Health and Social Care Bill

Memorandum submitted by the Centre for Mental Health, the Mental Health Foundation, Mind

and the Royal College of Psychiatrists (HSR 45)

This evidence examines the impact of the recommitted Health and Social Care Bill on the one in six people every year who have a mental health condition. Our five organisations have come together to provide the Committee with evidence about the likely impact of the Government’s amendments to the Bill.

Involvement

We welcome the Government’s amendments to give the Commissioning Board and commissioning consortia a clear mandate to involve patients in decisions about the provision of services. We particularly welcome the amendments to clauses 19 (to create new section 13FA, for the Board) and 22 (for new section 14NA, for consortia), which create a duty to ‘promote the involvement of patients, and their carers and representatives in decisions about the provision of health services to the patients. However this duty needs to be clarified so that it requires commissioners not just to consult patients on changes to services on a personal level, but to involve groups of patients as active participants in the whole commissioning process. This is vital if we are to get the best value from mental health services that meet people’s needs.

A recent survey from Aviva [1] found that more than half of GPs feel that the quality of NHS care for patients with mental health problems is poor, with 52 per cent citing the lack of support for patients with mental health issues as their key concern. The GPs said it was hard to help patients with mental health problems because of a lack of access to support services in their area.

It is thus crucial that people with mental health problems are given a real and meaningful opportunity to influence local services and commissionining processes. We would like to see a full definition of involvement in the Bill. Currently, Clause 19, 13L(2), states that the Board would have to propose to ‘make arrangements to secure that individuals to whom the services are being or may be provided are involved (whether by being consulted or provided with information or in other ways)’. This is a very limited definition: we do not consider the provision of information to be meaningful involvement. The definition should be strengthened to ensure that, in all cases, it requires organisations to seek out the views of individuals affected by health services in order to help them to make a decision about how they will be commissioned.

This duty should be supported by a requirement on the Board and commissioning groups to be proactive in involving people from all sections of society, and particularly groups who do not regularly get heard. A well-resourced local HealthWatch will play a crucial role in ensuring these harder to reach groups are given an opportunity to speak out.

We welcome the amendments to set out regulations about the governance of clinical commissioning groups. Including lay members and a wider range of health professionals on clinical commissioning boards will help to broaden the range of voices at this level of each commissioning group. It is vital that these, include individuals with experience or expertise – or at the very least, access to expertise - in mental as well as physical health. This will begin to give mental health conditions parity of esteem with physical conditions as committed to in the Mental Health Strategy earlier this year.

Integration

We are pleased that the Government has added amendments to clarify the responsibility of the Secretary of State, the Board and commissioning consortia to promote integration. The government has also stated, in its response to the Future Forum report, that the NHS Commissioning Board will encourage the commissioning of whole care pathways, and we look forward to hearing more on this in the near future.

We welcome the inclusion of ‘health related services’ within the duty to integrate services. For people with mental health problems this is vital. A large proportion of people who use NHS mental health services also require support from other agencies such as employment and housing services, and coordinating these responses is vital to their health and wellbeing.

However, we remain concerned about the integration of local and national services. The Bill provides that prison and some secure health services will be commissioned nationally, by the National Commissioning Board. This could lead to a dislocation in the support people are offered as they move between locally and nationally-commissioned services.

We are also unclear whether the Government’s amendments will encourage integration over time as well as across services. Patients with a long term or recurring condition often state that consistency of care is essential to help them recover. They see improvements from having someone coordinate their care with them and are frustrated when their physical and mental health conditions are dealt with separately:.

‘I’ve been to multiple appointments in six different hospitals over three years. My GP’s receptionist admitted no GP reads the letters that come in on me and they haven’t even got on my electronic records that I am getting ketamine for my back. A better system is what pregnant women get – take a care card with you yourself whenever you go to an appointment. Or it would be great if there was a nurse attached to each GP practice who could run the show for mental health patients. A single point of contact from day one.’( Mind survey respondent, May 2011)

As Baroness Young, Chief Executive of Diabetes UK, told the Committee, [2] , patients 'are interested in having someone bring together that pathway of care and discussing with them what that pathway might look like.' While local arrangements for providing this coordination for patients will vary, we would like the Bill to clearly define integration as both consistent support over time, as well as multiple services joining up to offer holistic support at any one time.

Health and wellbeing

Health and Wellbeing Boards have the potential to bring together a wide range of agencies to support people with complex needs and to promote good mental health in communities. To achieve this, the Bill should mandate, rather than just enable, Health and Wellbeing Boards to work closely with ‘health-related services’. It should include housing and criminal justice organisations as members of all HWBs and require all commissioning groups in an upper tier local authority area to be represented, rather than, as the Bill stands, being able to delegate this to one individual. This would allow HWBs to act as the ‘glue’ for local partnerships to form to develop more coherent and cost-effective responses to the needs of communities and the most disadvantaged within them.

To support these efforts, we believe that Joint Strategic Needs Assessments and health and wellbeing strategies should be of a high quality across the country. We believe that the Bill should be amended to require the Commissioning Board to provide guidance to commissioning groups in producing these documents and ensuring they are effective.

July 2011


[1] http://www.hi-mag.com/health-insurance/product-area/group-risk/article373055.ece

[2] 29 June 2011 , Health and Social Care (Re-committed Bill) , Committee stage debate

Prepared 19th July 2011