Health and Social Care Bill

Memorandum submitted by the British Heart Foundation (HS 23)

The British Heart Foundation (BHF) welcomes the Government’s intention to create an NHS which focuses on improving health outcomes and tackling health inequalities and that is responsive to patients’ needs and wishes. We also support the emphasis on public health and the allocation of a ring-fenced budget.

However, the Government must ensure that the significant changes to the NHS being considered by Parliament do not impede the delivery of high quality care for patients. We also believe that there are several areas where the Bill needs to be amended to ensure that patients are truly at the heart of the NHS. For more detail on this, please see the submission we have jointly made with seven other national health charities [1] .

This briefing summarises the BHF’s overall messages around the proposals for NHS reform. Some of these messages do not relate to specific provisions in the Bill, but instead identify key issues and risks that must be considered as the proposals and legislation are developed.

Key messages from the BHF

1. The significant changes to the NHS must not impede the delivery of high quality evidence-based care

· In developing and implementing the ambitious plans for the NHS, the Government’s primary priority must be the provision of high quality care, in accordance with national guidelines.

· In December 2010, a national audit of heart failure [2] showed that guidelines on the treatment of heart failure patients were not being followed and that patients were dying needlessly because of lack of access to specialist care.

· Systems must be in place, including through commissioning and national regulation, to ensure that all heart patients have access to high-quality, specialist cardiac care.

2. Ensuring a strong patient voice and effective scrutiny

· The NHS Commissioning Board and GP consortia must be required to involve and genuinely engage with patients and carers in commissioning decision-making. This should be reflected in the publicly available annual reports of the Commissioning Board, and in consortia commissioning plans and the assessment of consortia performance.

· Local HealthWatch should build on the work of LINks, should work closely with local services and clinical networks, and must have sufficient authority, independence, and resources to carry out their functions. Local HealthWatch should have a key role in contributing to Joint Strategic Needs Assessment, commissioning plans, and local scrutiny processes.

· Advocacy work by local HealthWatch must not detract from patient and public involvement in shaping services.

· The scrutiny function in local authorities must be led by independent elected representatives.

3. Supporting patient choice

· Genuine patient choice is dependent on access to accurate, understandable and meaningful information at a time and place that suits patients, as well as patients having the confidence, skills and personalised support to make choices. Some vulnerable groups and some people from black and minority ethnic groups will need particular support in being empowered to make and communicate choices.

· Voluntary sector organisations like the BHF, and specialist health professionals, including BHF cardiac nurses, will provide valuable support to patients in exercising choice and control.

· Some people may prefer to trust in healthcare professionals to make decisions on their behalf - these preferences must be fully respected.

· Some people will find it difficult to act on choices or may have a more limited range of options available due to lower incomes, lack of personal transport, or limited mobility. All patients must receive high-quality evidence-based care, where ever they go for treatment.

· Shifts in demand must not destabilise essential local services or result in popular services becoming overburdened.

4. The new freedoms for providers must not impede the delivery of comprehensive and integrated care

· Providers’ increased autonomy and accountability for planning and developing their own workforce must not impede national workforce planning or access to consistently high quality and comprehensive training and development.

· Providers must not be deterred from delivering specialised services for small and dispersed patient groups or from taking on complex cases that may be more costly.

· Increased competition between providers must not impede networking and integrated care - cardiac and stroke networks and coordinator roles like BHF specialist cardiac nurses are key to promoting integrated, innovative, and cost effective care, and their vital work must continue and develop.

5. Directors of Public Health with independence, authority and resources

· We strongly welcome the focus on public health and the development of a Public Health Service with a ring-fenced budget.

· Directors of Public Health must have the independence, authority and resources to advise on policy areas that have a bearing on physical activity, healthy eating, and all aspects of population health and health inequalities.

· We welcome the commitment to empowering local communities, but state regulation is required to create environments that enable people to exercise genuine freedom and to make choices that protect their health. National oversight and monitoring will also be essential.

6. Partnership working with the voluntary sector

· Charities like the BHF should be involved in commissioning decision-making so we can share experience of integrated care and commissioning and of innovative service models.

· Charities can also share intelligence on patients’ needs and experiences, and facilitate discussions with the patients, carers, and health professionals with whom we already engage.

7. Multi-disciplinary commissioning

· Specialist healthcare professionals, including BHF specialist cardiac nurses, are well-placed to advise on optimal patient pathways and the commissioning of high-quality, patient-centred, and cost-effective care.

· To improve the quality and continuity of care and promote integration, the NHS Commissioning Board and GP consortia must involve health and social care expert professionals in commissioning decision-making.

8. Promoting clinical research

· Research must be regarded as a priority by commissioners and providers, and given appropriate status in the new market-orientated system; the tariff system, the NHS Outcomes Framework, and the quality regulation by the Care Quality Commission should provide strong incentives for conducting research. The Bill should ensure a duty to promote research.

· As the principal budget-holders and commissioners, GPs will need considerable support to recognise the importance of commissioning research activity and to ensure patients are aware of clinical trials and similar opportunities.

· We welcome the commitment to make available for research aggregate datasets from data held securely in people’s records - we look forward to further information about the research data service that is to be developed.

9. Data collection to promote continuous improvement

· While we welcome the shift from targets to health outcomes, process measurement must continue where clinically relevant - continuous improvement is dependent on the collection of data not only on the overall outcomes of the NHS and Public Health Service, but also on the effectiveness of individual interventions that lead to these outcomes.

· The Government should ensure that support is made available so the valuable work of national, independent, clinically-led audits can continue.

February 2011

[1] Alzheimer’s Society, Asthma UK, Breakthrough Breast Cancer, Diabetes UK, National Voices, Rethink, and the Stroke Association

[2] The Information Centre for Health and Social Care (2010). National Heart Failure Audit 2010. Leeds: The Information Centre for Health and Social Care