Let full council decide.

Let full council decide.


6th December 2017

By Graham Smith

The panel of Cornwall councillors tasked with conducting an inquiry into taking over the National Health Service is unlikely to hold its first meeting until just one week before Christmas. This means its investigation into the establishment of an Accountable Care Organisation will now be squeezed into less than six weeks, with Christmas and New Year in between, thereby diminishing the public gaze.

The six councillors appointed by the Health & Adult Social Care scrutiny committee are Andy Virr and Sue Nicholas (Conservative), Colin Martin and Karen McHugh (Liberal Democrat), Bert Biscoe (Independent) and Loveday Jenkin (Mebyon Kernow.) The Labour seat on the committee had been occupied by the late Candy Atherton and Labour did not put forward a substitute to take part in the inquiry.

Although the inquiry panel will meet in public, at County Hall, its work will not be webcast. Its first session will be given over almost entirely to a presentation from NHS England, which is seeking to introduce ACOs in a handful of areas without any Parliamentary scrutiny or public debate. Such dramatic changes to the NHS would normally require the government to introduce a White Paper. The constitutional issues stemming from this are now forming part of a Judicial Review legal challenge, which will most likely end up in the Supreme Court.

The terms of reference and scope of the inquiry have been set by Cornwall Council’s chief executive, Kate Kennally, who a year ago took over as chair of the Sustainability and Transformation Board in a not-quite-bloodless coup, fuelled by disputes over just how “Cornish” the new model of healthcare was to be. The ACO is integral to the 2015 Devolution Deal, transferring powers from Whitehall to Truro.

A letter from the then council leader John Pollard, published by Cornwall Reports in February, laid bare the internal tensions. Ms Kennally believes that by merging the various NHS partners with the council’s own social care department, “back office” costs can be slashed by 20%. You can download and read Mr Pollard’s letter here:John Pollard letter re STP, Nov 2016

A growing number of Liberal Democrats are now nervous that their party will be accused of selling out local health campaigners, who have been trying to save community facilities in St Ives, Saltash and Fowey. A number of community hospitals will be sacrificed if the council’s cabinet votes, as scheduled on 7th February, to proceed with the ACO. Instead, healthcare will be organised around as-yet-unidentified “sub regional hubs” with a much greater emphasis on healthy eating and exercise.

As recently as March this year, Lib Dems were condemning the STP proposals as “not fit for purpose” and demanding that Cornwall’s Conservative MPs “stand up” for community hospitals. A few months earlier, the Lib Dem’s party leader Tim Farron told the Cornish Times: “A LibDem led council would not accept the government’s Sustainability and Transformation Plan (STP) which is currently being consulted on. This is a hugely important and largely misunderstood plan. It’s not about improving healthcare services, it’s about cuts of upto a quarter £billion. It’s unthinkable that a LibDem led Cornwall Council would give this plan support.”

Now phrases like “U-turn” and “Lib Dem traitors” are already snowballing across social media.

The Inquisitors: clockwise from top: Loveday Jenkin, Sue Nicholas, Colin Martin, Karen McHugh, Bert Biscoe, Andy Virr

Andrew George, the former St Ives Liberal Democrat MP who has been among the more vocal of those campaigning for community health facilities, told Cornwall Reports he hoped the ACO debate could be kept away from party politics. But significantly, he has suggested that the council’s Lib Dem-led cabinet should not make a decision on 7th February and that the issue should instead be resolved by the full council. “You’ll be hearing rumblings that Cornwall Council may be asked to take greater responsibility for managing our NHS,” he said. “On the face of it it’s a good opportunity to improve health and social care integration and for greater democratic accountability.

“However, given past form, many suspect that, in reality, it’s a heavily booby-trapped poisoned chalice. Cornwall deserves cast iron evidence to show it doesn’t come with: i) ) a massive inherited debt; ii) pressure to invite profit making companies to cherry pick the easy and profitable bits (leaving the difficult and expensive stuff to the public sector); and iii) the passporting responsibility for government plans to cut £270m from Cornwall’s NHS by 2020.

“This is an occasion when the council can only act as a whole. When rational scrutiny and discussion is required by all parties working to pursue the best outcome. We know that some areas, like Labour dominated Manchester have already approved plans to do much the same. But that doesn’t mean it’s appropriate for Cornwall.

“The NHS will remain in serious jeopardy if some parties merely see it as a political football. NOTHING should be agreed unless and until ALL parties agree. Otherwise the whole thing will become more toxic than it’s worth for the good health of Cornwall’s patients and our NHS.”

Community hospitals are sometimes targeted by local health chiefs because they tend to be old buildings, relatively expensive to maintain, and often ill-suited to meet 21st century standards.

It is now nearly 20 years since the three hospitals most at risk of permanent closure and being sold today – Edward Hain (St Ives), St Barnabas (Saltash) and Fowey were rescued by the intervention of the then Health Secretary Frank Dobson, who ordered the Cornwall & Isles of Scilly health authority to abandon its closure plans. In 1998 Mr Dobson also rescued the Poltair hospital (Penzance) but that was subsequently closed in 2014, during the Conservative-Lib Dem coalition government.

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