19th November 2018
By Graham Smith
A legal challenge to Accountable Care Organisations – which many see as an existential threat to the National Health Service – is set for a crucial week. The outcome of the case will determine whether Cornwall Council’s “Kennally Care” project, which seeks to centralise strategic health commissioning at County Hall, makes further progress.
The Court of Appeal is due to hear a case brought by the campaign group 999 Call for the NHS tomorrow (Tuesday) and on Wednesday. The tortuous creation of what is now called an “Integrated Care Partnership” (ICP) is highly political, re-uniting Conservatives and Liberal Democrats and establishing Labour as Cornwall’s dissident voice.
999 Call for the HHS says: “NHS England’s proposed and newly rebranded Integrated Care Provider contract (it was called the ACO Contract originally) is a complex lead provider contract that contains one major feature – what is called a Whole Population Annual Payment.
“This single clause will radically alter the way in which NHS funding works – paying a fixed lump sum at the beginning of a financial year to cover “planned activities” – and is the fatal contractual change that will drive USA Accountable Care Organisation models into our NHS.”
Although NHS care would remain free at the point of delivery, local commissioners would be encouraged to purchase services from wherever they wanted. Private medical companies are already major players in Cornwall’s health economy and are watching developments closely.
The draft contracts for ICPs do not necessarily make more privatisation inevitable, but campaigners fear the proposed restructure certainly makes wholesale privatisation of the NHS much more likely. They say it unlawfully shifts the risk of there being an underestimate of patient numbers from the commissioner to the provider, and endangers service standards. Pro-NHS campaigners are planning to demonstrate in The Strand tomorrow morning.
Cornwall’s health and council bosses say they are progressing their ambitions only “at the speed of trust.” Cornwall Council, NHS Kernow and the Cornwall and Isles of Scilly Partnership Foundation Trust have already completed what they call the “mobilisation phase” of their ICP. The ICP will shortly become a “forum for joint decision-making” – with some fully “delegated operational responsibilities” by April 2019.
In Scotland and Wales, which have devolved powers over health, local governments have abandoned the purchaser-provider split.
A further complication is the extent to which Cornwall Council sees the restructure as part of its Devolution Agenda – setting its own targets, defining its own successes, and introducing its own “back office” cost-cutting. Critics are more likely to emphasise the increased fragmentation and bureaucracy.
County Hall is highly sensitive about claims that it is trying to take over the NHS, but Cornwall Council’s chief executive Kate Kennally has for nearly two years been chair of the Transformation Board, following a bloody power-struggle with NHS England. Ms Kennally would also become the chief of the strategic commissioners – with some now dubbing the restructured health system as “Kennally Care.”
Also next week, a Labour Bill to “re-instate the NHS” is due to get its second reading in the House of Commons on 23rdNovember – although some in Labour’s ranks, who 15 years ago enthused about the privatisations and outsourcings of Tony Blair’s government, are still attracted by the current government’s direction of travel and see little wrong with more “devolution” provided it comes with the necessary safeguards.
The central plank of Labour’s NHS Bill is its assault on the private medical sector, which the party’s current leadership regards as plundering public resources for private profit.