The Case for Cornwall and bold plans for integrating health

The Case for Cornwall is an ambitious plan with many aspects to it. Some will say too ambitious, but I believe it is best to ask for as much as you which will have a positive affect on residents, rather than some sort of half-hearted ask. It is not just an ask for Cornwall Council, but for all the health organisation in Cornwall.

One of the areas for the Case for Cornwall is on Health integration across the spectrum. It is not an easy ask, as there is eight different health organisations in Cornwall who deliver these health services. Those who deliver health services believe integration is to the best way forward. Out of these eight, three commission services in Cornwall. These are Cornwall Council, NHS England and NHS Kernow.

However, wanting to deliver integrated health service is easier said than done. A few reasons for this is because all the eight different providers all have different legal, governance, data capture systems and financial structures. So trying to overcome these is difficult without changes to legislation. There are also cultural differences between the organisations which will also need to be addressed.

These asks are:

  1. Support in developing a devolved ring-fenced place-based health & social care budget with a minimum five-year settlement;
  2. Local ownership and control of assets. (Please see the ‘property’ theme in the Case for Cornwall document for detail related to this ask);
  3. Delegated authority for commissioning of primary care GP Services with the opportunity to explore future delegation of other services important in our community model, e.g. pharmacy, optometry and dental services; and
  4. Government to consider a review of the funding allocation formula for Cornwall to ensure it matches the actual needs profile of our population.

The Case or Cornwall would also like to work with Central Government to explore two opportunities for greater local influence:

  • To influence design of a single framework for measuring the impact that health and social care services have on the health and well-being of a local population (‘a single outcomes framework’)
  • To influence how multiple regulators might develop a coordinated approach to a place in order to enable efficient and effective collaboration.

Of course if the government agrees to these plans, this integration will not happen overnight, or even in a year or two. As if the government agrees, these ambitious plans will take five-years to implement.

To support this the Council is also seeking transformation funding which is addressed below in the section on Managing the transformation. £2m per annum over the five-year period will provide vital programme delivery resource whilst maintaining business as usual.

Why are we asking for this? There are many reason, but a few are:

Cornwall and the Isles of Scilly have a total population of 545,335 (as of 2014). The population of Cornwall contains more residents over the age of 75 than the average for England with rates in the upper quartile of all local authorities across England and Wales.

The number of those aged 75+ is set to grow significantly and very quickly with a 32% increase by 2024. It is the group most at risk of multiple long-term conditions. If there is no change to current practice, numbers in the 75+ age group will exceed our capacity across health and social care to provide care for them. Family and friends providing care are also growing older.

We have some of the most disadvantaged neighbourhoods in the country. In Cornwall, one in ten live in the 20% most deprived areas in England. These areas are home to 53,000 people. 15,100 children (under 16) live in poverty, 22.8% households are in fuel poverty and more than 30,000 people are on health related benefits. People in our disadvantaged communities are at higher risk of living with at least one debilitating condition and for more of their lives. Of those claiming Employment Support Allowance and incapacity benefits 46% report a mental health problem as their primary diagnosis

Children under 19 living in poverty in Cornwall stands at 17.6% and is ranked 8 out of 20 of south-west region councils. Poverty matters and has a major impact on the health and wellbeing of our population both in the short and long-term. (I will be doing a separate blog post on children in poverty)

Cornwall experiences low wages and seasonal employment. Cornwall has the second weakest economy in the country – earnings were 19% below the national average in 2011. Cornwall also has unique challenges.

Most businesses are small, around 14% of the working age population is self-employed compared to a national average of 9% and the skills profile in Cornwall continues to be weak despite improvements

A Cost of Living analysis for Cornwall shows that there are a number of higher costs for the average household in Cornwall compared to the national average or to other parts of the UK – this includes water & sewerage charges, costs of energy & transport fuels & mortgages. Costs of living in Cornwall are set in the context of lower than average annual earnings & higher than average house prices.

All these and more, have an effect on health, and this is why having an integrated health system in Cornwall will result in better provision, and less money being spent on different organisational structures.

Is the plan bold, yes. Is the detail finalised, no. But one thing is for sure, this is the right thing to do. You can read more about the plan HERE.

These plan will be discussed at the next Cabinet meeting on the 8th July. The meeting starts at 10am and is webcast.

One comment

  • Colin Martin

    Some interesting ideas. Integration makes sense, if only we can find a way to do it which doesn’t become impossibly complicated.
    Your stats on older people, high cost of living and low wages are compelling, but think twice before mentioning that “10% in Cornwall live in the most deprived 20% of neighbourhoods in England”. The national average is… “20% in England live in the most deprived 20% of neighbourhoods in England”!
    Of course that’s still thousands of people needing extra support to avoid worse health outcomes, it’s just not an argument for above-average funding.

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