By Graham Smith
The prospect of Cornwall Council taking over the National Health Service will be re-evaluated next week once County Hall officials have settled on a form of words designed to unite the authority’s 10-member cabinet. Those officials are now turning for help to a small, private company which only a few people have ever heard of.
All the signs are that behind the scenes, the council is now designing an “informal” Accountable Care System intended to execute most of the ideas developed over the past two years of Sustainability and Transformation Plan talks between its senior executives and their NHS counterparts.
The key elements are:
- A single strategic health commissioner
- An agenda driven by Cornwall’s 2015 Devolution Deal, transferring powers from Whitehall to Truro
- Ever-closer budgetary ties between County Hall and the NHS
- Reliance on people improving their own health, through diet and exercise
- Rationalisation and sale of community health facilities
The political sensitivities of this approach are such that a whole new language has been created to help ease concerns about budget cuts and an increased risk of privatisation. After two years of almost-comic changing of acronyms, one of the most important words in this new language now is “informal.”
An increasingly-important player in the promotion of Accountable Care is a little-heard-of private company, known as the South West Academic Health Network, which was set up by NHS England in 2013. It aims to “improve health and create wealth in the region.” The Network is a Company Limited by Guarantee – a not-for-profit organisation, similar to a charity or community organisation, but which is not open to public scrutiny or democratic accountability.
The Network is part-funded by NHS England and its “member organisations” – mostly NHS “partners” but some come from the private healthcare sector. None of the Network’s board members is elected. The Network has prepared an “informal” route map to help steer councils towards Accountable Care Systems – and Cornwall’s officials, like those of other authorities in the region, rely heavily on this route map.
Explaining the rationale for Accountable Care, the Network’s route map says strategic commissioning can “hold providers to account through contracts.” You can download and read this 66-page blueprint here: Accountable-Care-Environment-Route-Map-2
The council’s cabinet held an “informal” meeting on Monday 26th February. To the dismay of chief executive Kate Kennally, that meeting found it had no majority for proceeding with a single-budget Accountable Care System – defined by the council’s Inquiry Panel as “Option 6.”
At least half of the cabinet, including a majority of its Independent members and two of its Liberal Democrats, said they did not understand why there was such a rush to proceed with Option 6 on 1st April. A Judicial Review intended to test the legality of single budgets is due for trial on 24th April.
Three days after that informal cabinet meeting, the council published an extraordinary press release, designed to paper over the cracks and agreed by health portfolio holder Rob Rotchell and by council leader Adam Paynter. Crucially, this press release was not even seen by Ms Kennally, It announced that the ACS recommendation had been shelved. The press release stated that proposals for a single budget – essential to “Option 6” – were no longer on the table.
Instead, the release talked of greater integration within existing frameworks – something which sounded much more like “Option 2” and which is already bringing improvements to the “delayed discharge” disconnect between acute and social care. Ms Kennally was furious and the following day both Mr Rotchell and Mr Paynter were ordered to issue a grovelling apology.
But the cat was out of the bag and the preference for “Option 2” was subsequently endorsed by the governing board of NHS Kernow, whose clinician members were severely critical of what they saw as County hall’s “politically-driven, Devolution agenda.”
Cornwall’s Tories were also furious, the Liberal Democrats were very confused, and Labour delighted – especially those “extreme Left-wing protestors” credited by the Tories for having brought about the change. The protests have indeed been successful in raising public awareness and at least slowing what just over a year ago was the council’s ambition to set up “at pace” a fully-fledged Accountable Care Organisation, with a single, defined five-year budget and Ms Kennally firmly in charge.
But the prospect of Kennally Care has not gone away. Cornwall councillors will get an update on Wednesday, which is when the business plan for the “informal” ACS is due to be published. Some councillors say they are actually looking forward to learning more about the difference between “aligned” and “pooled” budgets.
Those County Hall officials tasked with designing the language necessary to unite the cabinet, before its next formal meeting on 28th March, are now looking for an “Option 7.” This looks very much like an option which requires all future communications to be expressed in Orwellian Newspeak: but as long as it is only informal, perhaps it doesn’t really matter.