Health and Social Care Bill

Memorandum submitted by the Royal College of Surgeons (HS 42)

Introduction

This briefing document follows the evidence that Mr John Black, President, the Royal College of Surgeons’ gave to the Health and Social Care Bill Committee on 10th February. It covers the items of legislation which are relevant to NHS surgical services and patients. It suggests amendments to certain clauses of the Bill to take into account our views and those shared by other Royal Medical Colleges.

National Commissioning Board representation

Given the overarching powers of the NHS Commissioning Board to oversee commissioning in the NHS, the RCS is surprised and concerned that there is no requirement for clinical representation on the Board. In view of the Secretary of State’s repeated reassurances that the NHS will be clinician led, this is a fundamental flaw. Therefore the RCS believes that the involvement of practising clinicians, particularly those in hospital-based care, is necessary and would strengthen the effectiveness of this section of the legislation. We suggest that the following clause is amended to reflect this:

Clause 19; subsection 13G – "Duty to obtain appropriate advice"

The Board must make arrangements with a view to securing that it obtains advice appropriate for enabling it effectively to discharge its functions from [practising clinicians and other appropriate] persons with professional expertise relating to the physical or mental health of individuals.

Furthermore to ensure the duty to take on advice from practising clinicians is upheld through all the activities of the NHS Commissioning Board, the Board should be required to report how this has been achieved through its annual report (clause 19; subsection 13P). We propose that the following clause is amended to reflect this:

Clause 19; subsection 13P – "annual report"

Paragraph2

The annual report must, in particular, contain an assessment of

a) The extent to which it met any objectives or requirements specified in the mandate for that year,

b) The extent to which it gave effect to the proposals for that year in its business plan, and

c) How effectively it discharged its duties under sections 13D and 13L

d) [The extent to which it obtained and used advice from practicing clinicians to effectively fulfil its functions.]

Commissioning of regional services

We remain concerned about the commissioning of regional services, such as trauma, children’s surgery and acute emergency surgical services. We would like to see a defined regional role for the NHS Commissioning Board in order that regional based commissioning is not lost entirely, as it is the appropriate model for many services, with collaboration and coordination across a wide geographical area.

We would suggest the following clause is added to the general duties of the Board, to ensure that consortium work together to commission services that can only be delivered at a regional basis:

14A General duties of Board in relation to commissioning consortia

(8) [The Board must ensure that consortia work together to commission services that can only be delivered at a regional basis, taking advice from practising clinicians]

Consortia seeking clinical advice

Given the responsibilities of commissioning consortia (Clause 14A), we are concerned that there is no mention of engagement between these consortia and their respective local hospital-based clinicians, including surgeons. Specifically there is no mention of a minimum level of engagement, which would act as a key safeguard for the standards of patient care.

Therefore we would suggest the following clause is added to clause 14A:

14A General duties of Board in relation to commissioning consortia

(9) [The Board must ensure that consortium engage with practising clinicians to obtain and use advice when commissioning services for patients]

Competition Requirements

The RCS is concerned by the lack of detail on competition (Clauses 60-62) and the promotion of competition (Clause 63). We believe that a defined standard of treatment and care should drive commissioning and not the lowest price. Without detailed information on how standards of care and outcome requirements are incorporated into the decision-making process for tendering services, the RCS is concerned that standards of patient care may be compromised. We therefore suggest the following amendment to clause 63 to ensure that there is a level playing field:

63 Requirements as to good procurement practice, etc

(1) (d) ensure that all providers have a duty to provide training and education, participate in audit, research and the measurement of outcomes and have the capacity to deal with all aspects of care of the patient, both elective and emergency.

February 2011