Health and Social Care Bill

Memorandum submitted by the Socialist Health Association (HRS 49)

1. The Socialist Health Association (SHA) is a membership organisation which promotes health and well-being and the eradication of inequalities through the application of socialist principles to society and government. We have an extensive and varied membership which provides a wealth of information, knowledge and experience of the care system, both academic and practical.

2. This Bill fundamentally changes our NHS and makes it into a regulated market like gas, electricity and trains.  The government appears to intend that genuine competition will increasingly apply to most NHS services.  This was not in any election manifesto nor in the coalition agreement. Even as amended, the Bill still contains all the powers to form the regulated market and to bring competition law into the heart of the NHS.

3. We do not approve of this Bill as drafted and amended. We do however approve of some of the sentiments expressed in support of the Bill particularly in respective of improving responsiveness to patients. We would like to see those sentiments transformed into practice, and it is to that end that we make this submission.


4. Although the NHS has become pretty effective at listening to its users, it remains poor at responding. And it is the responsiveness of the service to its users that is the real hallmark of effective involvement. These amendments do not address that issue. The Bill should include clauses that enable the following:

5. The authorisation process needs to ensure that CCGs can demonstrate that they have the capacity to alter commissioning in response to recommendations from local people.

6. Monitoring of CCGs’ performance by the NHS Commissioning Board needs to assess their responsiveness. That is, that the CCG can demonstrate that commissioning has changed as a result of the recommendations of local people.

Lay representatives

7. It is probably a good thing to have 2 lay representatives on a commissioning board. However, it would be more important to ensure that it is impossible for any key commissioning decision throughout the CCG to be taken without lay representation.

8. The Bill says the regulations can set a maximum number but we think it should be open to the CCG to have a lay majority. Moreover it must be clear that these lay people should be local, not introduced from afar.

9. Training and support for all representatives needs to be established.


10. We remain concerned that Healthwatch will be underfunded and under-powered. The funding for Healthwatch must be ringfenced. It would make sense for HealthWatch England to be established a year earlier than currently planned ie in Oct 2011, to match the shadow establishment of the NHS-CB.

Shared decision-making between clinicians and patients

11. This needs more detail, but probably not prescription. So, there should be clear guidance from NHSCB about good practice in the field and how this can most easily be introduced by CCGs.

12. Health and WellBeing Boards

13. We would like them to be able to sign off CCGs’ plans.

14. Going beyond "inform and consult" to co-production and community development
We have an opportunity to move the agenda from an Involvement 1.0 approach to a more dynamic 2.0 approach – where local communities are supported towards a proactive dialogue with commissioners and statutory agencies, harnessing the perspectives of people who use services in co-design and co-commissioning. [1] [2]

15. These approaches should be linked with place-based budgets to enhance joint working across agencies at local level. The NHSCB with representatives of local government should offer guidance and discussion about these issues.

Taking advice from patients.

16. Strengthening the duties on the NHSCB and the CCGs to 'obtain advice'. Currently these require them to take advice from 'professionals' with expertise -- we want them to include 'people with expertise', including patients with expertise and experience in accessing and receiving services.

17. Key guidance from the NHSCB is needed

18. The NHSCB is not obliged to issue guidance to CCGs. This is a mistake. We know that patient and public involvement can easily fall off organisations’ agendas. The NHSCB will be immensely busy running the NHS – we would prefer that it have a duty to offer guidance and that CCGs have a duty to follow it.

Key guidance that we would like the NHSCB to offer should include:

· why PPI is an essential business requirement for CCGs

· effective working with your HWB

· effective working with lay representatives

· co-production and community development – developing proactive conversations with communities

· shared decision-making

· widening the audience: ensuring the spread of PPGs and other involvement mechanisms to a wide audience in communities


19. The discretion element for LAs risks diluting independent scrutiny at a time when executive powers (through HWBs) is increasing.

Links with the Equality Duty

20. There needs to be no conflicts of policy with this legislation.

Links with Locality Bill

21. The relationship between the two Bills needs to be clear.

July 2011



Prepared 19th July 2011