Health and Social Care (Re-committed) Bill

 Memorandum submitted by the Association of British Healthcare Industries (HSR 28)

About the Association of British Healthcare Industries

The Association of British Healthcare Industries (ABHI) represents the UK medical technology sector. Our purpose is to promote the rapid adoption of medical technologies to ensure better outcomes for patients. The medical technology sector in the UK employs 57,000 people at over 1500 manufacturing sites and has a turnover of £13 billion. The relatively large size of this industry sector reflects UK strengths and heritage.

Notes on this Memorandum

This document follows the structure of the Government response to the Future Forum report.

Summary

- Commissioners should Consult the Appropriate Specialists - The duty that Clinical Commissioning Groups have to ‘obtain advice’ from hospital doctors should be strengthened to ensure that they consult with the clinically appropriate specialist when a developing a commissioning framework for a particular condition

- Governance of Commissioning Bodies - It should be explicitly written into the legislation that Clinical Commissioning Groups should include hospital clinicians on their governing bodies.

- Innovation and Research - Annual Reports published by the National Commissioning Board and Clinical Commissioning Groups should demonstrate how they have fulfilled their duties in regard to promoting innovation.

- Health and Wellbeing Boards - A key function of Health and Wellbeing Boards should be to assess how local commissioners are performing against national benchmarks in terms of innovation.

- Better information for Patients - It should be made clear in the legislation that patients are required to be given information about the full range of treatments available.

Chapter 3

Multi-professional involvement in commissioning

This section relates to amendments 71, 72, 112, 113, 114 and 135.

1. The ABHI very much welcomes the broader involvement of clinicians in Clinical Commissioning Groups (CCG). We believe that this has the potential to equip CCGs with crucial specialist knowledge when commissioning often quite specialist services.

2. However, the amendments 72, 112 and 113 only require CCGs to "obtain advice" from a broad range of professionals with expertise in the "prevention, diagnosis or treatment of illness" and in the "protection or improvement of public health", appropriate for enabling them to effectively discharge their functions. Moreover, amendment 114 introduces a power for the National Commissioning Board to issue guidance to clinical commissioning groups on the discharge of their duty to obtain advice.

3. The ABHI believe the duty to "obtain advice" should be strengthened with clear direction given that CCGs are required to consult with the clinically appropriate specialist when developing commissioning framework for a particular condition. This should be made clear in the guidance issued by National Commissioning Board. Moreover, the input of secondary clinical specialists in CCG governing boards should be formalised in the legislation (we have added to this in our comments on Chapter 4).

4. The ABHI warmly welcomes amendment 135 which requires the Board to include in its annual performance assessment of CCGs an assessment of how effectively they have fulfilled their duty to obtain advice

Research and innovation

This section relates to amendments 115 and 116.

5. The ABHI is very pleased with these amendments as they place a duty on CCGs to have regard to the need to promote research on matters relevant to the health service, and impose a duty on CGCs similar to that which is already on the NHS Commissioning Board in the exercise of its functions to promote innovation in the provision of health services. This will ensure that CCGs actively seek to innovate when exercising their functions as commissioners.

6. This is important as historically there has been a poor link between the development of new treatments and technologies, and their adoption in the NHS to provide better care at better value.

7. To further address this challenge, the ABHI would recommend the NHS Commissioning Board’s annual report should demonstrate how it has taken into account the NHS’s role as an innovation champion. This duty should also be extended to the CCGs.

8. The ABHI is very pleased to see that the Government proposes to table amendments which will place a specific duty on the Secretary of State to have regard to the need to promote health service research and the use of health service evidence obtained from research.

Chapter 4

Strengthening Health and Wellbeing Boards

This section relates to amendments 125 to 133.

9. The ABHI is pleased to see a strengthened role for Health and Wellbeing Boards. In particularly, we think it is positive that CCGs have a duty to consult Health and Wellbeing Boards in relation to their commissioning plans – this is part of a broader requirement on Health and Wellbeing Board involvement.

10. However, the ABHI would recommend that a key function of Health and Wellbeing Boards should be to assess how local commissioners are performing against national benchmarks in terms of innovation in their treatment specifications.

Strengthening governance arrangements of clinical commissioning groups

This section relates to amendments 95, 98, 100 to 101 and 104 to 106.

11. As stated in our response to the section dealing with multi-professional involvement in commissioning, the ABHI supports initiatives to involve clinicians in the governing boards of CCGs. Provided that governing bodies are properly constituted, the ABHI welcomes regulations that require CCGs to obtain the approval of its governing body before exercising specified functions.

12. The ABHI is also pleased that these amendments ensure that governing bodies must meet in public, increasing their accountability.

13. While it is positive that the amendments allow CCGs to specify the categories of people who must be members of the governing body, and it is clear the Government intends that membership must include at least two lay members, one registered nurse and one doctor with secondary care experience, this has not been explicitly written into legislation. Although the ABHI notes the intention to allow for flexibility and local decision making, we do feel the requirement to appoint specialist secondary clinicians to the governing bodies of CCGs within the legislation would remove any ambiguity.

No decision about me without me

This section relates to amendments 68 to 70 and 109 to 111.

14. The ABHI supports measures that increase the quality of information offered to patients and widening the scope patient choice. Moreover, it is good that the range of people involved has been increased to include relatives and carers.

15. Guidance offered by the National Commissioning Board to CCGs on the patient involvement duty need to clear about the meaning of ‘involvement’ and ‘choice’. Modern medicine offers a range of treatments for many conditions and it is important that patients are aware all the information about the full range of treatments available. It is crucial that this information is presented in a manner which is easy to access by even the most vulnerable of patients.

16. In order to support this process guidance from the National Commissioning Board should include advice on the development of decision aids. We suggest that the National Commissioning Board seeks to identify and endorse organisations that can offer quality, informed advice on the full range of treatments that might be available. Such organisations might include, but not be limited to, patient advocacy groups, medical supply trade associations and individual manufacturers. This duty could be made clear in the legislation.

July 2011

Prepared 11th July 2011