Jump? How High? ACS Inquiry Last Day but Councillors wont see report til last minute

The fourth and last sitting of the Accountable Care System Inquiry convenes this morning – and after three sittings of being given almost exclusively evidence in the case for, it’s the chance to hear some of the counter arguments.

But the inquiry will have only until Monday to prepare a comprehensive report on their findings and then present it to the Health Committee for Scrutiny. Because of the time constraint, members of the committee will not be given any prior sight of the inquiry report until they meet at 10am on Monday morning.

The Health Committee must then make a formal recommendation to Council in regard to proceeding (or otherwise) with the plans for Cornwall’s Accountable Care System, based on the inquiry’s report.

Council’s Chief Executive Kate Kennally has presented the six options of management being put forward for the Integrated Strategic Commissioner element of the ACS. The options from 1-6 are varying levels of integration – and Ms Kennally supports Option 6 – the highest level of partnership working. The Health committee’s reccomendation will be considered at Cabinet on March 28th.

With only a positive case for the ACS being made so far and the partnership accord signed, it could seem that the only option that remains to the Inquiry, the only choice of recommendation left is to suggest how high to go when asked to jump.

Witnesses today will include Healthwatch Cornwall and  Union representation.

Cllr Martin talks to ACS protesters outside County Hall

Monday’s Health Committee meeting is an extraordinary meeting that is convening solely to talk about the ACS Inquiry findings.

“Accountable Care System Inquiry – Integrated Strategic Commissioning
Please note, due to the timescales of the Accountable Care System Inquiry the paper relating to this item will be tabled at the meeting”

The evidence submitted today includes 60 pages of submissions and comments from the public and Health campaigners.

The six options under consideration by the ACS Inquiry panel

There is no legal requirement for Cabinet to give Full Council a vote on the plans but with the administration keen to gather cross party council support, a ‘meaningful vote’ has been promised to Full Council for some time later in the year, probably September.


Dr Iain Chorlton, Chairman of Shaping Our Future’s Clinical Practitioner Cabinet, said: “Our plans to transform health and care detail the need for greater integration between health and care services. The results of our ongoing engagement with the public, clinicians, health campaigners, and people working across health and care, show support for a more joined-up delivery.

“There has always been a boundary between people who buy health and care services and those who provide them. Creating an Accountable Care System gives us an opportunity to bring commissioners and providers together and work together with the common aim of putting people before organisational priorities, which can only be for the benefit of everyone in Cornwall and the Isles of Scilly”.


Cllr Colin Martin, a member of the panel and Vice Chair of the Health Scrutiny Committee outlined 28 concerns he had about the creation of an ACS in Cornwall before the inquiry began. We’ll find out on Monday how many have been answered by the evidence he’s heard over the last month or so.

Cllr Colin Martin

He said at the time

“The point of this inquiry is to make sure that these potential problems are properly investigated.

“I am listening to people’s concerns and will make sure they are properly investigated. The members of the panel have a reputation for asking tough questions and the final decision will be made by the full council. I will not support the ACO unless all these concerns are dealt with”

Members of the Health Committee will discuss the Inquiry’s findings on Monday but they may feel they need to have more time to process the implications of the results.

The plans for the ACS in Cornwall in spite of what my be happening in the courts of England. Cornwall’s initial plans are to set up a ‘shadow’ ACS for a year, ‘to see how it goes’. Only next year will any formal process begin. NHS & Council chiefs also maintain that at present there is no plan to establish an Accountable Care Organistion, merely an Accountable Care System.

Jackie Pendleton, NHS Kernow’s Chief Officer explained it in her presentation to the inquiry, in perfect Yes Minister speak  “Under our proposal there will be a local shadow Accountable Care System (ACS) made up of one or more Accountable Care Partnerships (ACP), where groups of providers work together as a single network, taking collective responsibility for the effectiveness of service provision, with the ability to design new ways of working and move the money round the system to deliver more joined up, better coordinated and more efficient care”


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The evidence to the ACS Inquiry includes the detailed  KONP-Cornwall (Keep Our NHS Private) Submission

A NHS statement to KONP says the shadow year will be “to test, review and refine the approach to ensure that what is developed is right for COIS; the proposal being to develop a series of ‘gateway checkpoints’ to ensure each organisation can be assured that the success criteria for each stage have been met before the development of the system moves into any more formal phase”.

KONP ask “What is the evidence that setting up a new vehicle with the inevitable associated costs, is the best way to achieve greater integration of health and social care? Would such a vehicle be in the public sector? What undertakings could be given that this would continue?” and of course, just who will accountable and for what.

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