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Our response to RCHT Inadequate rating and its overview of integration

We know that Royal Cornwall Hospital Trust (RCHT) frontline staff works hard to ensure the safety of their patients, and although we do hear negative experiences people tell us about the great care they receive too.

In Cornwall, as elsewhere, our health and social care sector is under huge pressure, caused by a variety of problems such as staff shortage, reduced or no funding, and lack of onward care from hospital.

As the CQC recommends the trust goes into special measures following its overall Inadequate rating, we are keen to learn more about the next steps the leadership of the Trust (with the potential assistance from external help) will be taking to turn things around.

Our Chief Executive Amanda Stratford said: “This is a very serious situation that is disappointing but not unexpected with poor ratings and a downward trend occurring in recent years.

“Complex issues are causing the problems, many of which are system wide; there is no quick fix but we have to improve collaboration between the different agencies.

“That said, RCHT now has a full leadership board for the first time in five years and, having spoken with them at length yesterday (October 4) I am confident that there is a real commitment to drive change.”

We will be meeting regularly in future to ensure the patient voice is part of the improvement process and we hope that new roles at the trust will bring fresh perspective, while working with other trusts will enable sharing of best practice.

Ms Stratford added: “Wherever possible the trust is taking immediate steps to improve, taking learning from the smaller hospitals such as St Michael’s which have Good ratings.”

An example of this is the practice of daily safety briefings at St Michael’s being made mandatory across the Treliske site.

The Inadequate level for end-of-life care is also particularly disappointing to us as our 2016 A Good Death End-of-Life conference brought together a number of people working in this area to make improvements.

It is reassuring that the trust has now appointed end-of-life leads to ensure the level of understanding across the Trust is improved and is actively engaging with other agencies working in this field.

We know delayed transfers of care are a core issue which affect so many other areas of care and this must be addressed quickly. A series of community support workers are currently being recruited to help with this and we would expect to see evidence of improvement by the end of the year.

In its Partnership working to deliver health and social care in Cornwall report, looking at how the health and social care system is working in the county, the CQC said that “the current systems lack a cohesive approach, remain fragmented, lack ownership and have lost sight of the needs of people using services”.

The Shaping Our Future (SoF) process, currently taking place, aims to use the expertise of clinicians, the voluntary and care sector, and patients themselves to determine new and more effective ways to deliver great care within limited budgets.

We will be maintaining an active role within the development of SoF, which includes taking part in the Transformation Board, the Citizen’s Advisory panel and evaluating co-production workshops.

Having overseen how the SoF team is attempting to draw people together, and being aware that new roles are being created to manage this streamlining, we are hopeful that a more cohesive cross-sector mind-set and in-practice integrated system will transpire through the Accountable Care System for Cornwall.

However, SoF plans are not expected to be ready until 2018. In the meantime, it is the people at the coal face of care who appear to be holding things together as best they can.

The CQC rating shows that despite these best efforts, the Trust and the health and social care system in Cornwall is continuing to struggle. As we have said there is no quick fix but this does not make it any easier for anyone who cannot be discharged from hospital or has a lengthy wait for treatment.

Our priority is to continue to listen to people’s feedback about their experiences of care to continually feed in that perspective. We are able to provide a direct route for people to have their say on a multitude of health and social care issues and we encourage people to continue to do so.

Call us on 0800 0381 281 or visit https://www.healthwatchcornwall.co.uk/have-your-say/ to share your views.