…after a day of heat and fury at County Hall
By Graham Smith
When is a U-Turn not a U-Turn? Apparently when it comes via a council press release, issued late at night, in the middle of a blizzard. But then it might be followed by another U-Turn, such that you end up facing the same way you were right at the beginning.
Confused? Keep reading.
Cornwall councillors are this evening finding out, via an official apology from cabinet member Rob Rotchell, that the so-called “Option 6” way of integrating health and social care will still be going to cabinet on 28th March after all, with a recommendation for approval.
The official version of Option 6 says that the “strategic commissioning of health, social care and public services is undertaken through a new group on behalf of system.”
Another, official version of Option 6 says it is “strategic commissioning of health and social care through a new governance arrangement.”
Last night the council’s press release ruled out Option 6, saying: “We don’t believe in creating a new organisation or committee for strategic commissioning.”
But this evening, after council chief executive Kate Kennally spent much of the day in heated talks with Mr Rotchell and her counterparts at NHS Kernow, Mr Rotchell was forced to clarify that Option 6 is still very much alive, and to send this email to all members of the council:
“Firstly I wanted to apologise that you were not informed of the cabinet’s position on integrated strategic positioning and found out via a media release issued last night. I am extremely apologetic that this occurred and it is not how I, or the cabinet, wish to work and engage with you. Our communication protocols are being reviewed as a result of this to ensure it does not happen again.
“The inquiry group and the Overview and Scrutiny Committee invested significant work in considering the recommendations for integrated strategic commissioning which were put forward. The work was robust, thorough and considered. At the same time, there have been many mixed views and opinions, as well as confusion about the term ‘Accountable Care’.
“On Monday, I met with my cabinet colleagues to discuss the options and would like to confirm the position of the cabinet on integration.
“There can be no doubt that there has been an organised campaign in Cornwall against our plans for an accountable care system. Whether or not their objections or issues were founded in evidence, the result of the campaign has created concern locally about the intention behind changes to our local health and care services.
“Therefore our local position should be clear and unambiguous. The position of cabinet is:
- That we do not support the development of an Accountable Care Organisation or System for Cornwall and the Isles of Scilly because of its connotations with the American health care system and the more extensive involvement of the private sector in the delivery of health and care. We do support the integration of health and care services – developing integrated commissioning of health and care where we can make sure that we spend the resources of the NHS and the councils wisely, putting residents first and organisations second and bringing together health and care practitioners to work in a person centred way to provide care closer to home for our residents.
- We believe in the NHS – the Council wants to work with NHS services and organisations to deliver the best possible health services for Cornwall. This will mean entering into formal partnerships with NHS organisations, lobbying under our Fairer Funding campaign for more resources but it does not mean the Council running NHS services. We believe that we are stronger when we harness both the clinical expertise of the NHS with local democratic leaders to improve local services. That is why we don’t think we need to create any new organisation or committee for integrating commissioning. We think we can and should strengthen the statutory joint committee that we have got in place already – the Health and Well-Being Board so that it can be a more effective decision making body covering both Cornwall and the Isles of Scilly with the right membership to take forward our shared ambitions.
- We are committed to working in partnership to add value. The intention of a single plan, single system, single budget is laudable but in the current context unrealistic. We are not able to pool our budgets and create a single budget whilst the NHS is operating with a deficit. That said we do want to have joined up plans, aligned budgets and to find solutions together. Integrated commissioning must be able to shape how both health and care budgets are spent through joint decision making, but this does not in our mind require us to formally create a single budget. We know when we work in this way we can make a difference as we have started to see with our approaches to delayed transfers of care.
A report and outline business case will still be going to cabinet at the end of March, which takes account of the scrutiny recommendations and recommends establishing an integrated strategic commissioning function in line with option 6.
The cabinet is clear that the intention to integrate health and care is not weakened. This was a key outcome arising from a cabinet away day held on Monday which Cllr Armand Toms helpfully attended to shape cabinet policy on this important topic of health and social care integration.
I again apologise that the press release went out before this position was shared with you.
An all member briefing is taking place on 21 March which will further clarify cabinet’s position.
The key difference between the old Option 6 and the new Option 6, given that the words have not changed, appears to be that instead of a new organisation with a single, pooled budget Cornwall is to have an existing statutory organisation – the Health and Wellbeing Board – which will ensure that budgets become “aligned.”
The difference between “pooled” and “aligned” is the stuff of Brexit negotiations, and may yet attract further interest from lawyers. One of the health campaigners working with London lawyers Leigh Day said: “These councillors are just making it up as they along. Unbelievable. Who knows what the difference is between a pooled budget and an aligned budget? Are they working in Euros now? The lawyers will love this.”
The council’s torture of the English language suggests that what started as an Accountable Care Organisation, and then became an Accountable Care System (and Partnership), and was briefly a “vehicle,” is now to be known as an Integrated Strategic Commissioning Function.
The key words in Mr Rotchell’s email are “this does not in our mind require us to formally create a single budget.” The Judicial Review scheduled for 24th April is all about the legality of single budgets and the idea that Cornwall Council can escape the law by not having a formal single budget “in mind,” even if it exists in practice, does not inspire much optimism.
And Option 6, whose demise was this morning mourned by the council’s Tories, has now been resurrected.
The councillor who shared his all-member email with Cornwall Reports said: “This is now beyond embarrassing. This morning we were heroes. No we look like dumb***** who can’t even get a press release right. Have we changed our policy or haven’t we? Rob says we have. Kate says we haven’t. I refuse to read anything more about this until the war is over.”
Senior councillors are not the only ones finding themselves with a reason to apologise. This morning Cornwall Reports suggested that councillors had done well to stand up to Ms Kennally. We now recognise that there was not a jot nor scintilla of truth in this allegation, we withdraw it, and apologise unreservedly.