7th March 2018
By Graham Smith
Cornwall Council’s ambition to take over the health service appears to have taken a severe knock after the NHS Kernow clinical commissioning group criticised the plans and decided that any closer working relationship with County Hall would instead be governed by existing statutory mechanisms.
The CCG’s preference for “Option 2” rather than the council’s desired “Option 6” was accompanied by some unusually harsh words about the “political ambitions” of some councillors to further their Devolution Deal, transferring governance powers from Whitehall to Truro.
Some of the GPs who make up the CCG board also questioned the suitability of the council’s chief executive, Kate Kennally, to lead what has become known as “Kennally Care.”
It is still unclear how the council’s cabinet will proceed when it meets on 28th March. All 123 members of the council have been invited to a briefing at County Hall on 21st March.
There are now clear signs of splits within the cabinet. Politically, some of the Independent councillors in the 10-member cabinet are well to the left of most of the Liberal Democrats and are known to have harboured doubts about how Kennally Care would improve Cornwall’s health.
NHS Kernow agreed that it would “work towards” Option 6, but only after exhausting greater use of Section 75 Agreements to secure greater co-operation and integration where desired, particularly in relation to mental health services. Section 75 Agreements, created by the 2006 NHS Act, allow health and local authorities to pool resources to deal with specific issues and are seen by the GPs as far less risky than putting Ms Kennally in overall charge of all strategic health commissioning.
Dr Iain Chorlton, NHS Kernow chairman, is an enthusiast for Option 6 but accepted that the County Hall ambition to launch a new organisation on 1st April, even in shadow form, might now have to be abandoned. He said no business case for Option 6 would be ready before September at the earliest.
The CCG board decision came after a turbulent few days at County Hall, which has stripped away much of the tortured jargon to reveal the council’s raw party politics and bureaucratic ambition.
On Thursday night the Liberal Democrat-led council announced what looked like a high-speed and very dramatic U-turn. This so angered the council’s Conservative Inquiry Panel chairman, Andy Virr, who had recommended an Accountable Care System with a single budget, that he condemned the Lib Dems for surrendering to “far left-wing protestors.”
The next day the council’s Liberal Democrat leader, Adam Paynter, wrote to Mr Virr in an attempt to reassure him that despite changing the name of the proposed ACS to an Integrated Strategic Commissioning Function, and despite abandoning the original ambition of a single, five year budget, the council had not performed a U-Turn and that Kennally Care, as defined by Option 6, would still go ahead as planned.
But at the same time as the council’s cabinet portfolio holder for health, Lib Dem Rob Rotchell, was writing a grovelling apology to councillors for any confusion, his Lib Dem cabinet colleague Sue James was writing to constituents to say that she would not vote for Kennally Care no matter what it was called. “The Cabinet in Cornwall will not be voting on an Accountable Care System on 28 March,” she said. “The Sustainability and Transformation Plan is a Health not Council plan and CC said it was not fit for purpose. ….if I am wrong and an Accountable Care System (or any other proposal renamed but the same) comes to cabinet before the (National) Judicial Review, I will not be voting for it!”
St Austell and Newquay’s Conservative MP, Steve Double, also criticised the County Hall confustion. “This is one of the most important decisions facing Cornwall right now that will determine how our health and care services are run in the future,” he said. “Doing nothing is not an option, however neither is making knee jerk reaction decisions or playing politics with our health and care provision. I hope now that the cabinet at Cornwall Council will work with the NHS and other agencies to make a fully informed and carefully considered decision that is in the best interest of the people they are elected to serve.”
Mr Virr has now taken to Facebook to further criticise the Liberal Democrats: “Since my last statement on this on Friday afternoon, Cornwall Council’s cabinet has issued two further press statements, including one apologising for the timing and content of their first one.
“However, beyond this, there is still no clarity on what the Cornwall Council cabinet’s position is on its own scrutiny committee’s recommendation that Cornwall should move to integrated strategic commissioning for health and social care.”
“Health and social care are connected and interconnected. Patients awaiting packages of care stuck in hospital beds place extreme pressure on the NHS. Likewise, residents with excellent social care support in their own homes help to keep them well and can spot the signs of early sickness allowing more prompt treatment in the community. It is common sense, therefore, that health and social care must be joined up to achieve the best outcomes for our population in Cornwall.”
“Cornwall Council’s cabinet are ignoring the advice of the inquiry panel that spent four days looking carefully into the evidence for the pros and cons of joining strategic commissioning. The key issue to make this work is combining the budgets (not just aligning them). It is an odd marriage that doesn’t have a joint bank account, just as joint commissioning without a joint budget would be solely warm words, but in reality, arguing about who is going to pay for services. Proper joined up commissioning, however, would have a common plan and one budget to pay for the services jointly commissioned.”
“I urge the cabinet to reverse its decision to ignore the advice of health and social care leaders and instead do the right thing and make the best joined up use of the money that Cornwall has to spend.”
Mr Virr’s sentiments echo those of Ms Kennally who, most unusually, appears to have been thwarted – at least for now. And while Mr Virr’s anger might have been directed at the “far left-wing protestors” it was in the end the medical professionals who called time on the ACS project.
The County Hall chaos also provoked a critical response from the patients’ organisation, Healthwatch Cornwall, whose chief executive Amanda Stratford said: “It is disappointing to see such mixed messages from Cornwall Council, particularly as part of our evidence at the recent Inquiry recommended that all parties involved work together to create clear public communication.
“For us, transparency of process and listening to the public voice has always been of most import – on our own social media we have seen how passionate people are about the clarity of decision-making.
“In response to our requests for clarification, Kate Kennally, Chief Executive at Cornwall Council, confirmed that no formal decision had been taken and the wording of the article had been “unfortunate”, with the option for integrated commissioning chosen at the Inquiry still to be considered by cabinet on March 28.”
“With a seat on the Health and Wellbeing Board, we will also be seeking clarity on how any change to its remit may affect our role if the preferred option is not supported by cabinet at the end of the month.”
The 28th March cabinet meeting could offer further insights into the divisions at County Hall. Health campaigners insist they will remain vigilant, with the possibility of legal action if Option 2 slides into Option 6, bringing with it greater risk of privatisation.