The Westcountry's health system is facing a critical combination of pressures caused by increased demand, bed-blocking and the impact of the winter vomiting bug.
The Royal Cornwall Hospital Trust at Truro has been running a "major incident" since last week as ambulances stacked up outside accident and emergency.
It has since emerged that the region's largest hospital at Derriford in Plymouth was on "black alert" – the highest warning possible – on Monday as it struggled to admit new patients.
Both the RCHT and Derriford have since downgraded their alerts, although there remains intense pressure on beds.
A spokesman for Derriford, which was forced to cancel some operations and call in extra staff, said: "With thanks to the continuing hard work of our staff, healthcare partners in the community and the ambulance service, there has been a reduction in the pressure on our services.
"We are on red alert, which means that there continues to be some pressure on our services and we are closely monitoring the situation."
Also on "red alert" yesterday was Torbay Hospital, in South Devon, which has also seen an increase in the infectious winter vomiting bug norovirus.
"Red Alert status does not prevent the hospital from admitting new patients," a spokesman said.
"The status is part of a useful operational tool which helps to ensure we can continue to provide access to high-quality care for patients.
"It involves heightened levels of discharge planning and escalation measures, incorporating additional review and assessment of patients to ensure they are receiving care and treatment in the appropriate setting.
"Our trust works in close partnership with all agencies to minimise impact of bed pressures, including South West Ambulance Service Trust, GPs, Torbay and Southern Devon Health and Care NHS Trust, and social and intermediate care providers."
Hospitals have blamed a combination of factors for the problems including higher than average admissions, the winter bug which has closed some wards and delayed discharges – commonly known as bed-blocking – where patients are moved into community hospitals, care homes or sent home with support.
The problem has been less acute at the Royal Devon and Exeter Hospital and North Devon District Hospital at Barnstaple, which said they were on "amber" and "green" alerts respectively.
That was in stark contrast to Truro, where the hospital had to declare a major incident last Thursday to try to cope with demand. The status was finally downgraded yesterday afternoon.
About 20 operations each weekday had to be cancelled when three wards and two bed bays were closed due to a severe outbreak of the norovirus bug.
Trust chairman Martin Watts said: "While there are still wards affected by norovirus the restrictions on visiting remain in place at Royal Cornwall, West Cornwall and St Michael's Hospitals. Visitors are asked to call the ward they wish to visit for advice before setting out.
"Outpatient clinics and the vast majority of day surgery cases are unaffected, as is surgery at St Michael's Hospital. Any patients whose routine surgery has to be postponed will be contacted directly."
Call for review of Serco's out-of-hours GP care
The firm which runs Cornwall's out-of-hours GP service is in the line of fire once more after a highly critical report prompted an MP to call for its contract to be reviewed.
Serco is said to have "not consistently met national quality requirements" in the investigation conducted by an independent watchdog.
The National Audit Office (NAO) report published today goes on to make six recommendations to bring the service up to scratch and make Serco deliver value for its £32 million pay-out.
But MP Andrew George, a member of the powerful Health Select Committee, said sterner action should be considered.
"Local people need to have confidence in the service," he said.
"It provides the urgent out-of-hours GP cover for more than two thirds of each 168- hour week as well as for Bank Holidays."
Mr George said concerns were longstanding and he was particularly worried that problems had continued to occur even after a critical report by the Care Quality Commission (CQC) last year.
As a result, the MP said he would be urging action in a letter to Dr Colin Philip, chairman of the NHS Kernow, the GP-led clinical commissioning group which next month takes over purchasing healthcare on behalf of residents.
"I believe that the new Clinical Commissioning Group – NHS Kernow – should undertake a thorough review of the service and determine whether it can match reasonable expectations for safe staffing, transparency and candour to give confidence that it will uphold standards of patient safety.
"If it cannot then its contract should be annulled and the service re-tendered."
The NAO examined concerns in three areas: that Serco had been unable to fill shifts with appropriately qualified staff, making the service unsafe; that performance data was altered to appear as though standards were met; and that whistleblowers were not protected.
In their conclusion, investigators said that during the course of its contract "Serco has not consistently met the national quality requirements for out-of-hours services set by the Department of Health."
The report then notes that performance was "now recovering".
The NAO also examined concerns that Serco staff had changed performance data and that a total of 252 unauthorised alterations had taken place which overstated national quality requirements in seven cases.
The report delivers six recommendations, including urging commissioners to take a more active role in monitoring, linking financial incentives to delivery of essential quality standards and specifying minimum staffing levels in the contract.
Labour MP Margaret Hodge chairman of the Committee of Public Accounts, said the NAO report made for shocking reading.
"Serco's performance in a £32 million contract to provide out-of-hours care in Cornwall has fallen unacceptably short of essential standards of quality and safety," she said.
"I find it disgraceful that Serco staff fiddled the figures on an astonishing 252 occasions between January and June 2012. This tampering presented a false, much rosier picture of its poor performance."
Mrs Hodge said the lessons to be learned were clear: "Serco needs to raise its game and demonstrate that it is accurate and honest in reporting its performance."
Dr Louis Warren, who manages the Serco out-of-hours GP service in Cornwall, welcomed the NAO report as proof it was now performing to scratch.
"Over the last six months the GP out-of-hours service that Serco provides in Cornwall has been the subject of the most comprehensive scrutiny and exhaustive series of audits possible.
"The NAO report has not only substantiated what the CQC and other reports have already shown – that the service is safe and well regarded by patients – but also confirms that we have taken swift and decisive action in response to the previous CQC report."
In a joint statement, NHS Kernow and the PCT said the recommendations would be taken on board.
"We recognise the need to ensure that safe staffing levels are maintained within this service going forward, recognising that providers have the responsibility for their staffing levels. Our role is to ensure providers' services meet all key performance indicators and National Quality Requirements. We are working with Serco to ensure all actions within the NAO report are addressed."
MP: Health scandals are 'a legacy of Labour'
A GP-turned-MP believes the Government's NHS reforms are already improving patient care, and that health scandals dominating the media are a legacy of Labour's botched handling of the service.
Westcountry MP Dr Sarah Wollaston, who serves on the cross-party Health Select Committee of MPs, said damning reports into Stafford hospital and Cornwall's GP out-of-hours service reflect the state of the NHS prior to the coalition Government coming to power.
The Totnes MP, a former police surgeon, said while Labour spent "gazillions", ministers "lost complete control". They became fixated with meeting "top-down targets at the expense of real
patient care".
Dr Wollaston said today's National Audit Office report criticising Serco, the company that provides the out-of-hours GP service in Cornwall, is an example of where the last government went wrong.
Whistleblowers came forward warning of Serco staff altering performance and chronic shortages. Dr Wollaston said: "Labour increased the salaries of GPs but there was no link to any out-of-hours commitment to their
patients (leading to a private sector firm to be drafted in)."
Dr Wollaston has added her voice to growing calls for the NHS boss Sir David Nicholson to quit following the Francis Report, which found there were up to 1,200 excess deaths between 2005 and 2009 at Stafford Hospital. Sir David was in charge of the local strategic health authority at the time.
Dr Wollaston said: "How can anyone be said to have 'command of the detail' yet overlook more than a thousand deaths at one of the hospitals for which they were responsible?"
The Devon MP has criticised this Government's NHS reforms, and was central to forcing ministers to rewrite new NHS rules. Yet, while "great care" needs to be taken during a "transition", the reforms will give more power to doctors and nurses who understand patients.
She cited new hourly hospital "comfort rounds" where – among other support – "nurses make sure patients have fresh water, not water that has been there for two weeks". "These are the things that are happening now," she said.
Exeter Labour MP Ben Bradshaw, a former Health Minister, defended Labour's legacy of record low waiting times and record high public satisfaction. He added: "It's time this Government and coalition MPs began taking responsibility for the impact of their decisions."
![Hospitals in Devon and Cornwall at crisis point]( "Hospitals in Devon and Cornwall at crisis point")
