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The Bill takes a break
‘Specialists and public health doctors must be involved at the highest level of governance
in consortia’ says the RCP, as the Health and Social Care Bill takes a pause to ‘listen’
The NHS Future Forum, tasked with
examining possible improvements to
the Health and Social Care Bill, has been
established by the prime minister, David
Cameron, and the deputy prime minister,
Nick Clegg, with the health secretary,
Andrew Lansley. The forum is chaired by
Professor Steve Field, past chair of the Royal
College of General Practitioners. It will
focus on four areas of reform: the role of
choice and competition; accountability and
patient and public involvement; training
and the workforce; and the range of health
professionals involved in commissioning
decisions. The RCP will be engaging with
the Future Forum throughout the Bill’s
two-month pause and will respond to the
official consultation at the end of May.
The Bill left the Commons committee
stage on 31 March after minimal,
predominantly technical, amendments.
There have been no changes to the ‘duty
to obtain appropriate advice’ placed on
consortia and the NHS Commissioning
Board – an area of particular interest to
the RCP. In terms of concessions, the most
significant change relates to the tariff.
There were also some small amendments
to Monitor’s role. Four days after the Bill
left the committee stage, Andrew Lansley
announced that it would take a ‘natural
break’, lasting two to three months, in
its progress through parliament – an
unusual step. David Cameron and Nick
Clegg were enlisted, along with Andrew
Lansley, to listen to concerns and explain
reforms during this period, leading to the
establishment of the Future Forum. The
RCP has been fully engaged in this exercise
and met the Future Forum on a number
of occasions.
One day after the pause in the passage
of legislation was announced, the Health
Select Committee published their followup
inquiry report into commissioning. The
report focuses on the proposed structural
arrangements for commissioning under the
reforms. Many of the recommendations
reflect the RCP’s evidence submission, with
key recommendations including:
n Secondary legislation should require
hospital doctors and nurses to sit on local
commissioning bodies.
n Public health specialists should sit on
local commissioning bodies.
n Local commissioning bodies should
not be called GP consortia, but should
be referred to as NHS commissioning
authorities.
The RCP’s submitted evidence was
extensively quoted in the Health Select
Committee report: ‘In their evidence to us,
the Royal College of Physicians (RCP) told
us that they would like to see an approach
termed “commissioning without walls”
where a broad spectrum of clinicians is
involved in the commissioning process’.
The Health Select Committee stated that
the RCP feels that the provisions of the Bill
are too loose and that it leaves clinician
involvement as a matter dependent on
local relationships. ‘The RCP is calling for a
tighter requirement in the Bill for the NHS
Commissioning Board and consortia to
involve a full range of health professionals.
[We propose] a duty to involve specialists.
As it stands, we fear that the duty to obtain
appropriate advice may become a tick
box exercise, which has the potential to
damage patient care.’
Sir Richard Thompson, RCP president,
has written to the Health Select Committee
welcoming their report. The RCP will
continue to follow up progress of the Bill
with key parliamentarians.
The full version of this article is
available on Commentary Community:
www.rcplondon.ac.uk/commentary.
6 Commentary n June 2011 n www.rcplondon.ac.uk