NHS Kernow - Disclosure log Freedom of Information requests April 2017

Transcription

1 NHS Kernow - Disclosure log Freedom of Information requests

2 Contents Children s health... 3 FOI Children s dental services... 3 Clinical management... 4 FOI Delayed transfers... 4 FOI Diagnostics... 4 Continuing healthcare... 7 FOI Personal health budgets... 7 FOI Activity and spend... 9 Contracts FOI GP spend FOI Community health services FOI Patient transport Individual funding requests FOI Hip and knee replacements FOI Individual Funding Requests Information Governance FOI Enhanced data sharing Mental health & learning disabilities FOI CAMHS Tier 4 patients FOI Eating disorder services FOI Mental health spend Organisation FOI Nursing shortages FOI Governing Body members Prescribing & pharmacies FOI Wound care products FOI Homeopathy services Referral management FOI Referrals for chiropractic / alternative medicines Appendix: FOI Hip and knee replacements The information supplied to you continues to be protected by the Copyright, Designs and Patents Act You are free to use it for your own purposes, including any non-commercial research you are doing and for the purposes of news reporting. Any other re-use, for example commercial publication, would require the permission of the copyright holder. 2

3 Most documents supplied by NHS Kernow Clinical Commissioning Group will have been produced by local officials and will be our copyright. Information you receive which is not subject to our copyright continues to be protected by the copyright of the person, or organisation, from which the information originated. You must ensure that you gain their permission before reproducing any third party information. Children s health FOI Children s dental services Date received: 06/04/ As of March 31, 2017, can you tell me how many children were on the waiting list to visit the CCG children's dental hospital? 2. If the CCG does not have a dedicated dental hospital, how long is the wait as of March 31st, 2017, for children's dental services? 3. How long is the present waiting list, in terms of months/weeks to be seen? 4. How long is the wait for teeth extractions? 5. How many children are affected by the wait for teeth extractions? 6. Is there a wait for youngsters to be added to the waiting list? if, so how many children are waiting to be placed on to the waiting list? 7. How many dental nurses does the CCG employ for children's dental services? 8. How many vacancies does it have at present? 9. How many children were on the waiting list to visit the CCG's children's dental hospital on: a) March 31st, 2016? b) March 31st 2015? c) March 31st 2014? d) March 31st 2013? 10. If the CCG does not have a dental hospital, how many children were on the waiting list to visit the CCG's children's dental services on: a) March 31st, 2016? b) March 31st 2015? c) March 31st 2014? d) March 31st 2013? 11. How many children received treatment at the children's dental services between January 1, 2016 and December 31, 2016? A. NHS Kernow does not hold the information you have requested. Please redirect your request to NHS England (england.contactus@nhs.net), who commissions dental services in Cornwall and the Isles of Scilly. 3

4 Clinical management FOI Delayed transfers Date received: 07/04/ What is the longest amount of time in days a patient had been kept in hospital due to delayed transfer in the past 12 months? 2. Could you give me details for the three longest delayed transfer stays, the name of the hospital concerned and if possible the age and sex of the patients concerned and the department they were in (ie elderly care/general surgery, paediatrics etc)? 3. Are you also able to give a brief reason for the delay in each instance (ie lack of beds in care facility/delay equipping home etc)? A. NHS Kernow does not hold the information you have requested. Please redirect your request to providers to request this information: Cornwall Partnership NHS Foundation Trust: cpntr.freedomofinformation@nhs.net Plymouth Hospitals NHS Trust: plh-tr.foi-requests@nhs.net Royal Cornwall Hospitals NHS Trust: rch-tr.foi@nhs.net FOI Diagnostics Date received: 11/04/ Please confirm how many of the following diagnostic tests have been carried out in your area in each financial year since April 2013: 2. Please confirm what the average waiting time in your CGG was for the following tests in each financial year since April 2013: a) x-ray A. NHS Kernow does not hold the information you have requested. Please redirect your request to providers to obtain this information: Cornwall Partnership NHS Foundation Trust: cpntr.freedomofinformation@nhs.net Plymouth Hospitals NHS Trust: plh-tr.foi-requests@nhs.net We can however report that Royal Cornwall Hospitals NHS Trust has reported the following diagnostic test information. To obtain more detailed information, tests carried out in 2013/14 and information on waiting times, please contact Royal Cornwall Hospitals NHS Trust direct: rch-tr.foi@nhs.net 2014/ / /04/16 to 31/12/16 Diagnostic test 60,064 60,797 47,010 4

5 b) Ultrasound 2013/ / / /2017 Diagnostic test 30,636 25,427 23,067 30,584 Average waiting time 2 weeks 2 weeks 2 weeks 2 weeks c) CT scan 2013/ / / /2017 Diagnostic test 14,685 16,345 14,950 19,101 Average waiting time 2 weeks 2 weeks 2 weeks 2 weeks d) MRI scan 2013/ / / /2017 Diagnostic test 24,086 22,911 26,273 33,964 Average waiting time 2 weeks 2 weeks 2 weeks 2 weeks e) Gastroscopy 2013/ / / /2017 Diagnostic test 2,969 3,125 4,000 3,779 Average waiting time 2 weeks 2 weeks 2 weeks 2 weeks f) Colonoscopy 2013/ / / /2017 Diagnostic test 3,716 4,421 5,110 5,125 Average waiting time 2 weeks 2 weeks 2 weeks 2 weeks g) flexible sigmoidoscopy 2013/ / / /2017 Diagnostic test 1,186 1,530 1,776 1,617 Average waiting time 2 weeks 2 weeks 2 weeks 2 weeks h) histopathology A. NHS Kernow does not hold the information you have requested. Histopathology is covered within a block of pathology tests and this information is not reported to NHS Kernow. Please redirect your request to providers direct to request this information: Cornwall Partnership Foundation Trust - cpn-tr.freedomofinformation@nhs.net Royal Hospitals NHS Trust - rch-tr.foi@nhs.net Plymouth Hospitals Trust - plh-tr.foi-requests@nhs.net 5

6 Funding 3. Please confirm your CCG's budget allocation to fund imaging, pathology and endoscopy activity in each financial year since April 2013, and what it is forecast to be in 2017/18. A. Budgets are allocated at contract level rather than diagnostic level, and therefore we do not have specific diagnostic budgets. 4. Please confirm whether your CCG received additional funding from the National Diagnostics Capacity Fund to increase capacity and productivity of diagnostic services. If so, how much. A. NHS Kernow has not received additional funding from the National Diagnostics Capacity Fund to increase capacity and productivity of diagnostic services. Plans to invest and monitoring 5. Please confirm how your CCG assesses anticipated changes in demand for (a) x-ray; (b) ultrasound; (c) CT scan; (d) MRI scan; (e) gastroscopy; (f) colonoscopy; (g) flexible sigmoidoscopy; and (h) histopathology, and what assessment it has made of projected changes in demand. A. NSH Kernow anticipates changes in demand by looking at demographic growth both nationally and locally, ensuring that these are inclusive of local cancer pathway modeling data. 6. Please confirm whether your CCG has plans to improve and expand diagnostic capacity in 2017/18 and, if so, what those plans are. A. Diagnostic capacity is planned each year in line with demographic growth. 7. Please confirm how your CCG monitors capacity and performance for (a) x- ray; (b) ultrasound; (c) CT scan; (d) MRI scan; (e) gastroscopy; (f) colonoscopy; (g) flexible sigmoidoscopy; and (h) histopathology. A. NHS Kernow monitors diagnostic performance on a monthly basis through contractual meetings. 8. If diagnostic capacity has not been subject to increased investment, which of the 9 must dos from the 2016/17 NHS England planning guidance have been prioritised? A. As per our response to question six, diagnostic activity is planned each year in line with demographic growth. 6

7 Referral management centres 9. Please confirm whether your CCG operates or commissions a referral management centre that assesses referrals by local GPs. A. NHS Kernow has a Referral Management Service (RMS), which manages referrals from 58 GP practices, excluding those in East Cornwall. NHS Kernow commissions Devon Referral Support Services to manage referrals for the 11 practices in East Cornwall. More information on the referral management service is available on our website: We therefore exempt the release of this information under section 21 of the Freedom of Information Act, information accessible by other means. 10. If yes to question nine, please confirm whether the list of specialities that fall under the referral management centre s remit include suspected cancer cases. A. Devon Referral Support Services: Yes Referral Management Service: No Continuing healthcare FOI Personal health budgets Date received: 03/04/ What is the Kernow CCG current local offer of Personal Health Budgets beyond Continuing Health Care? A. NHS Kernow is currently in the process of evaluating the local offer of personal health budgets beyond continuing healthcare and currently offers personal health budgets outside of continuing healthcare in small pilot NHS England evaluations areas. NHS Kernow s policy on personal health budgets is available to view on our website: via this link: /Policies/PersonalHealthBudgetsPolicy.pdf 2. Where is this advertised? NHS Kernow publishes information regarding personal health budgets on its website and information leaflets that are available via the link below: 7

8 3. What is the current local offer for Personal Health Budgets for those with long term mental health conditions? A. NHS Kernow offers consideration for personal health budgets to all continuing healthcare eligible clients who have long term mental health conditions. Please refer to our response to question one for information regarding personal health budgets outside of continuing healthcare. 4. How do those with long term mental health conditions currently apply for a Personal Health Budget? A. NHS Kernow is currently in the process of developing the local offer of personal health budgets for those with long term mental health conditions outside of continuing healthcare. 5. What was the Kernow CCG local offer of Personal Health Budgets beyond Continuing Health Care as advertised on the PHBs CCG webpage on 8/2/2017? 6. Can you provide me with an exact copy of the information that was advertised on the above webpage on 8/2/2017? (It has since been changed) A. NHS Kernow s personal health budgets page remains unchanged and has not been edited since 6 December A local offer was not advertised on the website. 7. How many patients with long term mental health conditions were provided with a Personal Health Budget between April March 2016? A. None outside of continuing healthcare. 8. Of the above patients, how did they apply for such a budget? 9. Again, of the above, how were these patients identified as requiring need of or benefit of a Personal Health Budget (i.e. If not advertised then his did these patients become chosen to apply for one?) A. N/A. NHS Kernow offers consideration for personal health budgets to all continuing healthcare eligible clients who have long term mental health conditions. Please refer to our response to question one for information regarding personal health budgets outside of continuing healthcare. 10. How many patients with long term mental health conditions were provided with a Personal Health Budget between April 2016 and March 2017? A. None outside of continuing healthcare. 11. Of the above patients how did they apply for a Personal Health Budget? 12. Again, of the above patients, how did these patients become identified as requiring need of or benefit from a PHB? 8

9 A. N/A. NHS Kernow offers consideration for personal health budgets to all continuing healthcare eligible clients who have long term mental health conditions. Please refer to our response to question one for information regarding personal health budgets outside of continuing healthcare. 13. Between April 2016 and March 2017 was it at any time advertised on the personal health budgets webpage on Kernow CCG website that patients with long term mental health conditions were able to apply for a PHB? A. No. FOI Activity and spend Date received: 11/04/ The number of (a) adults and (b) children receiving Continuing Healthcare (CHC)/Continuing Care in your area. A. As of 1 May 2017: Adults: 806 (CHC only exclusive of FNC and joint funding Children: Less than five 2. The number of those from 1(a) and 1(b) who receive a Personal Health Budget (PHB)? A. As of 1 May 2017: Adults: 37 Children: None. 3. The number of those from 1(a) and 1(b) who receive: (a) care in their home A. As of 1 May 2017: Adults: 342 Children: Less than five. (b) care in a residential or nursing home. A. As of 1 May 2017: Adults: 464 Children: None. 4. The number of those from 2(a) and 2(b) who receive: (a) care in their home A. As of 1 May 2017: Adults: 37 Children: None. 9

10 (b) care in a residential or nursing home. A. As of 1 May 2017: Adults: None. Children: None. 5. The smallest and largest weekly budgets in s for 1(a), 1(b), 2(a) and 2(b). Reference Smallest weekly budget ( ) Large weekly budget ( ) 1a k 1b , a k 2b The indicative hourly rate paid for Personal Assistants/carers (PAs) under a PHB for (a) standard care and (b) complex care. A. NHS Kernow does not hold the information you have requested. The budget holder determines the individual hourly rate as part of their role in managing the finance within a care plan. 7. The indicative hourly rate paid for Personal Assistants/carers (PAs) under CHC/CC for (a) standard care and (b) complex care. A. NHS Kernow does not hold the information you have requested. This information is not routinely reported to NHS Kernow. 8. The maximum amount used under a PHB to fund social activities per annum? 9. The maximum amount used under a PHB to fund respite per annum? A. NHS Kernow does not hold the information you have requested. There is no maximum amount set. 10. The maximum amount used under a CHC/CC to fund respite per annum? A. NHS Kernow does not hold the information you have requested. There is no maximum amount set. However, the current maximum is 46, Whether you permit close family members who do not live with the service user to be employed under: (a) CHC A. NHS Kernow does not permit close family members who do not live with service users to be employed for continuing healthcare. 10

11 (b) PHB? A. Yes, under exceptional circumstances using national personal health budget guidelines. Contracts FOI GP spend Date received: 05/04/ Total planned spending by the CCG on general practice services for 2017/18, and a breakdown of how this figure is made up. Locally commissioned services (GPwSIs, physio, etc) - estimated - paid on activity 1,575,062 Out of hours - estimated (contract renewal mid year) 7,896,057 Local Enhanced Services - estimated - paid on activity 5,101,398 GP Forward View (GP Resilience etc.) - as per national allocations 92,000 GP Access Fund (to cover 110k population) 660,000 PMS Premium (year two of five year transfer of funds) 210,000 Transformation Fund developing at scale primary care 825,000 Total 16,359, Total spending by the CCG on general practice services in 2016/17, and a breakdown of how this figure is made up. Locally commissioned services (GPwSIs, physio, etc) 1,575,062 Out of hours 7,896, Local Enhanced Services 5,101,398 GP Forward View (GP Resilience, etc.) - as per national allocations 184,000 GP Access Fund (to cover 110k population) - as per national allocation of 6 p/p 660,000 PMS Premium 105,000 Winter resilience 222,000 Total 15,743,517 FOI Community health services Date received: 10/04/ Please provide a list of all the organisations that have held contracts (or other formal agreement) for the delivery of community health services since the creation of the CCG, together with the start and end dates of each contract. Please note that GMS and PMS GP contracts are excluded from this request (I believe the CCGs do not commission these in any case). 11

12 A. Adult Community Services are currently provided by Cornwall Partnership NHS Foundation Trust. NHS Kernow routinely publishes information on contracts, including start and end dates for contracts / eye care services, on our website: via this link: ategicreportsandplans/contractlist.pdf We therefore exempt the release of this information under section 21 of the Freedom of Information Act, information accessible by other means. These services were previously provided by Peninsula Community Health from 1 April 2013 to 31 March Please state what services were covered by each contract: A. Adult community services: Acute Care at Home Acute GP Cardiac Rehabilitation Community Hospitals Community Matrons Community Stroke Rehabilitation Community Stroke Team Community Care at Home Dermatology Clinic District Nursing Team Domiciliary Care - CHC Diabetes Specialist Nursing Elective Orthopaedics Expert Patient Programme Falls Specialist Practitioners Health for Homeless Intermediate Care Learning Disability Liaison Macmillan Specialist Nursing MIU (Minor Injury Units) MSK Interface Clinics MSK Physiotherapy Neurocare Advisory Service Nurse Practitioner Podiatry Records Management Rehabilitation Specialist Nursing Parkinsons Specialist Respiratory Nursing Specialist Wheelchair Service Speech and Language Therapy Standard Wheelchairs Service Stroke Rehabilitation Tuberculosis Service Telehealth TIA Tissue Viability Service Urodynamics and Continence 12

13 FOI Patient transport Date received: 24/04/ Please provide details on the suppliers who applied for inclusion on each framework/contract and were successful and not successful at the PQQ & ITT stages for non-emergency patient transport services in Cornwall and the Isles of Scilly? A. The successful provider was NSL Care Services, the contract was subsequently novated to E-Zec medical services in May 2016 when NSL exited the nonemergency patient transport services market and E-Zec took over their contracts. NHS Kernow does not hold the information you have requested regarding providers involved at PQQ and ITT stage. The procurement was conducted by the former primary care trust. Please contact the Department of Health s legacy team to request this information: reviews&informationteam@dh.gsi.gov.uk. 2. The contract values of each framework/contract (and any sub lots), year to date? A. The expected annual contract value for 2017/18 is 3,257, The start date and duration of framework? A. The contract commenced on 1 October 2013 for a duration of five years. 4. Is there an extension clause in the framework(s)/contract(s) and, if so, the duration of the extension? A. Yes, there are either 12 or 24 month extensions available. 5. Has a decision been made yet on whether the framework(s)/contract(s) are being either extended or renewed? A. No. 6. If applicable, are the above services conducted in-house? A. N/A. 7. Who is the senior person in the Local Authority (outside of procurement) responsible for the above services? A. The senior person responsible for non-emergency patient transport services is Helen Childs, Chief Operating Officer. 13

14 Individual funding requests FOI Hip and knee replacements Date received: 03/04/2017 Questions 1-3 cover both full and partial replacements within each category. 1. The number of electives funded each year in 2013/14, 2014/15, 2015/16 and 2016/17 for: a) hip replacement b) knee replacement surgeries Surgery type 2013/ / /16 01/04/16 to 28/02/17 Hip replacement 1,435 1,380 1,329 1,219 Knee replacement 1,354 1,279 1,345 1, The number of successful Individual Funding Requests (or equivalent procedure) made in 2013/14, 2014/15, 2015/16 and 2016/17 for: a) hip replacement b) knee replacement surgeries each year A. None. 3. The number of unsuccessful Individual Funding Requests (or equivalent procedure) made each year in 2013/14, 2014/15, 2015/16 and 2016/17 for: a) hip replacement b) knee replacement surgeries A. None. 4. The number of people recorded as having malnutrition (i.e. under nutrition) each year by GP practices in the area in 2013/14, 2014/15, 2015/16 and 2016/17 (if this is recorded by the CCG) A. NHS Kernow does not hold the information you have requested. Please redirect your request to NHS England (england.contactus@nhs.net), who commissions GP services, to request this information. 5. The number of people prescribed Oral Nutritional Supplements each year in 2013/14, 2014/15, 2015/16 and 2016/17, broken down by gender A. NHS Kernow does not hold the information you have requested. This information may be held at GP practice or provider level. Please redirect your request to NHS England (england.contactus@nhs.net), who commissions GP services, for further assistance or local providers: Cornwall Partnership NHS Foundation Trust (cpntr.freedomofinformation@nhs.net) Northern Devon Healthcare NHS Trust (ndht.contactus@nhs.net) 14

15 Plymouth Hospitals NHS Trust Royal Cornwall Hospital NHS Trust 6. Please provide a list of all GP practices in the CCG area and a contact address for each. A. Please find attached a list of GP practices, including contact details, in the CCG area. Please note that NHS England commissions GP services in Cornwall and the Isles of Scilly. If you require further information on these practices, please redirect your request to NHS England (england.contactus@nhs.net). FOI Individual Funding Requests Date received: 05/04/ Please state the total number of Individual Funding Requests (IFRs) received by the CCG in each of the following years: a) b) c) d) For each of the four years listed in Q1, please list the three most common treatment categories in which IFRs were submitted and how many requests were made in each category. 3. Please state the number of IFRs which were approved in each of the four years listed in Q1 Year Total requests Three most common requests (number of each) Removal of benign skin lesions (40) Breast reduction (14) Abdominoplasty (13) Removal of benign skin lesions (39) Assisted conception (22) Breast reduction (17) Removal of benign skin lesions (50) Assisted conception (21) Breast reduction (19) Removal of benign skin lesions (30) Breast reduction (17) Assisted conception (17) Total approved Please state the number of appeals cases which were considered by the IFR panel in each of four years listed in Q1 15

16 A : None : Less than five : None : Less than five 5. Please state the number of appeals cases which were upheld by the IFR panel in each of the four years listed in Q1 A. None. Information Governance FOI Enhanced data sharing Date received: 27/04/ How many of the GP practices within your CCG have switched on Enhanced Data Sharing from TPP? A. 10 practices have switched on Enhanced Data Sharing. 2. How is patient data being protected from being viewed by individuals who are not involved with that patient s care? A. NHS Kernow is not responsible for protecting patient data in edsm, however, our understanding is that in meeting the statement of compliance requirements, the system suppliers would have given assurances to NHS Digital with regard to the information governance security controls available within the system. Practices in our region have provided the following information: Electronic access control is in place ensuring all internal patients identifiable data is secure. There are data sharing agreements that grant role based permissions support access all or part of a patient record and permission is only granted for the purposes of direct care or where a legal basis has been identified for its use and sharing. All access is role relevant based on clinical need. Patients are able to opt-out of sharing their data and can completely opt-out of any override in any situation. Information on edsm is available to all patients in leaflet form, posters and on GP practice websites. Each organisation and all members of staff using edsm must adhere to the Data Protection Act 1998, which is available to all staff. Each member of staff log into SystmOne with their own log-ins or smart cards, which allows for the audit of records access to. Members of staff must adhere to Caldicott Principals around access and sharing of information. Annual information governance training is mandatory for all staff as part of the information governance toolkit requirements. This is underpinned by clauses in each contract of employment. 16

17 3. How do patients with sensitive medical issues e.g. mental health, HIV positive and early pregnancy prevent their data being shared? A. NHS Kernow is not responsible for appropriate sharing of patient data in edsm, however, practices in our region have provided the following information: Practices operate a default opt-out policy, with patients choosing to opt-in to sharing their data and can choose to opt-out at any time. This information is available to all patients in leaflet form, posters and on GP practice websites. Within a SystmOne computer record, information can be marked as private. This must be an informed decision made by the patient in consultation with a healthcare professional. Data added by the organisational unit is not visible to any other organisational unit, including emergency and out of hours services, unless record sharing is explicitly overridden. There is also the option on SystmOne to make some information not available in the online record. In addition, records can be marked as sensitive or safeguarding relevant so that records can only be accessed by staff with the appropriate access right. Patients are responsible for indicating their preferences at the point of contact to enable appropriate controls to be applied. 4. How is the CCG working to ensure data protection compliance and the avoidance of misuse of the data? A. NHS Kernow is not responsible for ensuring data protection compliance or misuse of data in edsm, however, our understanding is that in meeting the statement of compliance requirements and information governance requirements the GP practices and system suppliers would have given assurances to NHS Digital. NHS Kernow protects its own data by mandating annual information governance training for all staff and data protection compliance clauses are included within employment contracts. There is a data protection policy is in place, which is available to all staff and the organisation has an information governance lead responsible for all data protection matters, advice and guidance. The use and transfer of identifiable data is mapped, monitored and secured throughout the organisation, with assurance obtained that there is a legal basis for the use of all identifiable data. Staff are reminded on a regular basis of the essential data protection requirements with regard to data via staff communications and meetings. 17

18 Staff in GP practices are supported by NHS Kernow s Head of Information Governance on information governance advice and guidance. In addition to support provided by Data Quality Facilitators in each local area. 5. Does SystmOne have the capability to identify unauthorised access to a patient record by a user not involved with the patient s care? a) If so, how is this unauthorised access to patient data reported to the CCG? A. NHS Kernow is not responsible for securing data from unauthorised access or misuse of data in SystmOne, however, our understanding is that in meeting the statement of compliance requirements and information governance requirements, GP practices and system suppliers would have given assurances to NHS Digital with regard to appropriate security controls. Each GP practice has a nominated Privacy Officer. Access to records which are no longer active in the system are logged and alerted to the Privacy Officer. The Privacy Officer routinely reviews records for access, potential breaches or inappropriate access and incidents are escalated within the individual practices. The Privacy Officer also checks if records are accessed outside of the practice and if access appears to have been inappropriate, this would be escalated within the practice and if required, reported to the Head of Information Governance and Information Governance Lead at NHS Kernow. 6. How is the CCG planning to report unauthorised access to the patient? A. NHS Kernow follows NHS guidance with regard to information incident reporting and has internal processes for reported incidents. 7. What plans does the CCG have to handle data protection claims from patients whose data has been illegally accessed? A. NHS Kernow is considering data protection insurance as part of its information governance work plan. Mental health & learning disabilities FOI CAMHS Tier 4 patients Date received: 05/04/ Number of mental health beds for CAMHS Tier 4 inpatients every year from 2010-present. Please provide the information broken down per year where available. 2. Your procedure for dealing with CAMHS Tier 4 inpatients if no beds are available. 18

19 3. If/when beds are unavailable how many times from 2010-present have CAMHS Tier 4 inpatients been admitted to: a) adult psychiatric wards b) prison cells A. NHS Kernow was formed on 1 April 2013 and cannot provide information relating to the former primary care trust (2010 to 2013). Please contact the Department of Health s legacy team to request this information: reviews&informationteam@dh.gsi.gov.uk. For information relating to 1 April 2013 to date, NHS Kernow does not hold the information you have requested. Please redirect your request to the provider of these services, Cornwall Partnership NHS Foundation Trust (cpntr.freedomofinformation@nhs.net), or NHS England (england.contactus@nhs.net), who commission Tier 4 beds to obtain this information. FOI Eating disorder services Date received: 11/04/ All in-patient and out-patient eating disorder services currently provided for CAMHS and adult services in your area A. NHS Kernow has signalled clearly to providers that it favours a single children and young people eating disorder service that draws together into a single specification and contract the elements needed to meet the Access and Waiting Time Standards (2015) by At the time of this enquiry, pilot arrangements to bring together the three providers involved is underway and learning from the pilot will help to shape further how a single service operates. Although a single service, NHS Kernow will be looking at how elements such as physical monitoring and therapy can be provided at sites across Cornwall in response to the county s rural nature and poor transport links. The providers of service involved in the pilot are Cornwall Partnership Foundation NHST, Royal Cornwall Hospital Trust and Kernow Health CiC and services are also provided by Plymouth Hospitals Trust. For more detailed information on in-patient and out-patient eating disorder services currently provided for CAMHS and adult services in Cornwall and the Isles of Scilly, please contact providers direct: Cornwall Partnership Foundation Trust - cpn-tr.freedomofinformation@nhs.net Royal Hospitals NHS Trust - rch-tr.foi@nhs.net Plymouth Hospitals Trust - plh-tr.foi-requests@nhs.net 19

20 The questions below relate to the financial years: 2014/15, 2015/16, 2016/17 and 2017/ The budget and monies promised to deliver the CAMHS access and waiting time standards on Eating Disorders A. NHS Kernow has published details of the CAMHS transformation monies it has been able to allocate to schemes in 2015/16 and 2016/17 and proposed schemes for 2017/18 in papers to the NHS Kernow Governing Body meetings of 6 December 2016 and 7 February These are available online at We therefore exempt this information under Section 21 of the Freedom of Information Act, information available by other accessible means. 3. The budget and monies received to deliver the CAMHS access and waiting time standards on Eating Disorders A. NHS Kernow has received 302,000 from NHS England in the years 2015/16 and 2016/17 in support of CAMHS transformation work towards achieving the Access and Waiting Time Standards (July 2015). 4. Your total budget and expenditure for all CAMHS eating disorder services (please include any additional monies received to deliver access and waiting time standards, as specified in Question 3. A. Children and young people s eating disorder services are contained within a block contract with the following NHS providers and therefore, NHS Kernow does not hold the information you have requested. Please redirect your request to providers direct to request this information: Cornwall Partnership Foundation Trust - cpn-tr.freedomofinformation@nhs.net Royal Hospitals NHS Trust - rch-tr.foi@nhs.net Plymouth Hospitals Trust - plh-tr.foi-requests@nhs.net 5. Your total budget and expenditure for all adult eating disorder services A. Adult eating disorder services are contained within a block contract with the following NHS providers and therefore, NHS Kernow does not hold the information you have requested. Please redirect your request to providers direct to request this information: Cornwall Partnership Foundation Trust - cpn-tr.freedomofinformation@nhs.net Royal Hospitals NHS Trust - rch-tr.foi@nhs.net Plymouth Hospitals Trust - plh-tr.foi-requests@nhs.net 6. Your average and range of waiting times for CAMHS eating disorder services for both severe and non-severe cases 20

21 A. Children and young people s eating disorder services are contained within a block contract with the following NHS providers and therefore, NHS Kernow does not hold the information you have requested. Please redirect your request to providers direct to request this information: Cornwall Partnership Foundation Trust - cpn-tr.freedomofinformation@nhs.net Royal Hospitals NHS Trust - rch-tr.foi@nhs.net Plymouth Hospitals Trust - plh-tr.foi-requests@nhs.net 7. Your average and range of waiting times for adult eating disorder services for both severe and non-severe cases A. Adult eating disorder services are contained within a block contract with the following NHS providers and therefore, NHS Kernow does not hold the information you have requested. Please redirect your request to providers direct to request this information: Cornwall Partnership Foundation Trust - cpn-tr.freedomofinformation@nhs.net Royal Hospitals NHS Trust - rch-tr.foi@nhs.net Plymouth Hospitals Trust - plh-tr.foi-requests@nhs.net FOI Mental health spend Date received: 20/04/ At the time of responding to this request, has the CCG s financial plan for 2017/18 and 2018/19 been agreed by NHS England? A. No. 2. In the CCG s financial plan for 2017/18, or latest draft of this plan if this has not been finalised by NHS England at the time of responding to this request, has the Mental Health Investment Standard (formerly Parity of Esteem) been achieved? A. No. 3. If the Mental Health Investment Standard (formerly Parity of Esteem) has not been achieved for 2017/18, please indicate the reason using the codes below: 1) Commissioners in deficit, not achieving 1% plan metric or with very low growth. 2) Mental Health Investment Standard (Parity of Esteem) achieved across health economy. 3) Historically high investment in mental health. 4) Other. A. 1 - Commissioners in deficit, not achieving 1% plan metric or with very low growth. 21

22 4. If answering Other, please provide further explanation as to why the Mental Health Investment Standard (Parity of Esteem) has not been achieved for 2017/18. A. N/A. 5. In the CCG s financial plan for 2018/19, or latest draft of this plan if this has not been finalised by NHS England at the time of responding to this request, has the Mental Health Investment Standard (formerly Parity of Esteem) been achieved? A. Yes, however, as per our response to Q1, the financial plan has not yet been approved. 6. If the Mental Health Investment Standard (formerly Parity of Esteem) has not been achieved for 2018/19, please indicate the reason using the codes below: 1) Commissioners in deficit, not achieving 1% plan metric or with very low growth. 2) Mental Health Investment Standard (Parity of Esteem) achieved across health economy. 3) Historically high investment in mental health. 4) Other. 7. If answering Other, please provide further explanation as to why the Mental Health Investment Standard (Parity of Esteem) has not been achieved for 2018/19. A. N/A. 8. At the time of responding to this request, has the Chief Executive of your main mental health provider signed a letter stating that the CCG s mental health planned spend for 2017/18 and 2018/19 is an accurate reflection of health economy investment in mental health, as requested by NHS England? A. No, not at this time. Organisation FOI Nursing shortages Date received: 18/04/ How many nurses are working for the NHS across Cornwall, without a UK/British passport? 2. How many of these would be affected by the Freedom of Movement, following Brexit? 3. The Department of Health says the NHS could be short of 40,000 nurses by 2026, how many of those are here in Cornwall? 22

23 A. NHS Kernow does not hold the information you have requested. Please redirect your request to providers direct to request this information: Cornwall Partnership Foundation Trust - cpn-tr.freedomofinformation@nhs.net NHS England (england.contactus@nhs.net) Plymouth Hospitals Trust - plh-tr.foi-requests@nhs.net Royal Hospitals NHS Trust - rch-tr.foi@nhs.net FOI Governing Body members Date received: 27/04/ Please supply me with a list of names and business addresses of the non-clinical members who sit on the Governing Body of the NHS Kernow CCG. A. NHS Kernow publishes information on Governing Body members, including addresses, on our website: We therefore exempt the release of this information under section 21 of the Freedom of Information Act, information accessible by other means. Prescribing & pharmacies FOI Wound care products Date received: 04/04/ Who has operational responsibility for the formulary including the addition or deletion of products? A. NHS Kernow s Medicines Optimisation team have operational responsibility for the formulary. 2. Please provide information on how compliance with your formulary is enforced? A. NHS Kernow routinely reviews and audits the formulary. 3. Please provide information on how products are evaluated prior to being accepted onto the formulary? If this is part of a clinical evaluation or clinical trial, please provide the results. A. Products are evaluated based on clinical evidence, as well as being cost effective and safe evaluation. 23

24 4. Please provide information on who is responsible for the cost of wound care in your setting is it CCG or Acute? A. NHS Kernow is responsible for the cost of wound care. 5. Please provide information if the wound care products are on prescription FP10? 6. Please provide a list of the wound care products that you are planning to keep on prescription FP10? A. Information on wound care products are available on the Cornwall Joint Formulary: We therefore exempt the release of this information under section 21 of the Freedom of Information Act, information accessible by other means 7. Please provide information if you are planning to take wound care products off prescription FP10? A. NHS Kernow undertook a contract tender for the direct supply of dressings and awarded the contract to Convatec on 14 March The contract is currently in the mobilisation phase with the direct supply expected to commence on 1 June Please provide a list of the wound care products that you are planning to take off prescription FP10? Actico Acti-Fast blue- 7.5cm Acti-Fast yellow 10.75cm ActiFormCool Activa brand ActivHeal ActivHeal ActivHeal Hydrogel Hydrocolloid Hydrocolloid Foam Activon Tulle Activon Tube Adaptic Touch Algivon Plus Allevyn Life Anabact gel Aquacel Extra Cica-Care Clinipod Clinisorb Comfeel Plus Comfeel Plus Transparent Cosmopor easigrip (0.5m & Flaminal Forte Flaminal Hydro 1m) Hospicrepe 233 Hydrofilm Hydrofilm Plus Intrasite Conformable Iodoflex Irripod Juxta Wrap Kaltostat K-Band K-Soft Medi Derma S Barrier cream 28g Non-Sterile (100 pads per pkt) Medi Derma S Barrier film applicators Nurse it (Alvita) PICO Povitulle Profore #1 Scanpor Sorbsan Flat Sorbsan Plus Sorbsan Sterile (5 pads per Steripaste UCS cloth Ribbon pkt) 24

25 Urgotul absorb Vacutex UrgoTul Absorb Border Vacuum Assisted Closure (VAC) UrgoKTwo Zetuvit E Sterile Urgotul SSD Zetuvit Plus 9. Do you hold information about your patient demographic? If so, please provide information on what is your patient demographic and what are the most commonly treated wounds from your patient demographic 10. Please provide any information that you have relating to the average monthly usage of each product in the formulary? A. NHS Kernow does not hold the information you have requested. Please redirect your request to NHS Business Services Authority to request this information ( 11. Please provide information on the number of wound care products used that are not currently on the formulary? A. Information on wound care products are available on the Cornwall Joint Formulary: Therefore, products that are listed on the Drug Tariff but not on our formulary are the products not used. 12. Please provide any information on the monthly usage levels for nonformulary wound care products in the last twelve months? A. NHS Kernow does not hold the information you have requested. Please redirect your request to NHS Business Services Authority to request this information ( 13. How often do you review your wound care formulary and when was this last undertaken? A. The wound care formulary is reviewed on an annual basis. The date of the last review was November Please provide information about the procedure that you use of the information you assess when reviewing your formulary? A. The review is undertaken based on NICE guidance and local trials alongside specialist nurse input and advice. 15. Please provide a list of the suppliers that are currently on your formulary? 16. Please provide figures for your total spend on wound care products in 2015 and 2016? 17. Please provide figures for your total spend on Compression bandages in 2015 and 2016? 18. Please provide figures for your total spend on Foam dressings in 2015 and 2016? 25

26 19. Please provide figures for your total spend on Anti-Microbial wound care products in 2015 and 2016? 20. Please provide figures for your total spend on Alginate (Silver) wound care products in 2015 and 2016? 21. Please provide figures for your total spend on Hydrocolloid wound care products in 2015 and 2016? 22. Please provide figures for your total spend on Wound contact products in 2015 and 2016? 23. Please provide figures for your total spend on Exudate Absorber (Super Absorber) Dressings products in 2015 and 2016? 24. Please provide figures for your total spend on Acute Wound Care products - Post Op Film Dressing Plus Pads, Steri-Strips, Stockinette and Semi Permeable Film Dressings in 2015 and 2016? 25. Please provide figures for your total spend on Skin Integrity wound products Barrier Films and Barrier Creams in 2015 and 2016? 26. Please provide figures for your total spend on Vascular Access wound products Semi Permeable Film Dressings and IV Dressings in 2015 and 2016? 27. Please provide figures for your total spend on hosiery products in 2015 and 2016? A. This information is available from NHS Business Services Authority: We therefore exempt the release of this information under section 21 of the Freedom of Information Act, information accessible by other means. 28. Are you planning on collaborating with another healthcare entity to provide wound care services? A. Yes. 29. Please provide information on your current supply route DHL, wholesaler or vendor direct? A. N/A. Currently provided via FP Do you currently have a contract in place for supply of wound care products? If so when does it expire? A. No, not at this time. 31. Please provide information on how many delivery points do you have for wound care deliveries? A. There are 152 delivery points for wound care deliveries. 32. Please provide information on how many community locations are holding stock of wound care and prescribing to the community? A. N/A. Currently provided via FP10. 26

27 33. Please provide information on what software platform do you use for ordering wound care products? A. N/A. NHS Kernow does not use a software platform for the ordering of wound care products. Products are ordered via the internet. 34. Do you have a wound care clinic in place for your local demographic and where do your referrals come from? A. NHS Kernow does not hold the information you have requested. Please redirect your request to Cornwall Partnership NHS Foundation Trust to request this information (cpn-tr.freedomofinformation@nhs.net). FOI Homeopathy services Date received: 06/04/ How much in total has your CCG spent on providing patients with homeopathy services and medicine in (i) 2014/15 and (ii) 2015/16? 2. Please provide me with a list of the products/services that you sanctioned in relation to Question 1. A. This request for information has previously been disclosed in an FOI request in December 2016 (FOI 56840) and is available to view on our FOI Disclosure Log: (foi)-requests/foi-disclosure-log/ We therefore exempt the release of this information under section 21 of the Freedom of Information Act, information accessible by other means. Referral management FOI Referrals for chiropractic / alternative medicines Date received: 07/04/ Please give the number of referrals made by the CCG/health board for the following treatments or services in each of the last three financial years (2014/15, 2015/16 and 2016/17): a) Chiropractic/Spinal Manipulation (low back and neck only) A. 2014/15: /16: /17: 1,110 b) Osteopathy (low back and neck only) 27

28 A. 2014/15: 1, /16: /17: 1,227 c) Cranial Osteopathy d) Craniosacral Therapy e) Iscador aka Mistletoe Therapy f) Herbal remedies g) Reflexology h) Traditional Chinese Medicine A. NHS Kernow does not hold the information you have requested. NHS Kernow does not routinely commission the treatments listed above. A list of these services are available on our website ( via this link: grequests/policies/commissioningpolicies2016.pdf 28

29 Appendix: FOI Hip and knee replacements 29

30 Practice Code Locality Address 1 Address 2 Address 3 Address 4 Address 5 Postcode Practice Manager Practice Manager L82021 Alverton Surgery Alverton Surgery 7 Alverton Terrace Penzance Cornwall TR18 4JH Alison Hanley Alison.Hanley@nhs.net Y01922 Stennack Surgery The Stennack Surgery The Old Stennack School St Ives Cornwall TR26 1RU Lydia Hale lydia.hale@nhs.net L82038 Cape Cornwall Surgery Cape Cornwall Surgery St Just Penzance Cornwall TR19 7HX Ian Cary Ian.Cary@nhs.net L82047 Marazion Surgery Marazion Surgery Gwallon Lane Marazion Cornwall TR17 0HW Jackie Brown jackie.brown23@nhs.net Y01050 Rosmellyn Surgery Rosmellyn Surgery Alverton Terrace Penzance Cornwall TR18 4JH Lorna Nicholas lorna.nicholas@nhs.net Y01051 Morrab Surgery Morrab Surgery 2 Morrab Road Penzance Cornwall TR18 4EL Jim Payne jim.payne1@nhs.net L82053 Penalverne Surgery Penalverne Surgery Penalverne Drive Penzance Cornwall TR18 2RE Lesley Searle lesley.searle1@nhs.net L82070 Sunnyside Surgery Sunnyside Surgery Hawkins Road Penzance Cornwall TR18 4LT Linda Rees linda.rees@nhs.net L82036 Bodriggy Health Centre Bodriggy Health Centre 60 Queensway Bodriggy Hayle Cornwall TR27 4PB Stephanie Jones stephanie.jones19@nhs.net L82017 The Health Centre, St Mary's The Health Centre, St Mary's King Edward Lane St Marys Isles of Scilly Cornwall TR21 0HE Alison Jenkins Alison.Jenkins9@nhs.net L82057 St Keverne Health Centre St Keverne Health Centre St Keverne Cornwall TR12 6PB Anita Dugmore Anita.Dugmore@nhs.net L82056 Mullion & Constantine Group The Health Centre Mullion Cornwall TR12 7DQ Neil Stevens Neil.stevens5@nhs.net L82059 Meneage Street Surgery Meneage Street Surgery 100 Meneage Street Helston Cornwall TR13 8RF Linda Granger l.granger@nhs.net L82018 Helston Medical Centre, Helston Helston Medical Centre Trelawney Road Helston Cornwall TR13 8AU Alison Butterill A.Butterill@nhs.net L82617 Phoenix Surgery Phoenix Surgery Camborne Health Office Rectory Road Camborne Cornwall TR14 7DL Ali Henley ahenley@nhs.net L82068 Praze-an-Beeble Surgery Praze-an-Beeble Surgery School Road Praze-An-Beeble Cornwall TR14 0LB Anne Craig anne.craig3@nhs.net L82620 Harris Memorial Surgery Harris Memorial Surgery Robartes Terrace Illogan Redruth Cornwall TR16 4RX Dawn Jonathan dawn.jonathan@nhs.net L82041 Carn to Coast Pool Health Centre Station Road Pool Cornwall TR15 3DU Wendy George/ wendy.george3@nhs.net/ L82042 Manor Surgery, Redruth Manor Surgery Chapel Street Redruth Cornwall TR15 1AU Julie Campbell Julie.campbell16@nhs.net L82044 Veor Surgery Veor Surgery South Terrace Camborne Cornwall TR14 8SN Teresa Kemp Teresa.kemp1@nhs.net L82014 Trevithick Surgery Trevithick Surgery Basset Road Camborne Cornwall TR14 8TT Stephen Holby stephen.holby@nhs.net L82024 Clinton Road Clinton Road 19 Clinton Road Redruth Cornwall TR15 2LL Caroline Pugh carolinepugh@nhs.net L82054 St Agnes Surgery St Agnes Surgery Pengarth Road St Agnes Cornwall TR5 0TN Liz Thierens liz.thierens@nhs.net L82061 Carnon Downs Surgery Carnon Downs Surgery Bissoe Road Carnon Downs Truro Cornwall TR3 6JD Sally Rickard Sally.Rickard4@nhs.net L82015 Chacewater Health Centre Chacewater Health Centre Chacewater Cornwall TR4 8QS Susan Gunn Susangunn@nhs.net L82028 Three Spires Medical Practice Three Spires Medical Practice Truro Health Park Infirmary Hill Truro Cornwall TR1 2JA Katy Hawker K.hawker@nhs.net L82001 Lander Medical Practice Lander Medical Practice Truro Health Park Infirmary Hill Truro Cornwall TR1 2JA Liz Wilson liz.wilson16@nhs.net L82013 Perranporth Surgery The Perranporth Surgery Perranporth Cornwall TR6 0PS Lisa Fogg Lisa.fogg@nhs.net L82622 Westover Surgery Westover Surgery Western Terrace Falmouth Cornwall TR11 4QJ David Whitworth david.whitworth@nhs.net L82049 Falmouth Health Centre Falmouth Health Centre Trevaylor Road Falmouth Cornwall TR11 2LH Geoff Dennis Geoff.dennis@nhs.net L82006 Penryn Surgery The Penryn Surgery Saracen Way Penryn Cornwall TR10 8HX Mark Taylor Mark.taylor35@nhs.net L82052 Trescobeas Surgery Trescobeas Surgery Trescobeas Road Falmouth Cornwall TR11 2UN Yorick O'Nyons yorick.o'nyons@nhs.net Y02517 Newquay Health Centre The Health Centre St Thomas Road Newquay Cornwall TR7 1RU Jane Meachem Jane.meachem@nhs.net / L82029 Narrowcliff Surgery Narrowcliff Surgery Narrowcliff Newquay Cornwall TR7 2QF Susan Beadle sbeadle@nhs.net L82023 The Petroc Group The Medical Centre Boyd Avenue Padstow Cornwall PL28 8ER Ian Gibson Ian.Gibson5@nhs.net L82035 Fowey River Practice Fowey River Practice Rawlings Lane Fowey Cornwall PL23 1DT Amanda Bone amanda.bone1@nhs.net L82045 Probus Surgery Probus Surgery Tregony Road Probus Cornwall TR2 4JZ Debbie Barnicoat debbie.barnicoat@nhs.net L82048 Portscatho Surgery Gerrans Hill Surgery Gerrans Hill Portscatho Cornwall TR2 5EE Nicola Hayward nhayward@nhs.net L82051 The Clays Practice The Clays Practice Clays Area Health Office Victoria Road Roche Cornwall PL26 8JF Judith Kurth judith.kurth@nhs.net L82011 Brannel Surgery Brannel Surgery 58 Rectory Road St Stephen St Austell Cornwall PL26 7RL Liz Trevarton liz.trevarton@nhs.net L82039 Lostwithiel Surgery Lostwithiel Surgery North Street Lostwithiel Cornwall PL22 0EF Rowena Angell rowena.angell@nhs.net L82025 Mevagissey Surgery Mevagissey Surgery River Street Mevagissey St Austell Cornwall PL26 6UE Nicola Deakin n.deakin@nhs.net L82026 Middleway Surgery Middleway Surgery Middleway St Blazey Par Cornwall PL24 2JL Katrina Clemes k.clemes@nhs.net Y04957 St Austell Healthcare Wheal Northey 1 Wheal Northey St Austell Cornwall Pl25 3EF Bridget Sampson (Exec Manager) bridget.sampson@nhs.net L82003 Port Isaac Practice Port Isaac Practice Hillson Close Port Isaac Cornwall PL29 3TR Pat Shuttlewood pat.shuttlewood@nhs.net L82058 Bottreaux Surgery Bottreaux Surgery Boscastle Cornwall PL35 OBG Matthew Gibbons matthew.gibbons4@nhs.net L82008 Stratton Medical Centre Stratton Medical Centre Hospital Road Stratton Cornwall EX23 9BP Kathryn Pengelly kathryn.pengelly@nhs.net Y01127 Neetside Surgery Neetside Surgery Methodist Church Hall Leven Road Bude Cornwall EX23 8LA Melanie Chenoweth melaniechenoweth@nhs.net L82618 Camelford Medical Centre (Dr Garrod) Camelford Medical Centre (Dr Garrod) Churchfield Camelford Cornwall PL32 9YT Carmel Flynn carmelflynn@nhs.net L82009 Carnewater Practice Carnewater Practice Dennison Road Bodmin Cornwall PL31 2LB Sally Poxon sally.poxon@nhs.net L82004 Wadebridge & Camel Estuary Practice Wadebridge & Camel Estuary Practice Brooklyn Wadebridge Cornwall PL27 7BS Sonia Geach sonia.geach@nhs.net L82010 Stillmoor House Medical Practice Stillmoor House Medical Practice Bell Lane Bodmin Cornwall PL31 2JJ L82007 Camelford Medical Centre (Dr Nash) Camelford Medical Centre (Dr Nash) Churchfield Camelford Cornwall PL32 9YT Michelle Sue Rabson Pratley susan.rabson@nhs.net pratley.michelle@nhs.net L82037 Pensilva Health Centre Pensilva Health Centre School Road Pensilva Liskeard Cornwall PL14 5RP Catherine Pickstone catherine.pickstone@nhs.net L82050 Rosedean House Surgery Rosedean House Surgery 8 Dean Street Liskeard Cornwall PL14 4AQ David Sheppard david.sheppard@nhs.net L82016 Oak Tree Surgery Oak Tree Surgery Clemo Road Liskeard Cornwall PL14 3XA Liz Delbridge (Deputy) Liz.Delbridge@nhs.net Y00969 The Rame Group Practice The Rame Group Practice Penntorr Health Trevol Road Torpoint Cornwall PL11 2PD Claire Greaves clairegreaves@nhs.net L82043 Quay Lane Surgery Quay Lane Surgery Old Quay Lane St Germans Cornwall PL12 5LH Debbie Todd debbietodd@nhs.net L82022 Old Bridge Surgery Old Bridge Surgery Station Road Looe Cornwall PL13 1HA Mark Allen markallen3@nhs.net L82012 Tamar Valley Health Tamar Valley Health The Health Centre Haye Road Callington Cornwall PL17 7AW Linda Donaldson Rosemary Rogers linda.donaldson4@nhs.net/ rosemary.rogers2@nhs.net L82046 Saltash Health Centre Saltash Health Centre Callington Road Saltash Cornwall PL12 6DL Lynn Chenery lynn.chenery@nhs.net L82030 Launceston Medical Centre Launceston Medical Centre Landlake Road Launceston Cornwall PL15 9HH Peter Harper peter.harper5@nhs.net L82066 Port View Saltash Port View Surgery Higher Port View Saltash Cornwall PL12 4BU Tina Seedhouse tina.seedhouse2@nhs.net