6th March 2018
By Graham Smith
A small group of unelected people will today meet in Bude to decide the future of Cornwall’s health service.
The board of NHS Kernow is being urged to accept “Kennally Care” and hand over control of strategic health commissioning to Cornwall Council. Opinion within the NHS Kernow board is finely balanced.
After more than a year of discussion and debate, the 14 individuals (only 13 have votes) must now decide between “Option 6” – which some fear could lead to a breakup of the National Health Service – and “Option 2,” which seeks to use existing statutory mechanisms to achieve greater integration of health and social care.
Cornwall Council’s ambition to take over the NHS has been growing since November 2016, when the council’s chief executive Kate Kennally ousted Joyce Redfearn as chair of the Sustainability and Transformation Plan. The Kennally Care vision of the future sees County Hall control of health as an integral part of the 2015 Devolution Deal, which signalled the transfer of powers from Whitehall to Truro.
Health campaigners who fear greater privatisation, and who are seeking to maintain the traditional, national model of healthcare, have now all but written off the 123 elected members of Cornwall Council as irrelevant, vowing to take their revenge at the ballot box at the earliest opportunity.
Instead, campaigners hope that a pair of High Court judges will intervene, through two separate Judicial Reviews, to ensure that the NHS survives as a national organisation – at least unless or until Parliament legislates otherwise.
The 14 board members are led by chairman Dr Iain Chorlton, who is approaching the end of his three-year term. He had declared that he wants the government to reappoint him for a further three years. Dr Chorlton is a supporter of “Option 6.”
He is joined by executive directors Jackie Pendleton and Simon Bell. Clinical members include Maggie Scott, a nurse, and Dr Sarah Bridges. There are three lay members: deputy chair Chris Blong, a former army officer; the Rev Jeffrey James, from Mylor; and accountant John Yarnold who does not vote.
The key, however, could be the five GPs: Drs Paul Cook, Judy Duckworth, Alison Flanagan, Francis Old and Rob White. This group is known to be particularly suspicious about the wholesale transfer of strategic health commissioning powers to County Hall. They are already familiar with “Option 2” as a mechanism for further integration with adult social care.
Dr Iain Chorlton, NHS founder Nye Bevan and Kate Kennally: the NHS Kernow board today holds the key to the future of healthcare in Cornwall
At last month’s board meeting, the Rev James suggested that Option 2 might be continued before moving immediately to Option 6. Dr Chorlton, however, insisted there was “an ambition” to progress Option 6.
The NHS Kernow board is known to have been alarmed on Thursday night by a surprise council statement, which declared that the council had suddenly abandoned plans for an Accountable Care System. The council now says that although it is indeed abandoning an ACS, it still plans to “align” budgets (instead of pooling budgets) and proceed with Kennally Care in the guise of an Integrated Strategic Commissioning Function.
This “Function” will not be a new organisation – it will be Cornwall’s existing Health & Wellbeing Board, possibly with one or two new members. Some councillors believe it is nothing more dramatic than the re-invention of Cornwall’s former Area Health Authority, abolished in 2002. But campaigners fear that any devolved, five-year budget signals the break-up of the NHS and warn patients not to fall ill during the fourth year, when funds are likely to be low.
Within both the council and NHS Kernow the battle has finally boiled down to finding words which either clarify, or deliberately obscure, the final destination.
The distinction between an “aligned budget” and a “pooled budget” skirts very close to a “single budget” – which is at the heart of the current Judicial Reviews – and which the council insists it is no longer pursuing. The government has actually published advice to local authorities, trying to explain. It says: “aligned budgets are generally less visible than pooled budgets” but makes it clear that the objectives are usually identical.