Health and Social Care Bill

Memorandum submitted by Changing Faces (HS 139)


Changing Faces is the leading UK charity that supports and represents people who have disfigurements to the face, hand or body from any cause. A 'disfigurement' is the generic term for the aesthetic effect or visual impact of a scar, burn, mark, asymmetric or unusually shaped feature or texture of the skin on the face, hands or body. It is estimated that 542,000 (one in 111) people in the UK have a significant disfigurement to the face and approximately 1,345,000 (one in 44) people to their face and body. ‘Significant’ is taken to mean ‘psychologically and socially significant’.

Changing Faces advocates for better access to and better quality of psychosocial and mental health care for people with visible differences as a result of an accident or illness, or from birth. People with disfigurements are significantly more likely than people without disfigurements to develop mental health problems, a problem that is currently not fully reflected in national and local health budgets. In addition, the necessary cross-specialty commissioning requires understanding and awareness of the specific psychosocial needs of people with disfigurements which we know is not always the case. ‘Severe disfigurement’ is included in the Equality Act 2010 and thus comes within the remit of the Equality Duty.

We urge politicians, health professionals, commissioners and policy makers to recognise and address the psychological and social (psychosocial) impact of having a disfiguring condition. It is their responsibility to (re)develop appropriate services to prevent and/or treat psychosocial problems if they occur. Psychosocial services, if provided during physical treatment as part of the care pathway, result in significantly better patient outcomes and patient satisfaction. We strongly support the development and extension of multi-agency working as mental health problems are frequently associated with wider social problems, either as cause or effect. Multi-agency partnerships are therefore vital. We stress the importance of partnerships with the social care sector as well as with the employment and education sectors.


Changing Faces is very concerned with the lack of evidence for the need for reform of the NHS in general and the lack of convincing evidence on whether and how marketisation is going to improve patient care. We think that a strong focus on price is a very risky approach which may jeopardise the potential positive effects of the Bill on patient experience. In addition, we are worried about the combination of cuts and reforms, which we believe needs to be dealt with more transparently.

We welcome the vision of the Bill to strengthen evidence based commissioning and decision making led by clinicians, the strong focus on improving information, and a patient centred approach which is guided by patient experience and health outcomes. As a charity, we are however concerned that GPs need a lot of support in commissioning mental health services; PCTs’ mental health commissioners have developed knowledge and expertise that must be passed on to GPs so there needs to be a clear strategy on how to realise this. Changing Faces welcomes the strategy as set out by the Department of Health but is afraid that lack of emphasis on mental health prevention will negatively affect patients with disfigurements in the transition stage. The GPs we work with report to have limited specialist knowledge on mental health and are concerned that this will negatively affect the care for patients with disfi gurements who have psychosocial needs.

We are very aware that mental health does not currently benefit from the same degree of public consideration as other health issues and we fear that GPs will not be able to prioritise th e commissioning of psychological therapy services, when other services are considered more popular. We think that the Improving Access to Psychological Therapy Services (IAPT) for people with long term conditions may improve access to services for people with disfigurements, however there needs to be an understanding of how a changed appearance can adversely affect normal day to day living , as this can form the basis of people’s psychosocial issues. Our client group currently reports that understanding is poor amongst the majority of health and social care professionals.

For our client group, integrating physical and mental health care is of utmost importance, as many people with visible differences suffer from functional impairments, accompanied by pain, itch and other side effects of treatments and health conditions. We see the Bill as an opportunity to improve the integration of care, which is currently highlighted by the health professionals we frequently work with as a serious weakness in specialties such as Ophthalmology, Dermatology, Oncology and Plastic Surgery services. The majority of the people supported by Changing Faces report that their psychological and social needs are currently not fully met and that health and social care professionals lack understanding of the difficulties of living with a disfigurement . It is for this reason that we think people with disfigurements are at particular risk of losing out as any reform comes with the risk of threatening continuity and quality of services.

There are some good practice examples in cleft lip and palate care where all members of the multi-disciplinary team have a shared responsibility to recognise and respond to psycho-social needs of patients and parents. In burns care, quality standards based on NICE guidance include protocols and guidelines on psychosocial care, acknowledging its crucial importance in ensuring quality of life of patients.

Based on anecdotal and academic evidence from health and social care professionals we advocate for mainstream commissioning of mental health services and reduce the number of cases referred to the independent board. We are concerned about the potential lack of transparency of the Commissioning Board and consortia’s decision making and believe that meetings need to be open to the public and patients need to be involved in decision making at all levels (personal, operational and strategic). From consultation with health professionals, we understand that there is a strong likelihood that access to services will vary depending on where people live; a lack of consistency of care that Changing Faces is alarmed about.

We urge the Public Bill Committee to consider our evidence and concerns and create a Bill that supports the reduction of the health inequalities of over one million people with disfigurements in the UK. A reduction of the incidence of mental health issues in this population will contribute to improved social participation and cost savings in all other area’s of life.

March 2011