EXCLUSIVE: Cornwall’s health revolution – Risk Assessment won’t be ready until February, just weeks before shadow ACS is launched
19th December 2017
By Graham Smith
As health campaigners head for County Hall this morning (Tuesday) to lobby councillors ahead of their first Inquiry Panel meeting called to consider Cornwall Council’s takeover of the NHS, Cornwall Reports can reveal that no risk assessment has yet been completed.
And an early draft of a Comprehensive Impact Assessment warns of NHS job losses against a background of drastic budget cuts.
The Cornwall Accountable Care System, signed into existence in “shadow” form last week to allow a council takeover of the NHS, does not yet have a full business case.
Cornwall Reports has established that work on the risk assessment will not be shared with the wider public until February at the earliest, just two months before the shadow ACS is due to start.
There will then follow 12 months of “learning on the job and making it up as we go along” to identify problems and experiment with different ways of making the ACS work.
The draft Comprehensive Impact Assessment (CIA) identifies possible job losses as a result of budget cuts. It also admits that some of the impacts on levels of service could be negative – but it says they might also be positive. This document, which is currently being updated, was completed in October 2016. You can download and read the CIA here: CIAFOI
The lack of any risk assessment in advance of launching the shadow ACS is an indication of how the reforms are being rushed through. So far there has been no public consultation about the ACS, which council and health chiefs hope to have fully operational by April 2019. The lack of any detail means that public consultation would be very difficult.
A Freedom of Information response to Cornwall Reports, however, does suggest that elected councillors will be allowed to “consider” an Outline Business Case for the ACS in February – although it also makes clear that by that time there will still be very little hard information. The answer does not go so far as to promise a vote and in any case the “in principle” decision has already been taken, when the accord to establish a shadow ACS was signed last week.
“The proposal is to use 2018/19 as a period of shadow working to test the concept and refine the approach prior to making final recommendations around any formal changes to organisational form or responsibilities,” says the answer.
The FOI answer said: “Outline Business Case provided a high level articulation of the future operating model we believe will support residents of Cornwall and the Isles of Scilly to stay as healthy as possible for as long as possible, help themselves and each other so they stay independent and well in their community and provide services that everyone can be proud of and that reduce the cost overall. The attached CIA is a working document and as we develop our proposals fuller will be expected to be developed in more detail.
“While the ambition to develop an Accountable Care System forms part of the attached draft CIA, the scoping of what an integrated health and care system, which we refer to as an Accountable Care System, is very much work in progress.
“A business case setting out the case for change, impact assessment and options appraisal of the opportunities for the development of an Integrated Strategic Commissioning function in Cornwall and the Isles of Scilly involving Kernow Clinical Commissioning Group, Cornwall Council, Isles of Scilly Council and NHS England from April 2019 is planned to be completed by February 2018.
“The purpose of this integrated strategic commissioning business case is to seek, in principle, support for the approach and approval to further develop the recommended option. Cornwall Council has established an inquiry panel inviting attendance from Isles of Scilly Council to support the development of the preferred option within the business case and NHS Kernow will consider the plans through its Governing Body, alongside discussion with member practices. This paper will then be considered by each of the organisations affected in early February 2018 and will be publically available.
“Developing new integrated ways of working across multiple organisations across the system will need to be worked through and appropriate support and approval secured, so the proposal is to use 2018/19 as a period of shadow working to test the concept and refine the approach prior to making final recommendations around any formal changes to organisational form or responsibilities.
“The network of current providers who deliver health and care services to the people of Cornwall and the Isles of Scilly will also come together and work in shadow form as if they are a single system during 2018/19.
The principles of the shadow working are that:
Each organisation will continue to operate within their existing statutory framework which means that the Councils, NHS England the CCG and provide trust will remain the statutory accountable bodies in the system.
All parties will work ‘as if’ they were already a single care system to develop a new approach to working together that transcends organisational boundaries
Proposed models will be tested, reviewed and refined prior to contracting for or formally altering organisational form and / or accountabilities
Work will be supported by an accord which describes the principles of collaboration agreed by partners.
“Using the shadow working year as an opportunity to test new ways of working will help ensure that we develop the right model for delivering integrated health and care for Cornwall and the Isles of Scilly.”