15th January 2018
By Graham Smith
Cornwall’s transition from mainstream National Health Service to a council-led Accountable Care System will still go ahead on 1st April, despite the “slippage” announced last week by chief executive Kate Kennally.
Clarification of the timetable was the only new fact to emerge during this morning’s (Monday’s) Inquiry Panel hearing at County Hall.
The council’s cabinet is due to endorse the “preferred option” of senior officials at a meeting on 28th March and the “shadow” Accountable Care System will be launched, formally, a few days later. The council actually signed the contract to set up the new system before Christmas.
There is, however, a chance that the full council might challenge the authority of the cabinet at a meeting next week. Councillors will have the opportunity to debate a Labour motion calling for delay until the outline business case for the ACS – which has not yet been published – has been fully debated.
The motion, to be proposed by Penzance councillor Cornelius Olivier, says: “Any participation by this council in a new system of organising health and social care in Cornwall, such as the creation of an Accountable Care System, should only proceed after being agreed by a full meeting of the Council.”
This motion is due to be debated on 23rd January and would have the effect of ensuring that the full council – rather than the cabinet – takes the crucial decision to establish the “direction of travel” before the ACS reveals its full and final business case in September. The alternative is to allow the ACS to launch on 1st April and then – in theory – councillors would get a chance to stop it five months later if they did not like its consequences.
If the Labour motion is carried – and many councillors, of all parties, have said they think the issue is of such importance that only the full council should decide – it would mean reorganising the calendar of meetings, or delaying by nearly three weeks the proposed launch of the ACS. There is no meeting of the full council scheduled for March and the first scheduled meeting in April is not until 17th.
Meanwhile a legal challenge to the whole idea of Accountable Care has been given a date to proceed to a full Judicial Review, at Leeds High Court, on 24th April. Part of the legal challenge is that Health Secretary Jeremy Hunt is encouraging these new structures without any legislation or Parliamentary scrutiny.
Officials are currently working on the basis that the September council meeting will vote through the necessary constitutional changes required to allow formal participation in a new “vehicle” which will at that point require a statutory basis.
Today’s witnesses were Helen Childs from NHS Kernow and Caroline Court from Cornwall Council’s Public Health team. Both said there were no plans to introduce an Accountable Care Organisation – which brings with it a far greater potential for privatisation of the NHS – but that without some reform the various component parts of the existing fragmented system would continue to operate in “silos” and “cost-shunting.”
The original proposal from Cornwall Council, NHS Kernow, the Royal Cornwall Hospital Trust and the Cornwall Partnership Foundation Trust, was indeed for an Accountable Care Organisation. Sometime between December 2016 and May 2017, this was changed to an Accountable Care System but without any obvious change to the draft outline business case.
Cornwall Reports understands that early in 2017 many GPs expressed horror at the suggestion of an ACO and forced NHS Kernow to retreat. Senior managers say, however, that while they have “no plans” for an ACO they cannot rule out for all time the possibility that the idea might return.