Should I stop ‘banging on’ about Cornwall’s Sustainability and Transformation Plan?

Should I stop ‘banging on’ about Cornwall’s Sustainability and Transformation Plan? There are definitely people who feel I should …. at least until after the elections in May when I suspect things will be so far advanced that there will be little chance to influence things! By then the question to Full Council will likely be “do we accept or not accept the plan?” But I want to know what you think.

If this is the first post on this subject of mine you have read then it is worth your going back through recent posts and catch up with the story so far.

As there will not be a debate at Full Council on 24 February, to give a steer to Officers and the few Councillors influencing the plan, I have tabled a question and it is below.

QUESTION TO JOHN POLLARD

Our devolution Deal, “putting Cornwall first” approach appears to be a major reason why the development of the Sustainability and Transformation Plan for Cornwall is being presented as following a partnership rather than an NHS led approach. Whilst there may be potential benefits in that for the people of Cornwall, the lack of an open and transparent democratic strategic steer places the legitimacy of the outcome at risk. To give such a steer was the reason I, with the support of many others, had hoped for a debate in this Chamber today. This is now giving a public perception that the final plan might be Officer led rather than locally driven and democratically accountable. Given that I have had significant public interest and support for my request and that a round of public meetings has now taken place, will you, as Leader, ensure that a full debate takes place at our next Council meeting?

My asking for a debate in the first place (perhaps by coincidence) has led to the publishing, on the Council’s website, of provisional dates for the sub-group of Councillors scrutinising the developing plan to meet. If you want to consider attending they will be public meetings. Sustainability and Transformation plan sub committee My initial request for a debate and subsequent disquiet has also led to a statement from the Chief Executive of Cornwall to allay my and other members concerns. I have copied this in full below. Have a read and if anyone wants to email me or comment on Facebook I’d like to have your views on whether all Councillors in Cornwall should debate and give a direction to the plans for Health and Social Care in Cornwall or whether we should wait to see what the wise few come up with? Email cllrsuejames@gmail.com or find me on Facebook, where there will be a link to this post – Councillor Sue James page.

CHIEF EXECUTIVE OF CORNWALL COUNCIL’S STATEMENT TO COUNCILLORS

Dear Members

I am writing to set out the current position with regard to the leadership arrangements and process/timetable for the development of the Sustainability and Transformation Plan (STP) which is the strategic plan for the achievement of health and social care integration in Cornwall.

It is a lengthy and detailed note but this is one of the most important issues that is being faced both nationally and by the people of Cornwall and I want all Members to be fully informed on the Council’s role in respect of the governance and timetable for the STP.

In both the Case for Cornwall and the Devolution Deal approved by Council in July 2015, the Government agreed to work with partners in Cornwall to transform health and social care services. This involved NHS Kernow and Cornwall Council as signatories to the Devolution Deal working with other local partners and NHS England to develop a business case to move progressively towards the integration of health and social care.

Since the Deal was signed a number of reports have been taken to Committees detailing the progression of health and social care integration and integration has become national policy with all areas required to develop plans to have integrated health and social care services by 2020.

As you know, from the initial public engagement work led last year led by Councillor McKenna, it was clear that the integration of health and social care services is something that has widespread support both from the public and within the Council. However, translating that intention into sustainable reality is a significant challenge not only in Cornwall but across the country. The challenge has often been exacerbated by the way in which the health and care system works, as there are many different organisations involved, often with competing priorities. The chance to develop a single plan which is owned by the different health organisations and the Council through the STP is a significant opportunity for us to make a fundamental step change in progressing this agenda.  

Last October, we were concerned that NHS partners were responding more to a national set of priorities through their engagement in the STP process rather than taking a Cornwall first approach as envisaged by the Member-approved Devolution Deal. Our intervention has resulted in some positive changes and discussions, with all parties recognising the need to work better together.

As part of this process of achieving a greater mutual understanding, a mediation session was held on the 5 December involving the chief officers of the four main partner organisations: RCHT, Cornwall Partnership Trust, Kernow CCG and the Council which led to the publication of a joint statement setting out the principles for how we are going to collaborate, aiming to put Cornwall and the best interests of its residents before competing interests of any individual organisation.  I attach that statement for your reference although I know that some have you will have already seen it.

You will see in that statement that I agreed to chair the STP Transformation Board following the resignation of Joyce Redfearn as its independent chair. This is recognition of the role that the Council has in providing wider place-based leadership and ensuring that there is transparency of approach by our NHS colleagues as we consider what changes need to be made to improve the quality of services, patient outcomes and financial sustainability. I want to reassure you that we are clear that these arrangements are about how we work together and not about making decisions on behalf of our respective organisations. 

The STP Transformation Board has evolved from meetings related to the progression of health and social care integration. Itspurpose is to oversee the development of the STP in Cornwall and to ensure there is a continued and focused effort on delivering outcomes.

So, what will this mean going forward?

Over the next six months, we will be concluding the current engagement exercise that is taking place with residents and patients on the draft Outline Business Case (OBC) and work will then be undertaken to develop the Full Business Case (FBC). The FBC will be considered by Cabinet and Full Council after the unitary elections in May.

This work will be led by the Programme Team, made up of representatives from the partner organisations, with the Council focus being on those areas that are specifically relevant for the Council e.g. integrated care arrangements and the “prevention” agenda. Trevor Doughty, through his leadership of the Adult Transformation Programme, will ensure that this work is aligned to the overall direction of the STP. The initial work on this programme has already been well received at the Health and Adult Social Care Overview and Scrutiny Committee (HASCOSC) and will be considered at Cabinet on 25 January. 

The HASCOSC will be undertaking focussed scrutiny on whether the case for change set out in the OBC is well made out, whether the approach is sound, whether the feedback from the engagement process has been acted on, whether there is effective patient, user and carer involvement and the involvement of clinicians. As part of that process, they will also consider whether the overall resources that are available for health and social care services for Cornwall are adequate.

In order to do this effectively, HASOSC have established a sub-committee to ensure dedicated focus on the STP. The sub-committee will be contacting groups and organisations within Cornwall and nationally to receive evidence and information regarding STPs generally and, specifically, the development of Cornwall’s STP.

It is envisaged that this work will build a base of knowledge from which Members can scrutinise the STP in depth. It is hoped that most, if not all, of the evidence gathering sessions of the sub-committee will be in held in public during February and March.

I will be ensuring that this work is properly resourced and that recommendations are fully considered through the STP Transformation Board and in subsequent reports to Cabinet, Council and NHS Boards.

The Health and Wellbeing Board also have a key role to play. They are considering synergies between the Health and Wellbeing Strategy, the Joint Strategic Needs Assessment and the STP. A report will be brought to its next meeting in March and it will allow partner organisations who are Board members, such as Safer Cornwall and the Department for Work and Pensions, to consider impacts and crossover with work they are undertaking.

After the elections, the FBC will be developed and finalised.  This will be subject to individual approval by each of the partner organisations: Cornwall Council, the RCHT Board, the CPFT Board and the Kernow CCG Governing Body.  It will only be after the approval of the FBC that specific formal consultation on service changes will take place.

To be clear, the Council, through the wider Membership will have the opportunity to consider its position on the FBC prior to the commencement of formal public consultation. If at this stage, the Council does not feel able to support the FBC, either, for example, because the recommendations from HASCOSC have not been acted on or because of a change of priorities by the new administration, then there will be an opportunity for my own position in relation to the STP governance to be reviewed as well as the administration’s direction of travel for integrated commissioning or joined up health and social care services.

HASCOSC have a statutory duty to be consulted in relation to proposed substantial variations to NHS services. Following a process of scrutiny, review and negotiation, there is the facility for a change to be referred to the Secretary of State for review. The duty will apply to substantial changes that emerge from the STP FBC in addition to any position taken by the Council regarding whether it should be supported.

I hope that this email reassures you that the approach that is being taken forward is in accordance with both the agreed strategic direction given by Full Council and the statutory responsibilities of both Cabinet and Council. I recognise that, over the next few months, the provision of local NHS services is likely to be an area of political debate but I think it is essential that the Council continues to take an active role in helping to shape the OBC and the FBC. 

We need to ensure that we are collectively determining with our health partners the future operating model for health and adult social care services which are required to be integrated by 2020. I believe that we have got an opportunity in Cornwall to do this really well – our geography and co-terminosity of commissioning and delivery areas make it possible to achieve our joint goal of significantly improved health and wellbeing in Cornwall.

The Programme Office will be developing a full Programme Plan for the next phase of work which will be submitted to the STP Board and shared with HASCOSC through its sub-committee. The STP Board has both political and officer representation from the Council and I will ensure that regular updates are received and shared with the wider Membership.

If any Member has any concerns or questions over either the governance or the timetable/process for the development and delivery of the STP, I would encourage them to contact either myself, the Leader, the Cabinet Member for Adult Care or the Chairman of HASCOSC.

Best wishes

Kate

Oll an gwella

Kate Kennally

Chief Executive

Cornwall Council