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Collaboration in Cornwall


9 February 2016

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Kernow CCG has been placed under legal directions by NHS England but it is using the devolution deal to make great changes for its population

Kernow CCG has been placed under legal directions by NHS England but it is using the devolution deal to make great changes for its population

These are exciting times in Cornwall as ambitious plans for the devolution of health and social care evolve.
The Prime Minister announced new powers as part of the deal for Cornwall – with more decision-making, budgets and accountability at a local level.
It means billions of pounds of government funding previously managed nationally will be given to Cornwall to manage transport, health and social care, property, skills development and European funding.
The deal includes a commitment to produce a strategic plan for the integration of health and social care – with the Government, NHS England and other national partners working locally with
NHS Kernow and Cornwall Council to co-design it.
The deal recognises that the whole system needs reshaping, which requires cooperation between partners, giving Cornwall the opportunity to be at the forefront of public sector reform.
We could become the first rural county in the country to benefit from devolved powers – with our innovative work around Living Well underpinning plans.
Devolution fits with NHS Kernow’s ethos of integrating health and social care, empowering local communities to have greater ownership of decisions and resources, tailored to local needs.

Living well
The proposals support the work already underway through Living Well, which is about supporting people to live the lives they want to live.
Living Well is an innovative health and care approach that brings together people working in health, social care, the voluntary sector and the community to support people with two or more long-term conditions or are receiving social care.
It starts with a conversation to understand the person’s story, with
tailor-made support to help them achieve their goals. This includes practical support as well as navigating and co-ordinating care. People are encouraged to take small, incremental steps towards becoming more socially and physically active, take more responsibility for their health, and building confidence. Living Well provides a framework for the system, locality, community and individual change required to make independent living a reality and preventative strategies sustainable.
The initial Living Well approach has focused on people who are at very high risk of dependency, who are often socially isolated. New figures among older people being supported by Living Well in Cornwall show:

  • A 34% reduction in emergency hospital admissions.
  • A 21% reduction in emergency department attendances.
  • A 32% reduction in hospital admissions overall.

Living Well empowers local communities to have greater ownership of decisions and resources, tailored to local needs, and could help move resources to focus directly on local patient care and outcomes. Devolution will apply this approach to the whole population locally.
It could act as a catalyst for our Living Well ambition – helping speed up the delivery. It could help to reduce bureaucracy and enable more resources to focus directly on local patient care and outcomes.

Breaking barriers
Our proposals around devolution include closer integration within Cornwall’s health and social care community – specifically, to work with the government to develop solutions to overcome
the practical barriers to integration and move towards a single, ring-fenced budget for health and social care.
As a test site for integrated personalised commissioning (IPC) (a new voluntary approach to joining up health and social care for people with complex needs), we are already starting to test how this might work, using the Living Well principles.
The government has asked civil servants to work with local partners in Cornwall to develop devolution proposals and discussions continue.
This includes exploring new ways of working with housing, education, the police, and other public and third sector bodies to look at the wider influences on health, wellbeing and prevention.
NHS Kernow and Cornwall Council are building upon existing close relationships to design a business plan to move things forward. The views of local people, patients, clinicians and partners will be crucial as part of this process.
NHS Kernow is also committed to building on existing relationships with the Isles of Scilly who is a key partner in integrating health and social care.
A programme of early engagement will inform the priority issues that need to be addressed and to shape the options for the integration of health and social care in Cornwall and Isles of Scilly.
There will be further engagement and consultation following the development of the draft strategic plan, to be delivered in summer 2016, on the specific proposals for any changes to the services delivered or how services are commissioned and provisioned.
The proposals would be an extension of NHS Kernow’s existing vision for joined-up care – which has received national acclaim in NHS England’s Five Year Forward View – with the emphasis on keeping people well and as independent as possible, easing pressure on hospitals and focusing on services in the community closer to home.
The Living Well programme is the embodiment of the Forward View maxim that the NHS will only be sustainable if we embrace and harness the energy of local people and communities.  

United vision
Increasingly, the focus of the NHS will be on catalysing local transformation and system redesign. This is seen at the forefront of this work in Cornwall.
NHS Kernow was a key contributor at the recent King’s Fund Integrated Care Summit talking about what devolution means for health and social care.  
The learning shared at the event has contributed to a King’s Fund briefing, providing an analysis of the devolution agenda and some of the key questions it raises for health and social care.
Cornwall – and the local NHS – is known for its innovation and we are delighted to be leading the way once again.
But we are very clear that devolution won’t lead to the fragmentation of the local NHS – we are engaging in these discussions on the basis that we will continue to operate and comply with the existing regulations and values of the NHS.
The intention is to maximise existing statutory powers and flexibility to support joint working and integration.
In December 2015, Kernow Clinical Commissioning Group (CCG) was placed under legal directions by NHS England.
We are working through the consequences of our financial challenges with NHS England but we see the Deal for Cornwall as being instrumental in resolving the financial challenges in health and social care by offering a new opportunity for integration.

Joy Youart, managing director (accountable officer) Kernow CCG.

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