Cornwall’s new Accountable Care Organisation is ready for take-off – just sign on the dotted line for a completely new way to good health and a balanced budget
4th December 2017
By Graham Smith
The board of NHS Kernow will tomorrow (Tuesday) be asked to endorse the heads of agreement for setting up Cornwall’s “Accountable Care System” – which will signal the end of Cornwall’s 70-year membership of a “National” Health Service and will replace it with an entirely new model of care. You can download and read the draft accord here: GB1718099AccountableCareSystemAccord
The document makes it clear that the Accountable Care System would, for the most part, be run by the same people who provide health and social care in Cornwall now: Kate Kennally, chief executive of Cornwall Council, Kathryn Byrne, Royal Cornwall Hospital Trust, Phil Confue, NHS Partnership Trust and Jackie Pendleton, NHS Kernow.
Supporters of the ACS (sometimes known as an Accountable Care Organisation, or an Accountable Care Partnership) say that because it will be designed and operated locally, it will be more responsive to local needs. But critics fear that by abandoning national minimum standards, introducing new “market freedoms” (usually code for privatisation) and with no certainty over long-term funding, the ACO could be a disaster.
The accord presented to tomorrow’s NHS Kernow meeting is ready for signature – calling into question the real purpose or significance of three “inquiry panel” hearings for local councillors, due to take place in the next few weeks.
The accord identifies the parties who will run the ACO, saying it will “operate as a partnership of providers for acute, mental health, community, primary, children’s, ambulance, wellbeing and social care services, including a range of public, independent and third sector organisations.
“It will need to encompass providers who sit outside of Cornwall and the Isles of Scilly, but serve our local communities. The ACP will be clinically and professionally led by a leadership team with collective responsibility for the effectiveness of the overall provision system, and a place based budget so that budget and accountability are located where ‘tactical’ decisions are made.
“The ACP will tactically deploy the place based budget to secure the improved outcomes in population health required by the strategic commissioners, delivering more joined up, better coordinated and more efficient care, supporting people to remain healthy, promoting self-care, increasing community resilience and independence with a core offer that provides responsive community based services when needed.”
A background paper, attached to the accord, admits the ACS will be a leap in the dark: “The national move towards Accountable Care Systems has little evidence or policy to guide it at this point.”
All three of the major national political parties went into the June general election with questions over their policies towards Accountable Care, but Labour’s annual conference subsequently clarified the party’s position as one of outright hostility.
Gang of Four: clockwise from the top Kate Kennally, Kathryn Byrne, Phil Confue and Jackie Pendleton
Accountable Care is being championed by Conservative Health Secretary Jeremy Hunt, without the usual Parliamentary scrutiny.
The absence of any Parliamentary debate has left the political classes without an obvious target, but health campaigners are now seeking to use the courts to make their voices heard.
The Liberal Democrats do not yet have a policy on Accountable Care, but in a press release issued 12 months ago, in Cornwall, they sought to give the impression that they were also opposed to the Sustainability and Transformation Plan which at that time was its precursor, and which will still lead to the closure of several community health facilities in Cornwall, including some cottage hospitals.
Last year’s press release from Cornwall’s Liberal Democrats. The Lib Dems used “the flawed STP process” to attack the Conservatives. But now they are in power, and want Cornwall Council to embrace the plan at a cabinet meeting on 7th February.
The Lib Dems were defeated in the May local elections, but nevertheless found themselves still sharing power with Independent councillors. They are now on the verge of performing what would be a spectacular U-turn, pushing for an early decision to set up an ACO, even though it will mean the permanent closure of community hospitals in Saltash, Fowey and St Ives.