By Graham Smith
The controversy over Cornwall Council’s ambition to take over the health service will be exposed today (Wednesday) during a public debate over the speed at which “Kennally Care” is to be introduced.
Splits within the council’s cabinet have hampered the original intention to launch an Accountable Care Organisation, with a combined budget, on 1st April. In December 2016 the council said it wanted to move “at pace” to set up an ACO.
Instead, senior council officials now hope to “mobilise” closer integration with the NHS, leading to a review in September, when they hope a single Accountable Care System, with a pooled budget, will get back on track.
The decision to step back and take a slightly more cautious approach allows for a Judicial Review to be heard at Leeds High Court on 24th April. That Review will determine if single budgets are lawful.
But the council’s enthusiasm for commissioning health services remains at odds with the policy of the NHS Kernow clinical commissioning group, which wants instead to use existing statutory mechanisms known as “Section 75” agreements.
Some councillors claim these agreements are “insufficiently strategic” to embrace their 2015 Devolution Deal aspirations. They still hope that the council’s chief executive, Kate Kennally, will become the single strategic commissioner for healthcare in Cornwall.
The revised ambition is to have an ACS working “as if” it were a single commissioning organisation by September, accelerating the move towards combined budgets. This could involve some NHS staff being re-located to County Hall. Much depends on national policy developments and how NHS England advises local government and health commissioners.
Councillors were recently invited to a special briefing about Kennally Care. Helen Childs, chief operating officer at NHS Kernow, told councillors: “At the moment we are sadly failing the people that we serve with the quality of the services that we provide.”
There has previously been concern over the possibility of an Accountable Care System (ACS) or Accountable Care Organisation (ACO) being introduced because some fear it opens the way to greater privatisation of health services in Cornwall.
However after holding a brief inquiry into the plans, the council has said it is no longer looking to create an ACS or ACO – but it does want to bring together social care services provided by the council and NHS services in Cornwall.
A statement read to the briefing from councillor Andy Virr, who chaired the inquiry, said that the evidence showed “overwhelmingly that doing nothing was not an option” and that health and social care should be combined.
This would involve combining the budgets for the services and working together to provide the best care for people in Cornwall. Mr Virr, a Conservative, has complained that “far Left-wing protestors” had successfully derailed his preferred solution.
Under the current proposals, the council will work together with NHS Kernow, the Council of Isles of Scilly and NHS England to create a “joined up” approach to commissioning of health, social care and public health services.
But crucially, councillors were told that this would no longer mean the creation of a new organisation. All current organisations would be remaining in place and continuing to be responsible for individual services.
The briefing also heard that the council would not take on any debts from NHS organisations and that each organisation would continue to be responsible for those.
Rob Rotchell, cabinet member for adults, said: “People are living longer but that doesn’t mean living longer healthily. That means people with much more complex needs are requiring care.”
Above: the 2015 “Devolution Deal” began the march towards a restructured health service with Cornwall Council – or some new organisation – taking the strategic commissioning decisions. Below: Dr Iain Chorlton, chairman of NHS Kernow, Nye Bevan, founder of the NHS and Kate Kennally, Cornwall council chief executive
Trevor Doughty, the council’s strategic director for children, families and adults, said: “This is about what is best for the people of Cornwall and we need to go in with that kind of mindset.”
He added: “We cannot go on with the number of people going into hospital and coming out needing complex care packages.”
Mrs Childs highlighted the issues with the current system and said: “Integrated strategic commissioning is a mechanism where we can use our resources to improve the care we provide.”
Under the new arrangements the current health and wellbeing board at Cornwall Council would remain in place but would be expanded so that it increased the democratic accountability for health and social care services.
Labour councillor Cornelius Olivier said that while the council was not wanting to label the new arrangements as an ACS or ACO he believed that is what it is. He said: “I can understand why people don’t want to use the term Accountable Care System anymore as it is a red rag to a bull.”
But Mr Olivier said that he did not see how the budgets of the various organisations could be pooled unless there was a new body formed. He was also critical of the different messages which had been issued by the council, saying that they had been “contradictory.”
Mr Rotchell responded saying: “To just merge budgets at this time would be unwise or not appropriate. But it is something that we have to work towards.
“My guess is that is something that is not going to happen within two or three years.”
Council chief executive Kate Kenally said that the plans would be under legislation that allows the pooling of budgets for health services and social care.
She said: “We will be looking to pool some or all of our NHS budgets and some or all of our local authority budgets. The process of allocating NHS budgets will be done nationally as it is now.”
Mebyon Kernow councillor Andrew Long questioned what the changes would do for improving the current situation where patients were struggling to access ambulance services and get into hospital to received treatment. He said that was what people in Cornwall were concerned about rather than the mechanisim to provide services.
Additional reporting by Richard Whitehouse of the BBC Local Democracy Service