Guest Blog by Professor Tony Woolf, Acting Chair and Secretary, Cornwall Arthritis Trust
Cornwall is well known for its coastline, beaches and mixture of rugged countryside with wooded valleys, great gardens and wonderful vistas. Poldark county. A visitor’s paradise but it has all the problems of rural and coastal communities with an economic dependency on agriculture and tourism and a low pay economy. Economic hardship is not immediately obvious but there are Cornish estates that rank among the highest in the league tables for multiple deprivation, and it is one of only two regions of the UK that was eligible for special assistance from Brussels as a result of having incomes per head less than 75% of the EU average. Housing is an issue with house prices driven by wealth of incomers and a rental market subsumed by holiday lets. On this socioeconomic background, providing healthcare to the population of 560,000 also has its challenges with a population that is widely spread across the county in small and medium-size towns and villages.
Cornwall has an ageing population through the combination of inward migration of retirees and outward migration of a young educated workforce. It has an influx of visitors during summer months, which, in combination with an ageing population and lack of social care, ensures year-round stress on healthcare services. It has a large central district general hospital in Truro with community hospitals spread across the county. Many secondary care services are delivered through peripheral clinics as travel time can be considerable, especially in summer, and challenging through the limits of public transport. In response to this challenge, the Cornwall Air Ambulance was started in 1987 – the first air ambulance service in the UK. Cornwall healthcare needs to also be largely self-sufficient due to the distance and travel time to other major centres – Plymouth is 50 miles and Exeter 100 miles from Truro – reflected in the challenges that Doc Martin faces.
The rheumatology service has developed over the last 50 years in response to these challenges through developing a hub and spoke model with a dedicated 18 bedded department funded by a specially created charity, the Cornwall Arthritis Trust, and supported by a dedicated multidisciplinary team that was opened as the Duke of Cornwall Rheumatology Unit in 1978 with a research department added to 1980. Peripheral clinics improve accessibility and the department pioneered in the 1980s the use of specialist nurses to work in the community and liaise and share care with primary care. The Cornwall Arthritis Trust has also supported the expansion of the rheumatology team through pump priming jobs and supporting training.
To develop high quality care locally but also nationally and globally, the charity has supported many research projects and most recently has been looking at how people with rheumatic and musculoskeletal conditions can be supported to stay in work. It has also enabled people in Cornwall, before the NIHR Clinical Research Network, to participate in clinical trials to ensure access to innovative therapies.
To ensure comprehensive services for people with rheumatic and musculoskeletal conditions, the charity supported the creation of a service for osteoporosis which has gained recognition through being bestowed the Duchess of Cornwall Centre for Osteoporosis. The charity is now supporting the development of services for Giant Cell Arteritis and Early Synovitis through provision of an ultrasound machine. However, there are many people with common rheumatic and musculoskeletal conditions such as osteoarthritis and back pain who do not get access to expert care but need to know more about how they can help themselves. We have therefore developed the cornwallarthritis.org.uk website to provide both general information but also local information about services and support available to help people help themselves: our strapline. The website was developed through consultation with users to ensure it provides the information they want to find and makes it easier for them to access reliable information about their condition and its management. We provide local information but also direct people to established sources, many of which are provided by other members of ARMA. We are therefore very pleased to now be part of the ARMA community and be able to highlight what is needed by local communities such as ours, but also to learn from others of how we can best support people with rheumatic and musculoskeletal conditions across Cornwall.