By Graham Smith
The NHS Kernow clinical commissioning group has agreed to proceed with a fundamental restructuring of healthcare in Cornwall – but at a significantly slower pace than that advocated by Cornwall Council.
The CCG decided to recommend “Option 2” as its preferred way of bringing health and social care closer together. The board agreed however “to move, in principle, towards Option 6 giving support to test the concept.” The formal decision to work first with Option 2 was agreed without a vote.
The clinical members of the CCG board expressed concern that Cornwall Council’s “devolution agenda” had become a political driver for change which would not necessarily improve anyone’s health. The CCG is far less enthusiastic than anyone at County Hall – verging on outright suspicious – about the council’s ambition.
Today’s (Tuesday’s) decision poses some difficulties for council officials because County Hall wants Option 6. The council’s cabinet is expected to rubber-stamp what has become known as “Kennally Care” when it meets on 28thMarch, launching an Integrated Strategic Commissioning Function, with effect from 1st April.
Health campaigners fear the ISCF is no different to the council’s proposed Accountable Care System, or its predecessor an Accountable Care Organisation, in that it could lead to greater privatisation of the NHS. In all scenarios overall responsibility for strategic health commissioning will eventually move from the NHS to the council, which has a long-established reputation for outsourcing and placing multi-million pound contracts in the private sector.
The restructure calls for “aligned” budgets to be operated through a beefed-up Health & Wellbeing Board. But CCG board members also wanted to make greater use of existing statutory mechanisms for joint commissioning in specific areas, where needed, particularly mental health.
Dr Iain Chorlton, chairman of the board, said he had received an apology from council leader Adam Paynter for the way the council had suddenly, and surprisingly, announced last week that it was abandoning its ambition to set up an Accountable Care System. The council later clarified its position and said it was still keen to pursue Option 6, but with an “aligned” budget rather than a single or pooled budget, and with the Health & Wellbeing Board to be known as an ISCF rather than anything “Accountable.”
Helen Childs said the question which had emerged among the chief executives over recent months was “why not?” She added that the “system lead” for the restructure would be the council’s chief executive, Kate Kennally.
Dr Iain Chorlton, NHS founder Nye Bevan and Kate Kennally
Mrs Childs said the CCG’s officers were seeking approval, in principle, to move cautiously towards Option 6 with a number of “gateways” to review progress and provide the opportunity for a change of mind if necessary. But, she said, there would be no detailed business case before September at the earliest.
John Yarold, one of the lay members of the CCG board, asked why the council’s Ms Kennally was to be the lead official when the greater budgetary contribution was coming from the NHS. Mrs Childs said that all of the leading roles were “interim” and could be changed in future.
Dr Rob White, one of the board’s GP members, said it was an “odd choice” to have Ms Kennally in charge, and he thought a clinician should have that responsibility. Dr Frank Old agreed.
Chris Blong, another lay member who is also the board’s deputy chairman, said the “gateways” were very important to provide an escape route if the restructure turns out not to work. “We don’t have all the answers, but we’re on a journey,” he said. Dr White replied that having gone through a “gateway” in one direction it might be impossible to return.
Dr Judy Duckworth was concerned about the relative weight of representation between NHS Kernow and the council on the new board. Mrs Childs said this was under review.
Simon Bell, chief finance officer, said the language used by the council last week had served to confuse many of the issues involved. “A lot of claims are being made for integration which I don’t see any evidence for,” he said. “Devolution is a political ambition but I don’t think it will help us improve people’s health. I worry that restructuring at this pace will distract us from what matters.”
Several board members said they were worried about the distinctions between “strategic” commissioning and “tactical” commissioning, particularly in relation to primary care.