Everything you ever wanted to know……

Everything you ever wanted to know……


Everything you ever wanted to know about the immediate future of Cornwall’s health service, but were afraid to ask

By Graham Smith –  5th December 2017

Regular readers of Cornwall Reports will know that for more than a year, a revolution has been underway in Cornwall’s health service.  New readers have asked for a catch-up

What is happening and when?

Cornwall Council’s cabinet will meet on 7th February and vote in favour of setting up an Accountable Care Organisation, to replace the National Health Service.

Replace the National Health Service?  Surely not!

Only by torturing language to the point of re-defining the word “National” could you argue that Cornwall would still be in the NHS.  Decisions about health priorities, minimum standards of care and all budgetary responsibility for providing a health service would be taken locally.  The development stems from the “Devolution Deal” of 2015.

But surely we can’t have one model of healthcare in Cornwall, and something completely different in Devon?

That is exactly what is being proposed to the Cornwall Council cabinet on 7th February.  Patients in North and East Cornwall would continue to get hospital treatment in North Devon and in Plymouth, as part of a mainstream NHS.  But the Royal Cornwall Hospital in Truro, and all other aspects of care currently commissioned by NHS Kernow, would be “free” of Whitehall control.

So why would that be a bad thing?

Maybe it wouldn’t be a bad thing, but there are still so many unanswered questions that the deadline of 7th February seems, to many, to be reckless and unnecessary – driven by party political ideology rather than clinical judgement.  Health campaigners are calling for a delay to allow proper scrutiny.

What about Cornwall’s community hospitals?

St Ives, Saltash and Fowey are already closed and will not re-open once the council’s cabinet proceeds with the ACO on 7th February.  Instead, the ACO will pursue a model of healthcare based on “sub-regional hubs” as described during its Sustainability and Transformation Plan public consultation.

Isn’t that the public consultation which was severely criticised by Cornwall Council on 15th March?

It is.

So some councillors have done a pretty big U-turn?

They have.

Remind me – what was the big idea behind the STP?

Cornwall needs to cut £277 million from health spending within five years (according to the government.)  So take more exercise and don’t eat crisps.  It’s cheaper than having to pay doctors and nurses.

Why haven’t we heard more about this?

Health Secretary Jeremy Hunt is promoting Accountable Care Organisations without any Parliamentary scrutiny, so there has been no debate at Westminster.  This has led to a legal challenge with some health campaigners now seeking a Judicial Review.

What about the media?  Why so silent?

Good question.  Cornwall Reports has been banging on about it for a year, at the tragic expense of our Poldark coverage.

What is the situation in Cornwall right now?

Cornwall councillors are supposed to be conducting an inquiry to decide if they think it’s a good idea to leave the NHS and set up an ACO.  That inquiry hasn’t even started.  But heads of agreement to establish the ACO are already prepared for signature – the officials are miles ahead of the politicians on this.

What could possibly go wrong?

The idea of Accountable Care Organisations comes from the United States, where healthcare is more often funded by insurance, rather than general taxation.  So for many people in the US, if you can’t afford healthcare, you don’t get it.  ACOs are widely expected to promote further privatisation, and some already have.  Cornwall’s ACO aims to be within budget by 2022.

The original development of Cornwall’s model came from a firm of private business consultants whose headquarters are in Chicago.  Although there is currently no reason to think that healthcare in Cornwall would, immediately, cease to be free at the point of delivery, we still don’t know how healthcare in Cornwall would be funded in the long–term.

One of the “healthy living” ideas which the ACO will promote is minimum alcohol pricing in Cornwall.  So booze will be cheaper in Devon.

Who will run this Accountable Care Organisation?

The ACO will be run by four people, none of them elected.  They are Kate Kennally (Cornwall Council,) Kathy Byrne (RCHT,) Jackie Pendleton (NHS Kernow) and Phil Confue (Cornwall NHS Partnership Trust.)  They don’t always see eye to eye, and Ms Kennally got her position on the STP Transformation Board only after some pretty gory infighting.

Aren’t RCHT and NHS Kernow currently performing so poorly that they are in Special Measures?


So giving the same people even more powers is meant to fix everything?

Couldn’t possibly comment.

OK, so it won’t really be “accountable” – but the NHS isn’t really accountable now, is it?

That is also correct.  Arguably it has always been a “top down” organisation.  When the NHS first got started in Cornwall after World War 2, it was as a sub-committee of the former County Council.  At that time, healthcare varied widely across the country, even within Cornwall.  By 1947 Cornwall’s health was managed by the NHS South West Regional Hospital Board, which continued until 1974.  It has undergone many changes since then.

Are there any ACOs already up and running anywhere else?

Yes – in Frimley Health, including Slough, Surrey Heath and Aldershot; South Yorkshire & Bassetlaw, covering Barnsley, Bassetlew, Doncaster, Rotherham, and Sheffield-Nottinghamshire, with an early focus on Greater Nottingham and Rushcliffe; Blackpool & Fylde Coast with the potential to spread to other parts of the Lancashire and South Cumbria at a later stage; Dorset; Luton, with Milton Keynes and Bedfordshire; Berkshire West, covering Reading, Newbury and Wokingham; Buckinghamshire.  So far the world has not yet come to an end, but they are only a few months ahead of Cornwall.  And those warnings about increased privatisation are already starting to come true in some areas.

There’s clearly no escape from politics here – what are the parties saying?

The Conservatives are pretty happy – Cornwall is about to do exactly what their Health Secretary wants.

Labour is very unhappy, not least because some of its senior representatives – those who established their careers during the Tony Blair/Gordon Brown years – don’t really understand what all the fuss is about.  Greater Manchester’s Labour mayor, Andy Burnham, is among the pioneers of the ACO revolution.  But Jeremy Corbyn and his supporters are fiercely opposed to ACOs and have pledged to “oppose and reverse” wherever possible.

The Liberal Democrats, in Cornwall, have previously been very critical of the STP and supportive of local community hospitals.  But political U-turns are never pretty and now Cornwall’s Lib Dems are on the verge of once more supporting Tory health policies.

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