Kennally Care slips at least a month with still no sign of business case or risk assessment
10th January 2018
By Graham Smith
Cornwall Council’s attempted takeover of the National Health Service slipped by at least a month this morning (Wednesday) when chief executive Kate Kennally revealed the cabinet will not now consider the issue until 28th March.
The council chamber’s public gallery was swelled by about 20 of the protestors who had earlier demonstrated their opposition to Accountable Care, which they fear will break up the 70-year-old National Health Service and trigger a new wave of privatisation.
The proposed Accountable Care System had previously been due for cabinet decision on 7th February. Ms Kennally added that the final business case for the new way of providing healthcare, and its associated risk assessment, will not now be ready until September. It had previously been promised for next month.
The Inquiry Panel to which Ms Kennally gave evidence this morning has also been granted more time – having previously been told it had to make a recommendation by the end of this month, it now has until 5th February.
Ms Kennally said there were uncertainties around national Judicial Review challenges to the legality of Accountable Care. One Judicial Review application has already been given permission to proceed and is expected to make further progress next month.
But away from the courts, there are also technical and political issues. While the delay might be seen as helpful in taking some of the heat out of the controversy, it also allows protestors to see more clearly the nature of the cuts which will accompany the transition from the original Sustainability and Transformation Plan to an Accountable Care System.
NHS Kernow is due next month to provide more detail about its plans to create four Urgent Treatment Centres (UTCs) – and at the same time, which of the ten Minor Injury Units (MIUs) now identified as being at greater risk will definitely close under Accountable Care. If NHS Kernow now also delays publicising criteria for UTCs that will simply fuel suspicion that its technical specifications are being manipulated for political reasons. None of the Inquiry Panel members asked about the MIUs.
The delay does go some way to addressing concerns that the creation of an ACS was being rushed. It has certainly caused some confusion among political parties, notably the Liberal Democrats who in the space of 24 hours last week went from accusing the Labour Party of “scaremongering” to insisting that only Lib Dems could “Save Falmouth Hospital.”
Cornwall’s Lib Dems are split on Accountable Care, with party leaders at County Hall keen to endorse Ms Kennally’s vision, but the party’s grass-roots are much more cautious. The Labour Party now has a clear policy of opposition to Accountable Care, but it has taken more than a year to evolve and the Manchester Mayor Andy Burnham – who is pioneering the new system – appears now to be out of step with his own party. The Conservatives are united in their enthusiasm.
Apart from the revised timetable, today’s Inquiry Panel heard little new. None of the Inquiry Panel members asked any of the questions previously suggested by Cornwall Reports.
Ms Kennally spoke without pause for more than hour, before the five panel members got to contribute. The panel then heard, via Skype, from Manchester where a similar scheme (known there as a Devolved Care System) is further ahead.
Ms Kennally said the conversion to an Accountable Care System would benefit Cornwall by £125 million in additional government funding – although most of that would be the simple accountancy exercise of theoretical debt write-off. £20 million would be earmarked for health prevention and there would also be a Capital and Transformation Fund.
Insisting that Cornwall would be healthier with a “single financial plan” she complained that there were “cultural issues within the NHS that prevent that from happening.”
Under the current proposals, Ms Kennally will sit at the top of a new merged structure as the single Integrated Strategic Commissioner. She said that such were the pressures on health and social care in Cornwall that “doing nothing is not an option.” The new plan would “establish the financial envelope for providers, understanding and shaping market conditions.” The ACS would “intervene in the event of any failure” by providers.
Commissioning would be via a “capitated outcome-based contract” to make the “best use of the Cornish pound.”
She said the overall strategic direction for the ACS would probably come from the already established Health and Wellbeing Board.
A further Inquiry Panel hearing is scheduled for next week.