NHS Cornwall: Be careful where you live

NHS Cornwall: Be careful where you live

Inside Kennally Care: details start to emerge of how charities and companies are now taking over Cornwall’s health service – with orders to cut spending

Posted 8th February 2019

Historians will eventually decide if this was a revolution or a coup.  It was certainly not announced.  But 23rd January is a date which deserves to be recognised as the moment the National Health Service in Cornwall was yanked into a brave new world of “place-based care” which at its heart relies on charities, private companies and dramatically smaller budgets.  The requirement is to “maintain cost and demand.”

In Cornwall, the term “place-based care” also appeals to those chasing their own ideological devolution agenda  and who believe that anything “local” has got to be better than anything imposed from Whitehall.  It is an ideology which works for grass-cutting in parish cemeteries, or the distribution of village dog-waste bins, but appears to be very risky for healthcare.

These ICABs were first announced in August, and Cornwall Reports was the only media organisation to report them.  They exist to promote the government’s vision of “place-based care” – which critics say is a euphemism for simply keeping the elderly out of hospital, thereby saving money, rather than improving their quality of life.

All of this is supposed to be happening in the name of “integration.”   Inevitably, it looks remarkably like every other assault on the NHS which has taken place, by all governments, under the guise of “re-organisation,” for nearly 70 years.  Integration?  Once upon a time there was a Department of Health and Social Security.  What has happened since has been disintegration.

The 23rd January  is when the first West Cornwall Integrated Care Area Board (ICAB) held its first meeting.  Five days later the Mid Cornwall board held its first meeting.  North and East Cornwall is to follow.

The NHS Kernow Clinical Commissioning Group (KCG) sought legal advice before setting up the new boards.  Cornwall Reports has asked to see that legal advice.

Then, using words it may come to regret, KCG said the members of these new boards are “self-selecting” and do not yet have any clearly defined terms of reference.  In future, however, they will have budgets and will operate as the delivery vehicles for the Shaping Our Future Transformation Board.

Under pressure, KCG revealed that members of the new boards include a variety of local organisations which would not normally be running a national organisation with statutory minimum standards.  All are very worthy and undoubtedly possess a high degree of expertise.  But Cornwall’s new Integrated Care Area Boards do not resemble anything like the National Health Service as we have known it since 1948.

One of the first steps, therefore, was to propose abolition of the statutory minimum standards and allow Kennally Care (in honour of Kate Kennally, Cornwall Council chief executive who won a bloody power struggle against the NHS to chair the Shaping Our Future board) the freedom to mark its own homework.

As well as the usual faces from Cornwall Council, NHS Kernow, the Cornwall Partnership Foundation Trust and the Royal Cornwall Hospital Trust, the new Area Boards include Volunteer Cornwall, Age UK and the Kernow Health Community Interest Company.

Volunteer Cornwall and Age Concern are both charities, governed by the Charity Commission.  Kernow Health CIC is regulated by the Department for Business Innovation and Skills.  The significance of any role of a Secretary of State for Health diminishes with every passing day, and this might yet be the undoing of Kennally Care when a legal challenge reaches the Supreme Court.

Kernow Health CIC is very interesting – the organisation, a federation of GP practices, was created in anticipation of the Conservative-Liberal Democrat coalition government’s 2012 Health & Social Care Act, which added more fuel to the purchaser-provider divide which has so fragmented, and privatised, the NHS.  There is now no part of the NHS which is too small to have its own chief executive.

NHS Kernow has still not answered questions about the individuals who make up the new ICABs, nor explained how they came to “self-select” themselves into positions of such power and influence.  Notice of meetings and agendas are not published.

The new boards have been given three years to achieve savings.  Their mission is “to contain cost and demand in the NHS. It must also support the delivery of the savings plan for adult social care services. The intention is to shift resources from reactive high cost unplanned care in acute settings towards pro-active preventative services in communities.”

Some of Cornwall’s health chiefs, encouraging sceptics to embrace the new model, suggest ICABs mark the end of the “purchaser-provider” divide, which privately they now accept has been a disaster.  Another view is that ICABs simply declare open season for a new wave of conflicting interests and contract mismanagement.

“Providers can attend the committees and would be encouraged to participate and give advice, all of which the CCG could consider as part of its decision making process,” gushed the promotional spiel . “Once a decision was made, the providers would then enact……This will enable commissioners to contract with a group of
practices for a service for a whole population rather than individual practices.”

 

From Shaping Our Future: “The three year system financial recovery plan to contain cost and demand” – what could possibly go wrong?

Place-based care: a land of milk and honey, where people don’t get ill?

Dr Finlay reacted stoically to the news that he should have “self-selected” himself onto the West Cornwall Integrated Care Area Board.  “Never mind, I’ll make a pot of tea,” said Janet.

Full marks to Kernow Health CIC for getting in on the ground floor.  Tough luck to those more traditional GP practices who failed to “self-select” their way onto the new boards.

As a model of governance, the ICABs bear more resemblance to the Poor Law Boards which existed until 1871, when they were replaced by Local Government Boards, prior to the creation of the Ministry of Health in 1919, rather than to any of the various publicly-accountable models which drove the NHS after the second world war.

The first few years of the NHS, which was created in the teeth of outright hostility from many doctors, and the entire Conservative Party, saw the organisation offering many management roles to people who were not obviously qualified – retired colonels (good for logistics) and the wives of baronets (tea and sympathy.)  Despite their lack of formal health qualifications, they did a pretty good job.

But the big difference between the 1948 NHS, and everything that had gone before, is that public healthcare suddenly and dramatically became much better-funded.  Today, the mission is chiefly about cutting spending.

Cornwall Reports is still trying to establish the geographical boundaries, called “footprints,” which define the borders between the West, Central and North & East ICABs.  Once these organisations have budgets, there will be patients, next-door neighbours, whose care falls to different boards.

It would be wise to live in the area with the more generous budget.

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