Peer review urges Cornwall to “follow the money”…

Peer review urges Cornwall to “follow the money”…

 …as Kennally Care nears launch

28th February 2018

By Graham Smith

A “peer” review of Cornwall Council has called for greater financial transparency in the arrangements for Kennally Care, as the authority moves closer to taking control of the local health service.

The review, organised by the Local Government Association and comprising councillors and officials from other South of England councils, concludes that Cornwall Council needs to explain what it is trying to do to the NHS and provide more financial clarity.

The council’s Liberal Democrat-led cabinet is due to vote on 28th March on setting up an Accountable Care System, in shadow form, from 1st April to take a lead role in the strategic commissioning of health services.  The council’s chief executive, Kate Kennally, is due to take overall charge of a single budget – leading to fears that the restructure exposes Cornwall’s NHS to even greater privatisation.

The LGA’s overall verdict on the council is generally positive, reflecting the political priorities of the team that came to Cornwall in December.  The three councillors comprised one Liberal Democrat, one Conservative and one Independent.  The officials included the chief executive of a Conservative council and one who specialises in “outsourcing” back-office services.

The LGA report considers “that commissioning for outcomes and wider determinates of health could be more visible.  We also felt that there currently exists insufficient financial clarity on who is funding what in terms of commissioning, for example the payment for intermediate care and beds in the care homes which are still owned by the council was not clear to us.

“Overall, that detail and precision in respect of commissioning needs real attention especially with a move towards ‘strategic’ and ‘tactical’ commissioning which will need to ensure the wider determinates are explicit and appropriately resourced.

“All of the above has implications for a range of key issues. The service within the council has a recent history of financial overspending and it will be critical not only for the service but for the council’s financial sustainability that very close attention is paid to managing those cost pressures and within this a renewed focus on understanding demand is key.

“Critical to that demand management will be the way the health and social care market develops and is managed. In the view of the peer team a greater focus on prevention and early intervention will be the way the health and social care market develops and is managed.”


Cornwall Council chief executive Kate Kennally will soon be in overall charge of a single budget for the “strategic commissioning” of healthcare

The report suggests that the council’s focus on “commercialisation” could help it develop greater influence in shaping the market.

“In the view of the peer team a greater focus on prevention and early intervention will be key to establishing a new and more effective approach,” it continues.  “For the present there are weaknesses in this and the way the market is managed.  For example, there appears to be a real fragility in certain part of the market such as domiciliary care, where workers in the field will often leave in the spring due to the draw of the tourism industry which can pay more for less challenging tasks.

“The council is committed to ensuring that it is creating the right market conditions to ensure the future sustainability and quality of this market by committing to paying the Living Wage Foundation living wage which will significantly increase the pay to those providers. The peer team observed that co-terminosity is really helpful in reducing the number of strategic partners the council has to work with across health and social care and this should be a real strength.

“However, it appears not to be working as effectively as it should be, witnessed by the CQC’s recent review, using powers under s.48 of the Health and Social Care Act. This found “that services need to make urgent and significant change to improve and work better together to ensure that people get the services they need as they move through the system”.

“As part of the above and related to the financial sustainability of the council, the importance of the management of the Improved Better Care Fund iBCF is of fundamental importance. The peer team heard that colleagues across the system want to keep this under review for the present to ensure flexibility of pathway redesign.

“In turn, in the view of the peer team the council needs to consider what this means for the adults social care, as potentially significant investment is required to be key to establishing a new and more effective approach.”

You can download and read the full LGA report here:LGA

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