The “not fit for purpose” verdict comes back to haunt Cornwall Council’s ambition for NHS takeover
3rd December 2017
By Graham Smith
Cornwall Council’s plans to run large parts of the National Health Service could be derailed by the council’s own assessment of those plans, in a judgement it made earlier this year.
On 15th March the council’s Health and Adult Social Care scrutiny committee agreed a statement condemning the proposals, saying the ideas were “not fit for purpose.” Yet some of the same councillors, who are now leading members of the ruling administration, are pushing for the council’s cabinet to embrace the plan at a meeting on 7thFebruary.
The council’s U-turn presents a triumph for senior officials and is embarrassing for Cornwall’s Liberal Democrats, who had previously described a public consultation exercise conducted by the NHS as “ill conceived.” Many Lib Dems are also nervous about being seen to now endorse Conservative government plans which experts say will break up the NHS as a truly national service and introduce yet more “market freedoms” leading to further privatisation.
The council’s failure to conduct its own consultation may result in a legal challenge. The trade union Unite, which represents many health workers in Cornwall, is consulting its lawyers over the grounds for a possible Judicial Review. Deborah Hopkins, who chairs the Cornwall branch, called on the council to delay its “unseemly haste” to set up an Accountable Care Organisation, which would signal the end of a “National” Health Service as Cornwall took local control and set its own priorities and standards.
The council is planning to hold three “inquiry panel” hearings, between now and the middle of January. The question for the lawyers is whether this will be sufficient “public consultation” for such a major change. Although the law does not specify who must be consulted, or when, judges tend to take the view that any public consultation exercise should have some meaning.
So far, the council has not demonstrated that it has even considered its own duty to consult, and instead is now seeking to rely on the NHS consultation published by the council, in glowing terms, on 3rd November. This is the same document which, seven months earlier, had been “not fit for purpose” – yet somehow this previous observation was not reported to councillors when they endorsed it in November.
The original NHS consultation had been widely derided as shambolic and chaotic. One public meeting, in Penzance, had to be abandoned once people realised they would not be allowed to ask questions.
An inquiry panel of only six councillors – two Conservatives, two Liberal Democrats, one Independent and one Mebyon Kernow – is due to meet within days for the first of its three sessions. Its first agenda is “scene setting and provision of context, what is an Accountable Care System; presentation by NHS England and overview of Cornwall & Isles of Scilly thinking.”
In January the six councillors will consider “Evidence from other areas; detailed overview of options and preferred option” followed almost immediately by “Discussion of preferred option and how it would work. Workshop taking evidence from other stakeholders.”
There will then be an extraordinary meeting of the Health and Adult Social Care scrutiny committee in late January, leading to a cabinet decision on 7th February. It is not clear if the cabinet will vote to set up an Accountable Care Organisation even if it lacks credible answers to questions about minimum standards of health care, national pay and conditions or long-term funding plans. NHS unions say it is unthinkable to proceed without such clarity, but they also fear the mood within County Hall is such that the senior officials must prevail, however nervous the politicians might be.
Plans to set up Accountable Care Organisations in other parts of the country are already heading for the courts, as health campaigners have successfully raised the funds needed for a Judicial Review on the grounds that NHS England lacks the authority to make such sweeping changes without Parliamentary approval.
Deborah Hopkins, of Unite, wants the council to pause, and consider
Spot the missing words: above, how the “public consultation” was reported to councillors on 3rd November. Below, what Cornwall’s leading Lib Dem councillors said about it on 15th March.
Above: The damning verdict of the Health & Adult Social Care scrutiny committee
On 15th March, members of the Health & Adult Social Care scrutiny committee, including the late Candy Atherton (Labour), Conservative Sue Nicholas and Liberal Democrat Rob Rotchell, queued up to tell Cornwall Reports what was wrong with the NHS plan
Unite’s lawyers are to consider if Cornwall Council might be joined with those existing proceedings, or in view of its “public consultation issues” a stand-alone legal challenge might stand a better chance.
Asked to explain why the officials’ report to the most recent committee meeting made no mention of any of the risks entailed, and why it failed to provide any account of the legal basis for the proposed ACO, the council responded with this statement: “The Health Overview and Scrutiny Committee, which is tasked with scrutinising health and adult social care services in Cornwall, will be asked to undertake an enquiry to learn from other areas that are establishing Accountable Care Systems and to make recommendations on the way forward.”