Health and Social Care Bill

Memorandum submitted by the National Federation of Occupational Pensioners (HS 46)

National Federation of Occupational Pensions

1 The National Federation of Occupational Pensioners (N.F.O.P) is the oldest and largest occupational pensioners’ organisation in the UK, with 90,000 members nationwide organised into 185 branches.

Summary

2.1 We welcome the Bill’s aim of increasing patient choice and empowerment, and we support any moves to allow older people to feel that services are more responsive to their – often complex - needs.

2.2 However our members are concerned about the impact the Bill will have on the quality of services they receive through the NHS. Many pensioners are not able to take advantage of the promise of greater choice as many are not able to make use of the internet to research providers, treatment or drugs. They will continue to rely on their GP or other health practitioner to guide them – and will want to be entirely confident that the advice they receive is not based upon a potential conflict of interest or motivated by budgetary considerations.

2.3 The Bill contains provisions to give GP commissioning consortia control over a vast proportion of the NHS budget, amounting to around £80bn. Given that consortia will be responsible for such a large amount of public money, it is surprising that the Bill does not contain more detail on how consortia will be held to account. We believe that better mechanisms should be put in place to help local communities and patients oversee and play a role in the commissioning decisions made by consortia.

2.4 The Bill will give Monitor a new role as both an economic regulator and promoter of competition. We believe that this dual role may be damaging to the provision of high quality health services. As the sole organisation representing Royal Mail pensioners, N.F.O.P is in a unique position to advise upon the lessons that can be learnt from the actions of Postcomm in regulating postal services.

2.5 Whilst welcoming some of the broader sentiments behind the reforms in the Bill, we firmly believe that more thought, care, and consultation must go on before these irrevocable and expensive changes to the NHS are made.

GP consortia and local accountability

3.1 Many older people have a good relationship with their GP, and may welcome a greater role for their trusted local doctor in the commissioning process. But Clauses 21 and 22, which lay out the role and structure of the new commissioning consortia are very light on detail, including how big the consortia will be, who will be involved in them, and how patients and local people can be involved in decision making. This lack of detail in the Bill creates uncertainty for older people concerned about how the reforms will affect the care they receive.

3.2 We believe that further detail is needed on how commissioning consortia will be held to account. For example, there should be more prescriptive detail in the Bill to ensure that the needs of distinct groups within local communities, such as older people, young people or ethnic minorities, are properly taken into account in the decisions taken by commissioning consortia. Clause 22 states that consortia must "have regard to the need" to "promote the involvement of patients and their carers in decisions about the provision of health services to them". We feel that this requirement does not go far enough. There should be an explicit requirement in the Bill for the proper representation of patients in the GP consortia management bodies.

3.3 The Bill will require local authorities to establish a Health and Wellbeing Board which has as its main duty to prepare with the commissioning consortia a joint statement of strategic needs and a health and wellbeing strategy, to which the commissioning consortia must have regard (Clauses 176 to 178). However we foresee three problems with this approach:

1) Only one councillor is required to sit on the Board, raising the question of whether this provides sufficient accountability;

2) With local authority budget reductions, the Health and Wellbeing Board may not have the resources to hold consortia to account;

3) The duty on the consortia to have regard to the needs assessment and strategy is too weak. The wording in the Bill, "must take account of", could be strengthened.

3.4 Furthermore, we are very concerned the reforms may result in greater inequalities in healthcare provision and an increased "postcode lottery". Whilst we recognise that local discretion can be an important part of meeting the needs of local people, we fear that older people will be more likely to suffer from inequalities as they may be reluctant, or unable, to change their GP even if the service they receive is of a lower standard. We would welcome a clear statement of intent from the Government on this important issue.

Monitor and competition

4.1 The Bill will see a big increase in competition at all levels of the NHS. Chapter 4 of the Bill outlines the role that competition will play in the new NHS, with the economic regulator Monitor having its first duty as ‘promoting competition’. We have concerns that if Monitor follows the same route as Postcomm in the postal services sector then promotion of competition will lead to severe damage being done to the NHS in the same way that Postcomm has damaged Royal Mail.

4.2 While there has already been some private involvement in certain specialist services, the move towards greater competition will transform the way that health services are delivered. With private companies able to ‘cherry pick’ services they provide, it is likely they will focus on straightforward procedures with a high success rate leaving NHS providers with more complex or challenging cases, which are less profitable.

4.3 There are obvious parallels here with the postal services sector, where the state provider has an obligation to deliver those services which are not profitable enough to tempt private sector involvement. If the NHS loses its most profitable services to more competitive providers, whilst obliged to retain the least profitable, there is a real fear that cash-strapped NHS services will be less able to provide the high quality treatment for complex and longer term conditions upon which older people rely.                       

February 2011