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Exclusive: Cornwall on brink of first county devolution deal

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A devolution deal for Cornwall including greater control over health and care spending is set to be announced by the chancellor next week, LGC has learned.

The ambition is that by the end of the decade the area will have developed options for the management of a £2bn pooled budget combining health, welfare and social care spending.

Full details are still to be finalised but chancellor George Osborne is expected to make reference to the deal it when he delivers the emergency Budget on Wednesday.

Cornwall will be the first area outside of a major city to win a devolution deal, in an apparent demonstration of the government’s commitment that all parts of the country can gain devolved powers.

LGC understands the devolution of transport powers, including the re-regulation of buses, are also under serious discussion. It is thought Cornwall will not have to adopt a directly elected mayor, unlike Greater Manchester, the only other area to date to win devolution of health and social care budgets.

In December, Cornwall Council unveiled its bid for wide-ranging devolution in a Case for Cornwall. Papers due to go before the council’s cabinet on Wednesday said it had become “increasingly apparent” the lobbying of government which had taken place had “paid dividends”.

However, the document stressed there was a difference between the Case for Cornwall and the “government’s proposed deal for Cornwall”.

Some proposals, such as allowing a share of fuel duty generated in the county to be retained locally, are highly unlikely to have gained any traction with ministers. However, others, such as powers to pool and invest capital receipts from the county’s public sector estate, are likely to have been looked on more favourably.  

Wednesday’s expected announcement will follow the devolution of health and social care budgets worth £6bn to the Greater Manchester Combined Authority earlier this year. However, while Greater Manchester has 10 metropolitan authorities and 12 clinical commissioning groups, Cornwall has just one unitary council and one CCG.  

LGC’s sister title the Health Service Journal understands that the devolution deal is likely to involve integrated commissioning of health and social care by Kernow Clinical Commissioning Group and Cornwall Council.

In April HSJ revealed officials from the Treasury, the Department for Work & Pensions and the Department for Communities & Local Government were examining the potential savings through bringing together spending on health, social care and some welfare payments.

Under Cornwall’s plans by 2020 health and social care budgets will have been pooled in full and the area will be looking at options to combine it with welfare into a single pot worth about £2bn, the cabinet paper said.

Joint commissioning of health and social care would start on 1 April 2016 with the domiciliary care and care at home budget, and the budget for children’s community services, with Kernow CCG leading on the former and the council on the latter.

However, HSJ understands that, unlike for Manchester, NHS England at present has no intention of delegating its budget for specialised services to Cornwall.

John Pollard (Ind), leader of Cornwall Council, refused to comment on what powers could be included in any deal but told LGC: “For some weeks and months we have been preparing a ‘Case for Cornwall’ which are the things we think Cornwall could benefit from having. We have been discussing those with officials and civil servants and those discussions continue.”

Simon Edwards, director of the County Councils Network, which has been campaigning for devolution to non-urban areas, said many counties were in “detailed discussions” with the government on “substantial” devolution deals. “Given the potential benefits of county devolution, we expect announcements on county deals imminently,” he said.

HSJ understands the devolution plans, and the integration of commissioning in particular, are seen as complementary to existing proposals to achieve greater integration between health providers in the county.

Acute provider Royal Cornwall Hospitals Trust and Cornwall Partnership Foundation, which delivers mental health services, began merger talks earlier this year.

In addition, a social enterprise which provides community services across Cornwall and oversees the county’s 14 community hospitals has said that it will not seek an extension to its current contract because of longstanding financial difficulties.

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