7 February 2011
A coalition of national health and social care organisations, National Voices, has commissioned an initial analysis of the Health and Social Care Bill, saying it “detects some weaknesses in relation to patient and public involvement and accountability.”
The author, National Voices’ policy associate Don Redding, will appear as an oral witness before the Bill Committee on 10 February.
Meanwhile, the organisation is writing to MPs noting “several cross-cutting concerns that we would like Parliamentarians to raise in Monday’s debate, to ensure that ‘no decision about me without me’ becomes a reality in the new NHS.”
The following is an extract from their letter:
We are concerned about the lack of emphasis on input into local service design and commissioning by expert health and social care professionals and patient groups. Furthermore where the commissioning of whole pathways of care for some conditions will fall under the remits of public health, the NHS Commissioning Board and GP consortia, this risks the fragmentation of service provision.
Integrated and effective care depends on collaboration between professionals, but the current duty on the National Commissioning Board and GP Consortia to “obtain advice” from health professionals is not a strong enough requirement for integrated working. Multi-disciplinary involvement of specialists, Allied Health Professionals, education, social care and patients is required to enhance continuity of care and improve quality standards for patients. We recommend that the duty to “obtain advice” is strengthened to a duty to “involve” health and social care expert professionals, expert patient groups and organisations.
Local democratic scrutiny
The Bill provides greater flexibility for local authorities to carry out scrutiny of the local health service as they see fit. There may be provision for local overview and scrutiny committees, but these will not be mandatory. Local scrutiny of commissioning plans is a crucial aspect of democratic legitimacy. We are concerned that the lack of detail regarding best practice around the scrutiny function will allow for less transparency and accessibility for the local population.
We therefore recommend that the Bill requires the scrutiny function to be exercised by a strong, independent structure within the local authority, led by locally elected representatives.
The involvement of the local population in commissioning and service design is fundamental to making ‘no decision about me without me’ a reality. The Bill sets out involvement in terms of local HealthWatch and HealthWatch England. However, HealthWatch should be just one aspect of a much wider range of involvement opportunities. This is particularly important for those more vulnerable or disabled patient groups who may be less likely to be represented by HealthWatch. We would like to see more emphasis on involving the public in local commissioning decision making.
There is considerable existing good practice in the area of public involvement. We recommend that the Bill sets out a definition of ‘involvement’ with regards to duties on the National Commissioning Board and GP Consortia.
Transparency and quality of information
The Bill does not identify how patients will be able to access and understand information about the quality of health and social care in their area. Genuine openness about the operation of health services and easy access to quality information is essential if the Government’s vision of patient choice and transparency in public services is to be realised.