Kennally Care: will the Inquisition get any straight answers?

Kennally Care: will the Inquisition get any straight answers?

6th January 2018

By Graham Smith

On Wednesday (10th January), Cornwall Council’s chief executive Kate Kennally is due to give evidence to the Inquiry Panel considering the future of Cornwall’s health service.

Cornwall Reports has been asking for the opportunity to interview Ms Kennally, and has even offered to provide the questions in advance.  We are still waiting for a reply.

In case any of the Inquiry Panel members are stuck for ideas, here are some of those questions:

  1. Minor Injury Units

As the lead commissioner, will she be able to guarantee the future of the ten Minor Injury Units which, according to NHS Kernow, will not be upgraded to become Urgent Treatment Centres?  If not, why not?  Does she agree with NHS Kernow that Penzance, Camborne, Truro and Liskeard are the correct strategic locations for the only Urgent Treatment Centres in Cornwall?  What public consultation would take place, and what democratic procedures undertaken, before any MIU is closed?

  1. NHS Estates (1)

In the interests of trust and transparency, will Kate Kennally immediately publish the NHS Kernow Strategic Estates Plan, and if not, why not?  Who will decide if any part of the NHS estate is then “surplus to requirements” and sold?

  1. NHS Estates (2)

Should the Accountable Care project ever progress to become a lawful entity, who would own the assets like hospitals and land?  Can Kate Kennally guarantee that none will be sold and then leased-back?

  1. NHS Estates (3)

In September, as chair of the Shaping Our Future team, Kate Kennally was consulted by NHS Kernow about its proposal to declare hospital land at Launceston as surplus to requirements.  She raised no objection and the land was put up for auction.  After a public outcry, this decision was reversed and in October the council itself actually bought the land – and is now appealing for suggestions as to how it might be used.  What happened inside Kate Kennally’s own mind between September and October to bring about this U-turn?  How confident should we be that this new, “joined-up” approach to management is going to bring any improvement?

  1. ACO or ACS?

In December 2016 Kate Kennally was one of the four chief executives who put their names to a letter describing a Cornwall Accountable Care Organisation (ACO.)  A few months later, and before the initial “expression of interest” to be a “first wave” was submitted to NHS England –the name had changed to Accountable Care System (ACS.)  What significance, if any, should be attached to this change in acronym?  If there had been any significant change in the Outline Business Case, why had this not been reported or explained to the council?  Will the new organisation (ACO or ACS) be governed by the NHS draft ACO contracts published in November and if not, what contractual procedures will be published, scrutinised and in place before 1st April?

  1. Why the rush?

At least one of the Judicial Review applications, seeking to have Accountable Care Organisations declared unlawful without a vote in Parliament, has been given permission to proceed – with a hearing next month.  Why is it not sensible to wait until all the evidence has been heard, and the courts allowed to come to a considered view, before spending any more time and money on a highly partisan project which could eventually be declared illegal?  How have we arrived at this point, with local politicians now on a verge of a crucial vote, without sight of the final Business Case or Risk Assessment?

  1. Public consultation

When will Cornwall Council consult the public about plans for Accountable Care, and what will the council do should the public say NO?  Does Kate Kennally agree with and actively support the view of Cornwall Council that the STP public consultation was “not fit for purpose?”

  1. The end of the National Health Service?

The background to Kate Kennally becoming chair of the Sustainability and Transformation Partnership stems from the letter sent by John Pollard to the founding independent chair, Joyce Redfearn, in November 2016, complaining (amongst other things) about NHS obstruction of the 2015 Devolution Deal.  More recently, councillor Rob Rotchell has publicly confirmed that the ACO/ACS can fairly be described as Cornwall Council taking over the strategic commissioning of health services in Cornwall.  Dr Iain Chorlton of NHS Kernow says this is not the case.  Which of them is right?

  1. Privatisation (1)

In January 2017 the STP commissioned the US-based private business consultants GE Healthcare Finnamore to produce a 112-page report about the future of healthcare in Cornwall.  This report made few definite recommendations but offered a range of “options” for further exploration, such as the bizarre possibility that a Single Commissioner could run not only healthcare but also the police.  Option 2 suggested healthcare in Cornwall could be run “without including NHS England.”  What status do any of these suggestions have now?   Why was this work undertaken in secret?  Why has this 112-page report not been circulated, formally, to elected Cornwall councillors along with a narrative to explain it?

  1. Privatisation (2)

Cornwall Council’s current budget proposals include a little-noticed 2% increase for Commercial Services – at a time when most front-line services are facing £75 million cuts.  The Commercial Services department handles the commissioning and management of contracts with the private sector.  The budget increase is costing £570,000.  What limits, if any, does Kate Kennally envisage to commissioning private companies, such as Virgin, to provide some aspects of healthcare in Cornwall?  Can she guarantee that none of the proposed expansion of Commercial Services is in anticipation of a greater role for the private healthcare sector?

  1. Privatisation (3)

Which individual member of the Commercial Services management team – Rachel Rotheroe, Niall Waters, Adam Birchall or Matthew Beardmore – would be primarily responsible for health sector contracts?  Does any have the required experience?

  1. The Inquiry Panel hearings

Why are none of the witnesses so far invited to appear in person before this Inquiry Panel from what could be described as the “anti ACO” point of view?  Why have the Inquiry Panel members themselves not been allowed to define their own terms of reference, timetable, or list of witnesses?

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