Cornwall’s Health Services -Kennally lays out plans for one budget under ACS

Decision on what option to choose delayed until March

Kate Kennally before giving evidence to the ACS inquirry panel today

Video interview with panel chair Cllr Virr after Kate Kennally’s appearance before inquiry panel

Kate Kennally Chief executive Cornwall Council, appeared before the council’s Accountable Care System inquiry panel this morning, the second session of investigation into the merits or otherwise of establishing a new way of managing health and care services.

Ms Kennally was there to discuss the different options of how  Integrated Strategic Commissioning will work under an ACS and specifically how they would bring together the commissioning budgets.

There is approximately £1.1 billion spent on all Health and Social care services in Cornwall but it is managed by four different commissioners and sometimes the interests of one organisation do not necessarily mean benefits for another. The Chief Exec spent the good part of two hours explaining how Cornwall will bring together commissioning budgets.

Four different budgets mean four different accountabilities, and if you bring it all together the public will understand better who is accountable for the services they receive, Ms Kenneally said. Accountability in a new body would be split between clinical specialists and democratically elected Councillors.

The Chief Exec outlined six different options to the panel as to how an integrated commissioning service might work and the roles and responsibilities of a strategic commissioning director and who will exactly be accountable to what.  There were six options of management as she saw it and it will be up to the cabinet of Cornwall council to decide which one to choose. The options range from 1) do nothing through to 6) create a fully formal ACS and varying but increasing degrees of statutory accountability, informal or formal partnership building and budget sharing in between.


That decision has now been put back six weeks and delayed from the cabinet meeting of 7th February to the scheduled cabinet of 24th March to allow for the national judicial review on ACOs as a whole, penned in for in second week of February. Kate Kennally recommends option 6 and if the cabinet also recommend this option then it will legally need Full Council approval, that will most likely be sought in September.

The idea is to pool resources to maximise efficiency but also in the end to improve the overall health of Cornish residents and prevent the population from needing to access as much health and care provision in the first place.

Ms Kennally began by recapping the situation as to where we are now and reminded the panel of statements from the previous session where the theme was ‘people not organisation first’. She said that the views of the public, the five thousand responses from the initial round of STP consultations will take centre stage as the plans progress. She said the responses and findings were in the public domain and all concerned could do worse than remind themselves of the priorities given by the public as part of the consultations.

Prevention is better than cure

Ms Kennally quoted the top two priorities from the consultations as 1. prevention to improve the populations health and 2. to achieve an integrated care system.

Putting the public at the heart of the plans was key: public before organisation.

An integrated care system has the idea of bringing different agencies together to reduce levels of competition and fragmentation.  Ms Kennally urged people to get the most out of the Cornish pound and make the 1.2 billion pounds go as far as possible.

Although partnership working happens now and is encouraged, Ms Kennally argued it was necessary to set up a formal accountable care system as integration is not happening systematically enough with the current informal arrangements and all organisations still tend to put their own priorities first. Sometimes the system encourages waste and can even create more expense in other partners. She used a waterbed analogy to say where savings can be made in one part of the system, it may actually increase costs in another.
If the budget is brought under one roof then competition, fragmentation and duplication will be reduced and therefore there will be more money to spend.

A strategic commissioner and a strategic commission board will set the direction of travel and it will be up to the organisations of the Accountable Care Partnership to deliver and to achieve the results. A strategic director will be able to put into place 5 or 10 year plans for example and the partnership could operate on a more steady financial footing.

The issue is how to bring this budget under one umbrella whilst also retaining the ‘sovereignty’ of statutory bodies as Ms Kenally called them and the legal responsibility and accountability that comes with each one.

After her presentation, Ms Kennally was questioned by the panel and then they heard, via a Skype link, witness evidence from the head of health services in Manchester which has already established a ACS.

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