31st May 2017By Graham SmithA political storm is brewing over the decision of Cornwall’s NHS…
NHS Kernow to be placed in Special Measures as Whitehall labels local health managers “inadequate”
24th July 2017
By Graham Smith
NHS Kernow has again been rated “inadequate” by health chiefs in London and is to be placed in special measures, which could mean direct rule from Whitehall.
A report by NHS England, the CCG Annual Assessment, puts the St Austell-based NHS Kernow at the bottom of a national league table, failing on the quality of its leadership and financial plan. NHS Kernow is one of 23 CCGs to fail and be taken into special measures.
The CCG, which has overall responsibility for deciding how to manage health budgets in Cornwall, also fails on a range of other indicators – including dementia services.
NHS Kernow has been in trouble for several years. In 2015 the organisation was placed in “legal directions” over its finances.
Last year the organisation appointed a £396,000-per-year “turnaround director” – ostensibly to deal with a £14 million deficit. Questions will now be asked about how much value that post brought to healthcare in Cornwall.
The latest set of data reveals that NHS Kernow has failed to improve after a May 2016 Price Waterhouse Coopers report described its leadership with these words: “The Executive does not operate as a cohesive team. There is a lack of clarity in roles and responsibilities which has led to confusion and dysfunction.”
Only three CCGs have managed to climb out of the “inadequate” rating in the past year. The rating means that all 23 “inadequate” organisations will now be placed into special measures, which usually involves “partnering” with a more successful CCG or even direct-rule from Whitehall.
The inadequate CCGs have failed to meet targets measured within an “Improvement and Assessment Framework” published last year. Areas where NHS Kernow have pleased their Whitehall bosses include “outstanding” cancer care and – intriguingly – NHS Kernow now has “in place” a “local strategic estates plan.” This will alarm campaigners who fear the organisation is preparing to close and sell local health assets, such as community hospitals.
But overall the scores published on the MyNHS website make for gloomy reading, with NHS Kernow “requiring improvement” for patients with learning difficulties, maternity, mental health, diabetes (“greatest need for improvement”).
An NHS England board paper, prepared by NHS Operations Director Matthew Swindell says: “All CCGs assessed as inadequate at the year-end have been placed in NHS England’s special measures regime. This allows the closer involvement of NHS England’s regional team to support CCGs and encompasses the application of national NHS England support programmes.”
In a letter to all CCG’s, Mr Swindell says: “There are significant differences between the top performing and least well performing CCGs. It is important that those CCGs with the least positive results learn from those which are engaging their stakeholders successfully, so that they can make improvements.”
31.2% of Cornwall's 10-11 year olds are overweight or obese, according to latest data
At the other end of the league table, the number of CCG’s rated “outstanding” has leaped from 10 to 21.
Mr Swindell adds: “In a spirit of openness and transparency, CCGs are strongly encouraged to publish their individual survey reports on their websites if they haven’t already done so.” The data does not yet appear to be on the NHS Kernow website, despite a Whitehall instruction a year ago that this information should be readily available.
Some of the more detailed data published on the MyNHS website reveal that 31.2% of Cornwall’s children aged 10-11 are classed as overweight or obese, and 14.5% of mothers were still classed as smokers at the time of giving birth.
NHS Clinical Commissioners chief executive Julie Wood said: “The scores do also highlight that there are cases where improvement is needed and CCGs need more support to make sure that they are able to give their populations the high-quality services that they are striving to provide.
“They are working in a tough environment, with spiralling demand and a myriad of competing priorities on their stretched budget, among these mental health, general practice and urgent and emergency care.
“Our recent analysis has shown that as matters stand rising inflation and a growing population mean that their budgets are set to shrink further over the coming years. This combined with factors such as the huge decrease anticipated in public health spending, means increasingly hard decisions will have to be made by clinical commissioners to address this.
“To make sure that they are able to deliver more for their patients, CCGs will need support from the centre on areas identified as need improvement – but beyond that, they and their partners across the health and care system, need there to be an honest conversation about what the NHS can realistically deliver with the funds it has.”