ANALYSIS – Cornwall’s health service: the shotgun wedding is a step closer, but no-one’s talking about the dowry or that slightly tricky guest list
20th December 2017
By Graham Smith
Yesterday’s (Tuesday’s) Inquiry Panel investigating Cornwall Council’s proposed takeover of the National Health Service was particularly instructive – albeit unintentionally – in two ways.
First, not one of the scheduled witnesses due to give evidence at Cornwall Council’s “Inquiry” into its takeover of the National Health Service is known to be remotely hostile to the principle of Accountable Care Systems, which are championed by Health Secretary Jeremy Hunt without any scrutiny in Parliament.
Second, the single most important witness – the one who actually owns most of the bricks-and-mortar of Cornwall’s NHS – is spectacularly absent. There are 33 community facilities in Cornwall owned by NHS Property Services, including what are quaintly known as cottage hospitals.
The new “strategic” vision for Cornwall, which is loved only by a NHS public consultation exercise which the council itself condemned as “not fit for purpose,” envisages a dramatically smaller estate. So how much are these buildings worth, and which, if any, might survive? These are the questions which local citizens are asking, but they will not be heard during the council’s Inquiry.
The government has already said it wants to use the cash raised from property sales to finance the NHS. This is a trick with a limited lifespan.
The Royal Cornwall Hospital Trust – which essentially owns the Treliske estate, plus St Michael’s and Penzance – was not asked about what will happen to its assets once the Trust is forced into bed with the Cornwall Partnership NHS Foundation Trust, and they both then answer to the new “Single Commissioner,” who has already been identified as Cornwall Council’s chief executive Kate Kennally.
If everything goes according to plan, RCHT and CPFT will be merged into a new Accountable Care Partnership by 1st April 2019. Who would then own the assets? What safeguards could prevent their sale? Does anyone seriously doubt that Ramsay Healthcare, which already owns the Duchy hospital on the same Treliske site and which recently won hands-down when it came to playing hardball with NHS Kernow over the Bodmin Treatment Centre, would not want to put in a bid?
These are all questions which did not get heard yesterday, and probably won’t be heard next month either because of the extremely narrow terms of reference governing the Inquiry.
Now for the guest list. NHS England and RCHT’s chief executive got a whole day to themselves, which is actually only three hours, and to be fair to the Inquiry Panel members, they did face some challenging questions. But the only new piece of information to emerge was that the 1stApril deadline was totally arbitrary, and that the world would not end if everyone just slowed down a bit.
We also learned that the word “Accountable” means different things to different people. Councillor Bert Biscoe would prefer it if an Accountable Care System was democratically accountable. Kathy Byrne, chief executive of RCHT, later explained that Accountable Care isn’t accountable TO anybody, it is accountable FOR a defined population. I’m sure Bert and Kathy are going to get along just fine.
Otherwise we simply got treated to some amusing slides and confirmation of what we already knew: Cornwall’s health service is not well prepared for this merger, with huge financial, managerial and performance problems. The only other part of the South West which is trying it, Dorset, started from a much stronger position.
Still to come we have the King’s Fund, which has never said a rude word about Accountable Care – possibly because its main paymaster is the NHS (Jeremy Hunt) and next-closest paymaster is a bevy of private healthcare providers, who stand to benefit dramatically if the ACS does lead to increased privatisation.
Every witness yesterday said: “This is not about privatisation.” Of course it isn’t. It’s about integrating a health service which has become grotesquely fragmented ever since former Health Secretary Ken Clarke pioneered privatisation in the early 1980s with the then hospital laundry service based at Pool.
Accountable Care as board game? One of the slides which informed yesterday’s Inquiry Panel meeting
With hindsight, Ken Clarke was a pussycat. The Thatcher-Major-Blair consensus which followed has resulted in a real dog’s breakfast, with no part of the NHS now too small to have its own chief executive and management board.
But the healthcare structure which would emerge from ACS does make wholesale privatisation much easier, because a Single Commissioner will have a fixed, place-based budget and must know with total certainty that she gets what she pays for, before the end of the financial year. And if privatisation becomes much easier, it automatically becomes more likely.
Whereas you once had to be a highly developed industrialised nation State to run a health service, the power of global corporations now puts them in pole position to buy and sell contracts anywhere they like.
Three years ago the government-commissioned Dalton Review concluded that private companies could be contracted to run major hospitals. Especially if the price is right. And why would anyone think that having Cornwall Council in charge of commissioning would lead to an increase in privatisation?
Just consider the list of things which your local council used to do, but doesn’t do anymore.
Arguably, it started in the 1980s with the creation of an arm’s length organisation to take over the old folks’ homes, which are now completely outside of the council. Does anyone think the leisure centres are better (no pun intended) as a result of their journey from local authority, to another arm’s length charity, via a contract with another charity in between? Dustbins used to be emptied by people employed by the council. A majority of Cornwall’s schools are now academies and not supervised by any local democratic organisation. Pretty much everything else now comes under Corserv (currently dealing with a little local difficulty) and even the extremely challenging world of children’s services is now heading for the door as yet another arm’s length company (NB: Virgin are watching.)
The Inquiry still needs to hear from patients, in the form of CCG’s own Patient Group, and from Healthwatch Cornwall, but neither has so far taken to the barricades to articulate any alternative to ACS. It’s funny how when people say “There Is No Alternative” they are not being political. It’s only those who insist that there is an alternative who are accused of dragging politics into a discussion.
So of course, pretty much everything about what is happening now is highly political. Attempts by some of the Inquiry Panel members to dismiss yesterday’s County Hall protest as “a Momentum rabble” are likely to backfire. Some of them actually work in the NHS and know what they’re talking about. The decision to exclude NHS trade unions from the Inquiry smacks of a done-deal. What harm could it do to hear points of view which don’t simply leave you with a smug glow?
Instead, it is left to groups like 999 Call for the NHS and Keep Our NHS Public to publish their briefing papers and try to make the case for a truly “National” health service. There are plenty of groups like this who have a different view to the only view framed in Truro. Why are these organisations not invited to give evidence? In what way is the King’s Fund valid, and KONP not, apart from their level of funding and resources?
Cornwall’s Inquiry could always try and call on experts like Professor Allyson Pollock, and ask her why she’s going to Judicial Review to try to stop Accountable Care. And as for the Socialist Health Association…well, that’s just far too political.