Policy by logo: Kennally Care gets a makeover, while doubts remain over whether Cornwall is getting an Accountable Care “System” or a full-blooded privatising Accountable Care Organisation

Posted By on 15th January 2018

15th January 2018

By Graham Smith

The establishment of an Accountable Care Partnership, to supply healthcare subject to the commissioning intentions of Cornwall Council's chief executive Kate Kennally, appears to have happened already - according to a new logo.

As six Cornwall councillors are due to meet today (Monday) for the third of their Inquiry Panel hearings, a briefing note prepared for Labour MP Ben Bradshaw ahead of a BBC interview reveals how health chiefs are now desperate to "massage the message" and soften the impact of the new structure.  You can download and read that briefing paper here: Q and A about Cornwall & Scilly 'Shaping our Future'

The agenda for today's meeting gives no clue as to which witnesses might be giving evidence and suggests that press and public could be excluded.  The only witnesses to give evidence so far have all been those NHS and council bosses who are enthusiastic supporters of "Accountable Care,"  The way the Inquiry Panel has gone about its work has done nothing to address the fears of health campaigners that it was just a smokescreen and public relations exercise.

On Friday former health minister Mr Bradshaw was given a briefing paper prepared by the Shaping Our Future team - the non-statutory coalition of health and council chiefs previously responsible for the Sustainability and Transformation Plan, which proposes closure of many community facilities, such as Minor Injury Units.

The logo at the top of this briefing paper has changed from the original Shaping Our Future design, adding the words: "Cornwall & The Isles of Scilly Health and Social Care Partnership."  Strictly speaking this "partnership" does not yet exist as a legal entity, although the council last month signed an "accord" designed to give birth to it with effect from 1st April. There has been no vote in the Cornwall Council cabinet, far less any debate involving the full council.

In his interview, and subsequent comments on Twitter, Mr Bradshaw was at pains to explain that the new model of healthcare in Cornwall was to be an Accountable Care "System" and not an Accountable Care "Organisation."

Signs of the times: the new logo (top) with new colours and a few important new words

Draft contracts published by NHS England make it clear that an ACO would have the authority to privatise huge swathes of the National Health Service, on 10-year contracts.  The Shaping Our Future briefing paper stated: "Locally there are no plans to establish an Accountable Care Organisation."

Yet a little over 12 months ago, Ms Kennally was one of the four chief executives who signed a letter to senior managers saying: "we will need to move with pace to establish an Accountable Care Organisation...."

Whether this was just a slip of the tongue, or a series of stray typing fingers, remains unclear.  Cornwall Reports has asked for clarification of exactly when, and why, the change was made from ACO to ACS and what differences exist between any outline business case for the two models.  The Kings Fund think tank, which favours both Accountable Care Organisations and Accountable Care Systems, says the two terms are frequently interchanged and that there is often no real difference.

Regardless of the potential for more privatisation of Cornwall's NHS, either the Accountable Care System or Accountable Care Organisation poses a more immediate threat to ten of Cornwall's Minor Injury Units.  The formal establishment of an ACS or ACO will give executive authority to implement the original STP proposals, which have changed since October 2016 only in so far as health chiefs have now identified the four locations most likely to be upgraded to Urgent Treatment Centres.

Above: what they said then.  The December 2016 letter announcing plans for an Accountable Care Organisation.  Below: what they say now:

Slow train coming: above, the October 2016 "proposal" to replace Minor Injury Units.  Below, last month's NHS Kernow management report, saying there is now a "commitment" to close the MIUs but that work to say which sites might survive as "Urgent Treatment Centres" is continuing.