18th December 2017
By Graham Smith
Cornwall’s leading Liberal Democrats have come out fighting in support of Cornwall’s Council’s takeover of the National Health Service, although there are signs of discontent among the party's rank-and-file who share concerns that it could contribute to the break-up of the NHS.
On Friday the council signed an “accord” to set up a shadow Accountable Care System, which by April 2019 will take full control of commissioning all health services in Cornwall.
The council’s health portfolio holder, councillor Rob Rotchell, said the ACS could be described as a “takeover” because the council will become responsible for strategic commissioning, in place of NHS Kernow.
Cornwall Reports ran a long video interview with Mr Rotchell on Saturday in which he clarified several important aspects of the ACS. These had clearly been causing confusion to some of his own cabinet colleagues who only days earlier had denied there was any takeover. Some had also shared the widely-held belief that nothing would be signed until after a modest level of inquiry. They were surprised to learn that the accord had been signed on Friday before any inquiry had even started.
Healthcare will continue to be free at the point of delivery, but County Hall will in future administer a fixed, place-based budget calculated according to Cornwall’s population. Many campaigners fear the move, which has had no public consultation or scrutiny, will lead to the break-up of the NHS, increased privatisation and lower standards of care as the money runs out west of the Tamar.
The establishment of an ACS in Cornwall also signals the end of any hope for several community hospitals, most of which are owned by NHS Property Services Company and now seem certain to be sold as healthcare becomes organised around “strategic hubs” in various parts of the county. The most recent “Shaping Our Future” document says: “This may mean a reduction in sites and concentrating services in better locations because we expect changes in community services to reduce the need for community hospital beds.”
Friday’s development was surprising because the council had previously said no decision would be made until three Inquiry Panel hearings, a scrutiny committee meeting, a cabinet meeting on 7th February and even a full council debate. But now the direction of travel has been set, and an important new policy established, without a single question asked or vote cast.
Although many members of the council’s ruling Liberal Democrat-Independent administration continue to claim they know nothing about Accountable Care Systems, which are being promoted by Health Secretary Jeremy Hunt in several parts of England, some have taken to social media to join what they see as party political battle for hearts and minds.
A protest against the new system is expected at County Hall tomorrow (Tuesday) as councillors arrive for the first of their Inquiry Panel meetings.
Cabinet member Sue James, of St Just, spoke of “a political spat in the media” and used her blog to reprint the council’s pro-ACS statement of last week. Lostwithiel’s Colin Martin went further, and linked unease about the new system directly to the forthcoming council by-election in Falmouth.
Although Mr Martin has been a Cornwall councillor for only seven months he is a vice chair of the Liberal Democrats In Cornwall and also vice chair of the council’s relevant scrutiny committee. He wrote on his Facebook page: “Labour and Momentum are predicting the end of the NHS in Cornwall in February unless they win the Falmouth by-election in January.”
While it is true that the Labour Party, in Cornwall, is challenging the council’s approach to healthcare, it has its own divisions on the issue and certainly does not enjoy a monopoly on opposition to Accountable Care Systems. Professor Stephen Hawking, one of the most high-profile patients in the history of the NHS, is backing a legal challenge which could halt the government in its tracks.
Judicial Review proceedings had already been launched by Professor Allyson Pollock, and other senior health professionals and academics including Dr Colin Hutchinson, Professor Sue Richards and Dr Graham Winyard. At the weekend they were joined by a host of other celebrated intellectuals, including Melvyn Bragg, Richard Eyre, David Lascelles, David Owen, Jonathan Pryce, Ken Loach, Rebecca O’Brien, Paul Laverty, John McCarthy, Alan Bennett, and Helena Kennedy QC.
Whatever their politics might be, these people lack neither brains nor money and their motives for opposing Accountable Care probably go beyond a local authority by-election in Falmouth.
"The fact that Jeremy Hunt is in favour of ACS tells me all I need to know. I’m not sold on the idea and I won’t vote for it. But now it doesn’t look like we’re getting a vote anyway. It’s a bloody disgrace. I joined the Liberal Democrats because I wanted to beat the Tories. Now I’m seriously thinking about leaving the party.”
The Liberal Democrats, as a national political party, do not yet have a policy on Accountable Care Systems and their immediate difficulty is in selling the idea to their own members in Cornwall. “Our leaders just do whatever the council officers want,” said one Lib Dem councillor. “I want to keep the NHS. End of. I don’t like the way this ACS thing is being handled – it’s all happening much too fast and it’s all been done in secret. We don’t have a clue what’s going on, and I think that’s true for most cabinet members, too.
“Labour are just being cynical opportunists. But the fact that Jeremy Hunt is in favour of ACS tells me all I need to know. I’m not sold on the idea and I won’t vote for it. But now it doesn’t look like we’re getting a vote anyway. It’s a bloody disgrace. I joined the Liberal Democrats because I wanted to beat the Tories. Now I’m seriously thinking about leaving the party.”
Professor Stephen Hawking. If you see him canvassing in Falmouth, please let us know.
But the Labour Party also has its problems.
First, there was Labour’s failure to take an offered place on the six-member Inquiry Panel set up last month to investigate the issue in Cornwall. The late Candy Atherton had been Labour’s sole representative on the relevant committee. The party had the opportunity to substitute and fluffed it.
Meanwhile in Manchester, Labour mayor Andy Burnham is keen to seize control of a devolved health service. Mr Burnham is a former health minister under Tony Blair, and Health Secretary, under Gordon Brown.
During that period he had no difficulty promoting greater “market freedoms” in the NHS. He later said he had changed his mind and felt that “New” Labour had got too close to private companies. And Manchester, with the youngest population in Britain, is certainly not Cornwall.
But as with the introduction of university tuition fees, academy schools and Private Finance Initiatives, Accountable Care marks one of the Labour Party’s fault-lines between the old Blairite enthusiasm for private markets and the new Corbynistas’ desire for state-run public services, funded by taxation. Thirty years ago those “old” and “new” tags would have been the other way round.
Labour Party policy today is arguably still a work-in-progress, but this year’s annual conference (theoretically the party’s supreme policy-making body) voted overwhelmingly to “oppose and reverse” Accountable Care wherever it can.
Party leader Jeremy Corbyn is calling for a Parliamentary debate before Accountable Care makes any further progress.
"But as with the introduction of university tuition fees, academy schools and Private Finance Initiatives, Accountable Care marks one of the Labour Party’s fault-lines between the old Blairite enthusiasm for private markets and the new Corbynistas’ desire for state-run public services, funded by taxation"
He has also supported the NHS Reinstatment Bill, which “proposes to fully restore the NHS as an accountable public service by reversing 25 years of marketization in the NHS, by abolishing the purchaser-provider split, ending contracting and re-establishing public bodies and public services accountable to local communities.”
"We’ll make sure that Cornwall has a health system that delivers value for money. But the best thing for us to do right now is keep our heads down and our mouths shut.”
Cornwall’s Conservatives are currently very relaxed about developments, enjoying the spectacle of their opponents’ difficulties and once more relishing the prospect of Cornwall’s Liberal Democrats supporting a Tory government’s policies. “We shouldn’t make the mistake of thinking that everything about the NHS is wonderful,” said one Conservative MP. “Why shouldn’t it be more democratic? We’re already the biggest party on the council and we’re aiming for overall control next time. And then we’ll make sure that Cornwall has a health system that delivers value for money. But the best thing for us to do right now is keep our heads down and our mouths shut.”
The Lib Dems’ protestations that the ACS “has nothing to do with privatisation” do not sit particularly comfortably with their plans to outsource children’s services. These outsourcing plans are now well advanced and were approved by the cabinet earlier this year without comment.
The council’s children’s services are also being merged with those of the NHS within a new “arms length” organisation which will eventually be commissioned by the ACS. It will be wholly-owned by the council, at least in the short-term, but similar outsourcing ventures have sometimes brought as many problems as they have solved. Some local authorities, such as Devon, have outsourced their children’s services to companies like Virgin. Virgin recently sued Surrey County Council after the company failed to win an £82million children’s services contract and was awarded a £328,000 out of court settlement.
Opponents of Accountable Care also point to what is happening in the Nottinghamshire ACS, where the private company Capita has already picked up a £2.7million contract and another firm, Centene (owned by a US health insurance company) will become an “integrator of care.”
The all-party campaign group Keep Our NHS Public has developed a 15-page briefing note on Accountable Care Systems which you can download and read here:KONP-Briefing-Paper-ACOs-ACSs-2017-11-20
It remains to be seen if any of Cornwall's councillors will ever get a meaningful vote on Accountable Care. As so often, the real battle is not between the political parties, but with the unelected officials who have already got their New Model Health Service.