1st March 2018
By Graham Smith
NHS Kernow officials have published their final pitch to persuade their governing board to agree the establishment of an Accountable Care Organisation, recently re-branded, again, as an “Integrated Strategic Commissioning Function.”
The ACO was quickly re-branded as an Accountable Care “System” and then after several months was briefly known as a “vehicle” before NHS England decided on its latest ISC title.
Despite the name changes, the main thrust of the restructure remains to establish a single, pooled budget for healthcare with Cornwall Council in overall charge of strategic commissioning. It is this aspect which could provoke a legal challenge, amid fears that it will eventually lead to greater privatisation.
The NHS Kernow board, which includes several doctors, is due to meet in Bude on Tuesday. Some of the GPs are known to hold deep reservations about the plan, although the board’s part-time chairman, Dr Iain Chorlton, is an enthusiast.
At last month’s meeting, board members resisted pressure to immediately agree to the restructure, suggesting that existing mechanisms, known as “Section 75 Agreements” were a safer way to further integration of health and social care. No detailed business case for the ISC, nor risk assessment, has yet been published.
The doctors account for nearly half of the governing boardand might win a majority for rejecting the merger proposals. There seems to be growing sentiment for further inquiry, to establish lines of responsibility and financial control, as well as Cornwall’s future relationship with a “National” Health Service.
If the board remains suspicious about the plan next week, Cornwall Council’s chief executive Kate Kennally will almost certainly miss her self-imposed 1st April deadline to launch the new structure. The council’s cabinet is due to rubber-stamp her proposals on 28th March. The chances of the Liberal Democrat-led cabinet voting against “Kennally Care” are said to be zero.
In language suggesting that NHS Kernow officials are becoming more desperate to persuade their clinician colleagues, the report to Tuesday’s meeting says: “Aligning budgets provides increased potential for single contracts, provides a whole system view and could lead to a more whole system, whole population approach to health and wellbeing.
A detail from the NHS Kernow board report, showing how the ISC might develop over the next few months if Tuesday’s meeting accepts the proposals
“Working together as a single team would support better information sharing, the creation of a whole system view and greater ability to influence and improve the quality of services for individuals.
“There are financial advantages of working as a single team providing options for greater efficiency. There may also be some VAT advantages with some additional goods / services being VAT exempt.”
The report goes on to explain that about 20% of NHS Kernow staff might need to relocate and would find their jobs change slightly as the council takes charge. But, the paper says, all would continue to be employed by NHS Kernow in the short-term.
NHS and council officials aspire to run a “shadow” leadership team from 1st April before creating a new organisation, with statutory powers, next year. You can download and read the entire report here:Integrated Strategic Commissioning Function
A meeting in Penzance tomorrow will update health campaigners on the latest legal moves to make the council wait until after a Judicial Review, due for trial on 24th April, determines if the proposed new structures are lawful.