Cornwall Council taking over the NHS? It’s more of a partnership, says the Doctor leading the revolution
12th December 2017
By Graham Smith
Details of Cornwall Council’s plans to take over the National Health Service are to be discussed for the first time in public next week.
At the same time, the chairman of NHS Kernow, Dr Iain Chorlton, has outlined his thoughts on the radical changes about to sweep through Cornwall’s healthcare system. Dr Chorlton is also a GP and Chairman of Shaping Our Future’s Clinical Practitioner Cabinet.
NHS Kernow has an annual budget of around £700 million to spend on health in Cornwall. Under the proposed new arrangements for a single health commissioner, from 2018/19 that budget would be administered by the council’s chief executive, Kate Kennally, from County Hall.
In an article published by Healthwatch Cornwall, Dr Chorlton says:”You might have heard the phrases Accountable Care Organisations, Accountable Care Systems, or Accountable Care Partnerships being used more and more during the past 18 months when people talk about the future of health and care services, but what are they and how do they relate to the varied work each of us are doing?
“In Cornwall and the Isles of Scilly we have begun to adopt the term Accountable Care Partnership, which I believe is a true reflection of our journey so far. Whilst many people may assume that the NHS is one, an aligned and coordinated health service, it is worth noting that since the inception of the NHS in 1948 it has never been a single entity.
“There has always been a boundary between those who purchase health care and those who provide it, or in our current iteration between those who commission and those who provide, such as GP practices and hospitals. Whilst we talk about international examples of capitated accountable care, such as in Christchurch, New Zealand, or Valencia in Spain, we have always worked with what is a fragmented system.
“What an Accountable Care Partnership sets out to do is bring together accountability for the delivery and performance of services – such as mental health, community hospitals, emergency care or transport – for ourselves. Now that there appears to be very little prospect of an amendment to the 2012 Health and Social Care Act, I fully expect that we will continue to work within current legislature and guidance.
“This means that the emphasis of commissioning health and care services will also change – a responsibility which has sat with clinical commissioning groups since 2013. There is a consensus from those behind the thinking of Sustainability and Transformation Plans (STPs or, Shaping Our Future, as we call our programme), that the role of a commissioner will become more strategic in the future. The system performance will primarily become the responsibility of organisations that provide services, which are working towards common aims –the tactical side of commissioning.
“As we bring together local NHS and care services, we must remain mindful of what is happening in other parts of the country but it is clear there is no national blueprint as to how we move in this direction. This provides us with the opportunity to develop our own ACP, influenced by our own thoughts.
“Even in areas such as Dudley where there is a current procurement to develop an Multi-speciality Community Service Provider (MCP), to deliver a range of services including community services; mental health and learning disability services; urgent care centres and GP services and out of hours’ care, this goes nowhere near creating a single provider for all services outside of acute hospitals. Individual GP practices will be working together, as individual providers, around a common population partnership aim.
“In Manchester, where there have been several hundred million pounds of investment to support devolution, there is no thought process that relies on widespread organisational merger.
“The accountable care developments are, in the main, held together through partnership and relationships. We need to remember this during the coming months and maintain our primary focus on achieving improved outcomes for people living in Cornwall and the Isles of Scilly.”
A meeting at County Hall, Truro, is to be held on Tuesday 19th December, 2pm – 4pm. Although members of the public will not be able to ask questions, they will be able to observe, for the first time, senior council officials and NHS managers debate progress towards setting up an Accountable Care Organisation/System/Partnership.
Dr Chorlton’s article makes no mention of the risks associated with the new organisation, or of the legal challenges mounted by prominent academics such as Professor Stephen Hawking.
Tensions between County Hall and the NHS managers have eased slightly since a major bust-up, a year ago, which saw Ms Kennally take over from NHS England’s Joyce Redfearn as chair of the Sustainability and Transformation Plan board. Interestingly, Cornwall Council officials do not use the phrase “partnership” and in their documents refer the new organisation as either an Accountable Care System or Organisation.
The council’s 10-member cabinet is due to vote in favour of setting up an ACO on 7th February, even though a six-member Inquiry Panel has yet to hold its first meeting. The ACO would operate in “shadow” form from April and is expected to be fully operational, with a single health commissioner for Cornwall, from April 2019.
The meeting on 19th December will be the first time the Transformation Board of the Shaping Our Future partnership (previously known as the Sustainability and Transformation Plan) will have met in public.
The Healthwatch website says: “We understand that there have been considerable concerns about how this (ACO) may affect Cornwall services, as well questions relating to the legal basis of ACO proposals such as a legal challenge made by a campaign group and backed by law firm, Leigh Day, in October, while the honorary vice-president of the British Medical Association in a Pulse article on December 5, said, `beware the ACO Trojan horse’.
“For us, it is vital that regardless of individuals’ political views on these changes that people have a clear understanding of the process and a means of expressing their concerns to those making the changes.
“The SoF team is discussing Cornwall’s ACS at the first in public Transformation Board meeting on Dec 19 at New County Hall, Truro, TR1 3AY, from 2pm to 4pm. We encourage people to attend or provide feedback on this topic via our Have Your Say online option.
“We will update on our website following this meeting and will do our best to keep you up-to-date on progress as we learn about it.
“As part of our involvement in the SoF process, we will continue to encourage the SoF communications team to share regular updates on this process to ensure there can be clarity for all.
“We urge anyone to share their view on this with us, and we will pass them anonymously to those involved with the ACS progression to help those voices be heard.”