A five year plan, government cash, and don’t get sick: the business case on which Cornwall Council is proceeding with Kennally Care
5th February 2018
By Graham Smith
The chairman of NHS Kernow has told Cornwall Reports he expects his organisation to survive the transformation to “Kennally Care” until such time as the law is changed to allow for its abolition.
Dr Iain Chorlton said the local NHS Clinical Commissioning Group would continue to fulfil its statutory functions unless and until the government agreed it was no longer necessary.
Only minutes earlier, the chief executive of Cornwall Council, Kate Kennally, had told a meeting of the council’s Health & Adult Social Care scrutiny committee that she thought it would be 2020 before any single new “local outcomes framework” would be on its own statutory footing. Critics say they do not recognise it as anything like the universal National Health Service as it has existed for 70 years.
The committee voted unanimously to recommend that the council’s cabinet, meeting on 28th March, should endorse a new “vehicle” which will restructure health and social care in Cornwall, in shadow form, from 1st April. The council has still not produced a final business case, nor risk assessment, and is facing the prospect of legal challenges from health campaigners who fear the creation of any Accountable Care System, or Organisation, could break up the NHS and lead to increased privatisation.
Dr Chorlton disputed the comments of Cornwall councillor Rob Rotchell, the cabinet portfolio holder for health, who in December confirmed that the restructure could be described as a “council takeover” of the NHS.
All eyes will now turn to the emerging detail of a business case. Ms Kennally confirmed that even the 28th March cabinet meeting will have to make do with the “draft business case” document presented to a Leadership Board in November, which you can download here: Strategic Case for Health and Social Care Devolution – for endorsement
The key points in this document are:
- An ambition to cut £17 million future revenue costs by “prevention rather than cure” – expecting Cornwall’s population to lose weight, eat healthily and cut down on alcohol through a local price-fixing mechanism
- Cornwall’s healthcare will be funded from a single five-year, place-based capitated budget
- The write-off of Cornwall’s historic £100 million NHS debt is a pre-condition for setting up an ACS
- Other financial incentives, such as £85 million for technology and buildings and £20 million to help with “transformation.”
- The draft business case makes numerous eye-catching promises, to be funded, in part, by the sale of community facilities. “We will hit national targets on A&E waits to 95% by 2018, and reduce delayed transfers of care in line with the NHSE improvement trajectory,” it says.
“We will deliver 1,200 extra care units and specialist housing, and develop Urgent Treatment Centres.
“We will deliver a command centre, with a system-wide intelligence platform. Our technology enabled system will support greater efficiencies and demand management, and we will release land via the One Public Estate programme to enable access to enhanced health services for 100,000 residents.”
One problem facing County Hall officials is that the draft business case relies on the discredited public consultation exercise published by the NHS last year. The council’s official position on this public consultation is that it was “not fit for purpose.”
A Comprehensive Impact Assessment, which you can download and read here: CIAFOI says there could be impacts for staff in the form of job losses and that, in future, staff would be hired for the new, unified organisation.
The draft business case says: “We are asking for our historical debt to be written off as a pre-requisite to strategic commissioning function, plus an acceleration of the review of financial Market Forces Factor for providers.
“We also want to move to a single outcomes framework and a unified regulatory approach. We will implement an Accountable Care System in shadow form by April 2018, with the creation of a single budget (for health, social care and public health) with local controls.
“We will deliver a single approach to commissioning and deliver services that are place based and outcomes focused. Accelerating the establishment of an ACS will also provide opportunities to achieve £4m reduction in system costs. We will achieve financial balance by 2021.”
Despite the relatively high-level of information in the draft business case, Dr Chorlton said he was not aware of any proscriptive details. “This is about how we can make best use of the public money that we have available to us,” he said.
Dr Chorlton said he did not think Cornwall would be dragged into the Judicial Reviews which are challenging the legal basis for Accountable Care. “I do not think we are at risk of facing a legal challenge simply on the basis of the discussions we are having.”
Asked if NHS Kernow would still exist in 2020: “There must be a clinical commissioning group unless the law is changed,” he said.