19th August 2017

By Graham Smith

Cornwall Reports has obtained a copy of the first private-sector assessment of plans to reduce spending on the local health and social care system.  It includes several radical ideas about privatisation and commissioning, but offers few details.

The 112-page document nevertheless sheds fascinating insights into the way health and council chiefs have shaken-off democratic scrutiny of proposals designed to slash £277 million from local budgets – and almost certainly close a number of community hospitals and other facilities, in a fire-sale of NHS assets.

The document starts with a critical assessment of how local health chiefs were progressing, prior to arrival of the private sector consultants, advising that further “investment” in process was required to meet target deadlines.

The GE Healthcare Finnamore document has been partially redacted and it is still not yet possible to identify details of which sites will be closed and sold.  The document was presented to Cornwall's health chiefs in March.  It is a large file but you can download and read it here: GE FIRST REPORT-ilovepdf-compressed (2)   Its production is part of a private consultancy budget likely to cost taxpayers £3.8 million, included within Cornwall’s Sustainability and Transformation Plan (STP) – now re-branded as “Shaping Our Future.”

Cornwall Reports is continuing its pursuit of a separate document, the Kernow Clinical Commissioning Group “Strategic Estates Plan,” which NHS England has confirmed is “in place” even though local health chiefs claim no decisions have been made, and are currently resisting disclosure on the grounds that “it is not a public-facing document.”

Among the NHS sites already closed, outside of the statutory public consultation process, are community hospitals and facilities at St Ives, Bodmin, Fowey and Saltash.  The government has  formal plans, endorsed by Prime Minister Theresa May, to “maximise disposals.”

The NHS has previously refused to disclose details of Cornwall’s hospital estate valuations on the grounds that they are “commercially sensitive.”

It has taken five months of asking, finally requiring multiple, formal, Freedom of Information applications, to unearth even a part of the GE Healthcare Finnamore initial report.  It was back in February that Cornwall’s health chiefs initially denied that the process of closing community health services was being outsourced to the private sector.

Cornwall Reports nevertheless established that the Chicago-based GE Healthcare Finnamore had been hired to tell the local STP executives how to proceed.  They have now partnered with other private-sector project management specialists such as Atkins (behind London’s Crossrail scheme) and The Social Kinetic, a PR firm which describes itself as “engagement specialists.”

Apparently without irony, a significant part of the initial report warns that failure to be transparent about the STP process can lead to a High Court challenge.  “Lack of trust among stakeholders encourages them to utilise the system and legalities to block progress,” it says.  “Rumour loves a vacuum – any gaps in communication and engagement will be filled by largely inaccurate stories, facts and suspicions,” adding that an inward-looking, secretive culture often leads to a Judicial Review.

Earlier this year Cornwall Council’s Health and Social Care Scrutiny Committee condemned the STP public engagement thus far as “not fit for purpose” – to the embarrassment of the council’s own chief executive, Kate Kennally, who chairs the STP board. 

The "Global Case Study" does not, apparently, include a National Health Service

Although the initial GE report is short on detail, its approach will alarm campaigners who wish to keep a state-run and democratically-accountable National Health Service.  Its illustrative commissioning schematic offers a variety of models drawn from around the world.  All of them rely, to some extent, on private health insurance and/or a major requirement for private sector delivery.

The report also reveals its willingness to embrace radical suggestions which some health campaigners will regard as dangerous – such as commissioning strategies which do not involve the National Health Service at all.  Among the options on the table is one requiring a Strategic Health and Care Commissioner who would also be responsible for Police and Crime.  The document does not suggest that such a Commissioner might be elected and the current status of the idea is not known.

Option 2: "Does not include NHS England"

Option 7: a "Strategic Health and Care Commissioner including Police and Crime Commissioning"

The STP’s eventual disclosure of the GE Healthcare Finnamore report was accompanied by this statement on behalf of the STP board, which is reproduced in full here:

“It (the report) provided an early assessment of the areas that required additional focus for the development of Cornwall and the Isles of Scilly Sustainability and Transformation Plan, and aligned with other feedback received at the time, including from the Scrutiny Sub Committee. We welcomed the report and have taken action on the recommendations.

• Engagement: In the five months since the report was finalised, significant progress has been made in our approach to develop a more integrated health and care system and create opportunities to improve services. Our approach has been recognised by NHS England as ‘making good progress’ and our recent achievements include:

Having listened carefully to stakeholders, we extended the timeframe for the development of a pre-consultation business case to enable meaningful co-production with people with expert knowledge based on their experience of using services. This includes patients, people who support them, staff who provide health and care services and our key partners.

We have just completed our first round of locally-based co-production events to help us gain even greater understanding of how people access and receive care and support, or their knowledge of working to support people. More than 300 people shared their experiences with us, and provided us with an invaluable insight on what areas work, where improvements can be made and what we need to take into consideration if re-designing services and how people access them.

These events, which were predominately aimed at those with experience of how services are currently delivered, were endorsed by the Scrutiny Committee and Healthwatch and were generally very well received.  The events have provided much valuable feedback to inform the next phase of co-production in working towards transformed models of community based, integrated health and care.

All the information captured during these workshops will be used to help shape a series of two further waves of workshops taking place throughout September and November to develop the plans which will form the basis of a public consultation in 2018.

• The South West Academic Health Science Network is supporting us in the development of robust modelling work to underpin our developments, so that we are planning on firm foundations bringing together service, workforce and financial data to support informed decision making.
• We have started to see the development of more integrated care, including the procurement of an integrated NHS 111 and out of hours GP service, which will be launched on 1 December 2017.
• Our plans for prevention have been endorsed by Public Health England as amongst the most advanced in the country.
• Our proposals to utilise technology to support the delivery of care are also receiving national interest.
• We have received devolved funds from Health Education England to support our transformation work locally, have drawn together a team from our local organisations who are coordinating our efforts across health and care, as well as drawing on expertise from a range of partner organisations.

 We have achieved a significant amount of work since GE Healthcare Finnamore conducted its assessment of our developing plan and are in a much improved position. Whilst we will continue to adapt and improve the way in which we deliver services, we do not intend to make decisions about the long term future of services and facilities ahead of consulting with the public on proposed changes in 2018.

We will continue to work with patients, the public, staff and stakeholders including the voluntary sector to shape our proposals and opportunities for people to contribute to the public consultation in 2018 will be advertised extensively including through the media, with our health and care partners, community groups and social media.”