Cornwall ACS Inquiry tell NHS Chiefs – ‘Don’t Build your House on Sand’

The six councillors that make up the inquiry into the viability of an accountable care system for Cornwall NHS met for the first time today.

The panel will report to the health and social care overview and scrutiny committee, who will in turn report recommendations to the cabinet. It’s not decided yet if the final recommendations will go to full council, however it seems more likely than ever that it will. It was revealed today that the council legal team is looking at whether the decision to adopt an ACS needs to go to full council or if the cabinet can vote it through.

The panel chair Cllr Andy Virr, by day an A&E Consultant at RCH Treliske, questioned the timing of the ACS introduction, saying that unless Cornwall wanted a house built on sand the checkpoints that need to be achieved before an ACS can be implemented must be robustly adhered to, for our own benefit, without any fudging of the figures to ease the process.

Kathy Byrne

Kathy Byrne, Chief executive of RCHT made the first presentation. She said she was optimistic that ACS could work but said it will be hard and “we’ll get things wrong but we need to put the citizen first rather than any organisation”.  All of those with an interest in a better health system in Cornwall need to try to build trust and genuine partnership working, assisted by accountability and transparency, she said. “We need to give it the best shot we can as the alternatives are few” she concluded.

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An Accountable Care System will be bring no new statutory bodies and there will be no change in staff employment contracts.

Colin Martin Lib Dem councillor asked why there is a principle being adhered to of aiming to reduce the amount of money spent overall on Cornwall’s health and social care. “If we are to put citizens first, we need more money” councillor Martin said.  The Chief Exec of Treliske answered that there had never been enough money.

Councillor Bert Biscoe said adopting the principle of reducing the overall cost of NHS Kernow services is unattainable. Managing costs yes, he said but not reducing constantly as we have a population growth that is ageing.

It wasn’t a case of cutting money it was just trying to live within means said Amanda Fisk of NHS South West. Cornwall’s NHS currently overspends to the tune of a few million a month but they would not be looking to cut below that line just looking for a balanced budget.

But Mebyon Kernow’s Cllr Loveday Jenkin said that integration won’t save money in Cornwall because of the rural nature of the services that need to be provided.

Dr Virr said his concerns so far are with timing and readiness .

The ACS is the fruit of the STP said Cllr Virr, however no blueprint for Cornwall’s STP exists. This last statement seemed to confuse NHS England staff who needed to be reminded that the original STP plan was rejected by Cornwall Council as being “not fit for purpose.”

“If you are basing this on the publication of a year ago then we have a problem” Dr Virr told them.

As far as the panel were concerned the STP was an ongoing process and needed to be completed, surely, before moving to the next stage, which is the shadow ACS.

On readiness, Dr Virr said that there were checkpoints along the way of the process and these needed to be robustly refereed before moving along. He used the example of the recent manipulation of urgent care statistics when he said he had extreme concerns about the fiddling or fudging of the figures of key thresholds.

It was at this point that Ms Fisk, a senior manger in NHS England South West said that she believed the STP process had finished in Cornwall. Cue groans from the public gallery and councillors pointing out that, actually, no it’s not.

The partners of the recently signed accord, a statement of goodwill intent were read out: CFT RCHT, Cornwall Council, Isles of Scilly Council, Kernow Clinical Commissioning Group, SW ambulance service and NHS England South West. These organisations will make up the partnership.

Cllr Bert Biscoe (Ind)

Bert Biscoe then asked why a sizable chunk of the Cornish population will being left out of the calculations by not thinking of those in the east and north who go over the border for treatment. He asked if Plymouth Derriford  and Barnstaple hospitals should be invited onto the partnership. And if they have been asked why have they said no? The question will be asked of the Devon hospitals.

Kathy Byrne described how the ACS will work on the ground with 20 GP clusters covering 15 to 25000 people. these clusters would sit under seven localities, one of them the Isles of Scilly, covering 65-100,000 of the population. This said Ms Byrne was an adequate local presence and there was a high level blueprint emerging.

The ACS will be established as a shadow organisation working, as if it existed, for 12 months at the beginning “to put the meat on the bones.”

The panel asked if this was supposed to be one organisation covering the whole of Cornwall why are they creating localities? There was also concern about creating a two tier system in towns and rural areas as it will be much easier for example to create a GP cluster in Truro or St Austell as it would be in North Cornwall.

In her presentation, Amanda Fisk of NHS South West said no organisation is going and there will be no new statutory boards created as no legislation existed to create statutory organisations and none was expected.

She used the example of Dorset as an existing ACS in the southwest region. She explained that there are performance gateways to go through, criteria, checkpoints to becoming an ACS.   NHS England is supporting all STP processes to develop into ACS across the country.

Councillor Biscoe pressed on the meaning of the word accountable. Ms Fisk described it as accountable to itself as it has no legal basis .

Finally it was Judith Dean’s turn to inform the inquiry. Ms Dean has recently been appointed to the temporary position of System Transformation Director, brought in by NHS England to Cornwall to help smooth the process of transition to an ACS. She was there to describe the process and the hoops you have to jump through. We were starting at a point with the CQC report, the urgent care figures and no money and unless something improved NHS England be more interventionist, she warned. An ACS is part of the solution, Ms Dean said.

It would be a mistake though, remarked the panel, to jump from the fire into the frying pan, if the system is not ready to cope. Or as Dr Virr described  “we could just be jumping from a burning platform into a rescue boat”

The shadow ACS could be in place on April 1st 2018. What is the driver for the 1st of April date asked Cllr Loveday Jenkin. Well it was just a random day was the answer,  you have to have something to work towards.

The Conservative’s Councillor Nicholls said if the ACS is being brought in quickly because the STP wasn’t fit for purpose, maybe it was an idea to the skip a stage and go straight to the ACS. The April 1st date is not fixed in stone insisted Judith Dean. Councillor Martin said he hoped this wasn’t a case of leaping beore a proper look.  Is it a case of “someone saying something must be done, here’s something, let’s do it” without checking it out properly.

The panel will meet again in the new year although one of the sessions may be behind closed doors for reasons as yet unclear.