.
; The NHS will respect the confidentiality of individual patients and provide open
access to information about services, treatment and performance. page 5.10
; It (the NHS) has over-centralisation and disempowered patients. page 10
; At its heart the problem for today's NHS is that it is not sufficiently designed around
the convenience and concerns of the patient. page 15
; Each year patients will see a new NHS unfolding, growing better, more convenient
with less waiting times for themselves and their families. page 16
; The vision of this NHS Plan is to offer people fast convenient care delivered to a
consistently high standard. Services will be available when people require them,
tailored to their individual needs. page 17 1.1
; The decline in the condition of the NHS estate has been halted. The biggest ever
hospital building programme is under way. page 21 1.24