The Kennally Care project to restructure Cornwall’s health service approaches a “gateway” – with lawyers and politicians in close attendance
By Graham Smith
Cornwall’s health and social care chiefs are preparing to pass through the first of their self-defined “gateways” to embrace a radical restructure of the National Health Service, putting County Hall in charge of strategic commissioning and paving the way for the possibility of greatly increased privatisation.
The tortuous creation of what is now called an “Integrated Care Partnership” (ICP) is highly political, re-uniting Conservatives and Liberal Democrats and establishing Labour as Cornwall’s dissident voice.
A Labour Bill to “re-instate the NHS” is due to get its second reading in the House of Commons on 26th October – although some in Labour’s ranks, who 15 years ago enthused about the privatisations and outsourcings of Tony Blair’s government, are still attracted by the current government’s direction of travel and see little wrong with more “devolution” provided it comes with the necessary safeguards.
At the same time, health campaigners have been granted leave to appeal a High Court ruling that ICPs – previously known as Accountable Care Organisations – are unlawful. The draft contracts for ICPs do not necessarily make more privatisation inevitable, but campaigners say the proposed restructure certainly makes wholesale privatisation of the NHS much more likely.
Although NHS care would remain free at the point of delivery, local commissioners would be free to purchase services from wherever they wanted. Private medical companies are already major players in Cornwall’s health economy and are watching developments closely.
This is because “healthcare providers” would not be paid per treatment, but by a ‘Whole Population Annual Payment’ – a set amount for the provision of named services during a defined period. This, it is argued, unlawfully shifts the risk of there being an underestimate of patient numbers from the commissioner to the provider, and endangers service standards.
Cornwall’s health and council bosses say they are progressing their ambitions only “at the speed of trust” but the first of their trigger steps will come this week and next: at today’s Shaping Our Future Transformation Board meeting, at Friday’s Leadership Board meeting and at next week’s Health & Adult Social Care scrutiny committee meeting.
Cornwall Council, NHS Kernow and the Cornwall and Isles of Scilly Partnership Foundation Trust have already completed what they call the “mobilisation phase” of their ICP. The ICP will shortly become a “forum for joint decision-making” – with some fully “delegated operational responsibilities” by April 2019.
The main ideological divide between the political parties is the purchaser-provider split, introduced by Margaret Thatcher’s and then John Major’s governments in 1990/91, continued by the Blair government but then greatly accelerated by the Conservative-Liberal Democrat coalition in its 2012 Health & Social Care Act.
In Scotland and Wales, which have devolved powers over health, local governments have abandoned the purchaser-provider split. The central plank of Labour’s NHS Bill is its assault on the private medical sector, which the party’s current leadership regards as plundering public resources for private profit.
A further complication is the extent to which Cornwall Council sees the restructure as part of its Devolution Agenda – setting its own targets, defining its own successes, and introducing its own “back office” cost-cutting. Critics are more likely to emphasise the increased fragmentation and bureaucracy.
County Hall is highly sensitive about claims that it is trying to take over the NHS, but Cornwall Council’s chief executive Kate Kennally has for nearly two years been chair of the Transformation Board, following a bloody power-struggle with NHS England. Ms Kennally would also become the chief of the strategic commissioners – with some now dubbing the restructured health system as “Kennally Care.”
The Shaping Our Future Transformation Board will today outline its latest thinking about the location of new Urgent Treatment Centres, and confirm that it has changed its mind about closing Cornwall’s Minor Injury Units (MIUs.)
An internal NHS Kernow report in January spoke of its “commitment to replace Minor Injury Units with fewer strategically placed Urgent Treatment Centres.” Today’s report acknowledges that closure of the MIUs would entail “considerable risk and little benefit … because they are well used and provide a good network of local alternatives to Emergency Departments.”
Today’s meeting will nevertheless signal the formal start of a “public consultation exercise” designed to close, and sell, hospitals at Saltash, Fowey and St Ives. While local health chiefs hope the value of these sites will stay in Cornwall, the NHS estate is government by a private company owned by the Secretary of State.
Even putting the political difficulties to one side, today’s report adds: “Any service closures would also reduce community based options for conveying ambulance crews, increase journey times and reduce available capacity to respond to new calls.”