Health and Social Care Bill

Memorandum submitted by the Royal College of Speech and Language Therapists (HS 65)

 

1. About the RCSLT

1.1. The Royal College of Speech and Language Therapists (RCSLT) is the professional body for speech and language therapists, students and support workers working in the UK. The RCSLT has almost 15,000 members, including nearly 95% of the speech and language therapists working in the UK.

1.2. Speech and language therapists are allied health professionals (AHPs) who work within multidisciplinary teams alongside other clinicians and allied health professionals.

1.3. There are just over 100,000 doctors and just under 100,000 allied health professionals. AHPs work autonomously with patents, they are not support staff. Their involvement and input is crucial to all commissioning decisions.

1.4. The RCSLT seeks urgent reassurance regarding the provision of speech and language therapy services in the new commissioning and public health arrangements.

2. Summary of evidence

2.1. Successful commissioning will depend on the involvement of all healthcare professionals. Allied health professionals must be represented in all key decision making structures at national, regional and local levels.

2.2. The RCSLT believes that allied health professionals must be represented on:

o National Health Service Commissioning Board

o Commissioning consortia

o Health and Wellbeing Boards

2.3. Allied health professionals should be named as a partner to developing the joint strategic needs assessment and the health and wellbeing strategy.

3. National Health Service Commissioning Board

Membership

3.1. Successful commissioning will depend on the involvement of healthcare professionals. Allied health professionals must be represented in all key decision making structures at national, regional and local levels. The knowledge and expertise of allied health professionals will be crucial to the decisions of the NHS Commissioning Board.

3.2. The NHS Commissioning Board will be a strategic body and should consist of the appropriate clinicians.

3.3. AHPs are already represented at a strategic level across Northern Ireland and Scotland. In Northern Ireland the commissioning structure for health and social care services includes AHPs. The Health and Social Care Board operates through five commissioning groups and each has representation from allied health professionals. In Scotland community health partnerships and community health and care partnerships include representation from allied health professionals at Board level. The RCSLT fully endorses the representation of allied health professionals at a strategic level and recommends that this is adopted into the English health and social care system without delay.

3.4. Schedule 1 lists the proposed membership of the NHS Board which fails to include representation of allied health professions. We recommend that to the list of membership as specified on page 221 Schedule 1 line 17 an allied health professional is added.

3.5. It is essential that the NHS Commissioning Board obtain clinical advice and expertise from allied health professionals in order to effectively discharge their functions. We recommend that on page 221 Schedule 1 after line 24 add (4) the NHS commissioning board must obtain appropriate clinical advice and expertise from allied health professionals in order to effectively discharge their functions.

Patient involvement

3.6. If a child, young person or adult has speech, language and communication needs they will require additional support to exercise their choice. It should also be recognised that people with communication needs, with the right support, are perfectly capable of exercising choice and making decisions.   Appropriate support will be critical to ensure people with communication needs have access to the information they need to make informed choices regarding their future care.

3.7. The NHS Commissioning Board will be responsible for securing the involvement of patients to enable them to make choices about the provision of health services. It is essential that patients with speech, language and communication needs are supported to be able to make choices. Appropriate support from speech and language therapists will ensure equitable representation across all care groups, universal and specialist services. On page 18 clause 13L (2) after line 33 add (d) by supporting those with speech, language and communication needs.

4. Commissioning consortia

4.1. The RCSLT is concerned that the variability in the structure of commissioning consortia may lead to health inequalities in decisions made and services offered due to the variation in clinical input. GP consortia must include input from a range of health and social care professionals including allied health professionals. Allied health professionals are best placed to understand their patients’ needs and shape services to meet those needs. They work across health, education, social care with adults and children and in acute and primary care hence represent a wide proportion of patients.

4.2. The RCSLT seeks assurances that any changes to the structure of commissioning honour the Secretary of State’s assertion in Parliament that a range of health professionals, including AHPs will be involved in planning and decision making [1] . We would welcome reassurances that GP consortia would be under a duty to work with a range of health professionals and the mechanisms to ensure that this happens locally. The government should set out clear expectations that all commissioning consortia should be under a duty to work with allied health professionals.

Duty as to reducing inequalities and promoting patient involvement

4.3. Commissioning consortia will be required to reduce inequalities and promote patient involvement. In the exercise of this function, commissioning consortia must consider the speech, language and communication needs of patients when involving patients to enable them to make choices about the provision of health services. On page 30 after 14N (1) line 29 add (e) by supporting those with speech language and communication needs or communication disability.

Duty to obtain appropriate advice

4.4. The duty on commissioning consortia to obtain appropriate advice on page 30 clause 14O needs to be strengthened in order to embed this approach into the system. The definition of physical and mental health is too narrow and should make provision for those who have communication impairment either accompanying or separate to a physical or mental impairment. Commissioning consortia should be under a duty to work with health professionals and seek their expert advice. On page 30 remove lines 33 to 36 and replace it with "Each commissioning consortium must make arrangements with a view to securing that it obtains advice appropriate for enabling it effectively to discharge its functions from persons with professional expertise, including allied health professionals, relating to the physical or mental health or communication ability of individuals.

Reports by commissioning consortia

4.5. On page 34 after 14Z (2) line 44 add the report must also explain how the commissioning consortium has discharged its duty under section 116B of the Local Government and Public Involvement in Health Act 2007.

4.6. Clause 177 of the Health and Social Care Bill on page 150 (section 116B) would amend section 116 of the Local Government and Public Involvement in Health Act 2007 setting out the duty of a consortium to have regard to the most recent joint strategic needs assessments and joint health and wellbeing strategy. This amendment aims to ensure that commissioning consortia must report on how it has exercised that duty. This ensures that all the strategies are joined up in exercise and functioning.

5. Joint strategic needs assessment

5.1. On page 149 clause 176 local authorities have to work with commissioning consortia within their boundaries to prepare a joint strategic needs assessment to identify the current and future health and wellbeing needs of the local population. Failure to accurately capture the needs of the local population will result in a substandard assessment and in turn will have a detrimental affect upon the consequential health and wellbeing strategy.

5.2. Experience suggests that joint strategic needs assessments are haphazard in operation. We would like to know what incentives or mechanism will be introduced to ensure that commissioning consortia will be required to follow the joint strategic needs assessment and be held accountable.

5.3. On page 149 clause 176 allied health professionals should be named as a key partner to developing the joint strategic needs assessment. As it stands, the legislation does little to encourage local authorities or a partner commissioning consortia to consult with appropriate persons. Given the importance of ensuring integrated working, particularly with regard to services for children or vulnerable adults, there should be a duty to consult with appropriate health professionals, including allied health professionals who may work across sectors such as education and justice and have expertise with regard to children and vulnerable adults.

5.4. On page 149 change clause 176 (6) remove lines 24 to 26 and replace with "(8A) In preparing an assessment under this section, the responsible local authority or a partner commissioning consortium must consult persons with experience of delivering relevant services, giving particular regard to health professionals, including allied health professionals, working with:

a) children; and

b) vulnerable adults"

6. Joint health and wellbeing strategies

6.1. Page 149 clause 177 imposes a duty on local authorities and commissioning consortia to produce a joint health and well-being strategy to address and meet the needs identified in the joint strategic needs assessment and to have regard to it when carrying out their commissioning functions. Joint health and wellbeing strategies will provide the overarching framework for NHS, social care and public health commissioning plans.

6.2. In clause 177, after section 116A(2) of the Local Government and Public Involvement in Health Act 2007 line 10 insert local authorities and partner commissioning consortia should work with local allied health professionals.

6.3. The Health and Social Care Bill presents an opportunity to correct the historic fragmentation of commissioning of speech and language therapy, in order to safeguard services for children and vulnerable adults. This is especially pertinent to services such as speech and language therapy, which often use pooled budgets as set out in section 75 of the National Health Service Act 2006.

6.4. Given the lack of a robust, established commissioning framework for speech and language therapy services (in the same way as for example, cancer or cardiac networks), transformation could further destabilise the fragile arrangements that persist in some areas. Services are currently delivered through a set of commissioning and funding arrangements particular to each locality (often isolated or led by one agency) and lack integration into mainstream service provision. The majority of speech and language therapists are commissioned by the NHS and local authorities, whilst others are funded independently by schools, early years centres, further education institutions and prison services.

6.5. In clause 177, after 116A(3) of the Local Government and Public Involvement in Health Act 2007 remove lines 11 to 15 and replace with (3) to "in preparing a strategy under this section, the responsible local authority and each of its partner commissioning consortia must, in particular, consider the extent to which the needs could be met more effectively by the making of arrangements under section 75 of the National Health Service Act 2006 (rather than in any other way), with particular regard to services for:

a) Children; and

b) Vulnerable adults"

7. Establishment of Health and Wellbeing Boards

7.1. The RCSLT hopes that the Health and Wellbeing Boards (Clause 178) will encourage local authorities to take a strategic approach and promote integration across health, social care , children’s services and education including safeguarding for vulnerable children and adults .

7.2. Health and Wellbeing Boards remit will encourage integrated working across health and social care which we wish to be explicitly extended to cover children’s services and education.

7.3. Whilst Boards will have a duty to promote health and social care integration there is no equivalent duty on GP consortia. This failure will jeopardise local relationships and an equal requirement should be placed on the consortia to promote health and social care integration.

Membership

7.4. We do not believe that health and well-being boards will automatically strengthen local democratic legitimacy. While this will depend in part on local relationships and approach, it is important that the right structure is created for the board to operate optimally in the local environment.

7.5. The listed membership of the Health and Wellbeing Boards in clause 178)2 is too limited and fails to consider frontline health professionals and allied health professionals. To be effective health and well being boards need to have an inclusive picture of local health need, this requires the involvement of local professionals with knowledge and understanding of the needs of the community where the board operates.

7.6. It is essential that allied health professionals are represented on Health and Wellbeing Boards. Health and Wellbeing Boards should be required to work with allied health professionals who can bring their expertise and knowledge across a range of pathways and settings spanning social care, public health, health and children’s services. On page 151 clause 178(2) after line 18 add (h) allied health professionals.

Functions

7.7. Page 153 clause 180(3) alone is insufficient to ensure local authorities are accountable to their respective Health and Wellbeing Boards. On page 153 clause 180 remove lines 14 to 16 and replace with (3) a Health and Wellbeing Board must give the local authority that established it its opinion on whether the authority is discharging its duty under section 116B of the 2007 Act. This opinion must be made public. As with the amendment to Clause 22, above, this amendment would ensure that local authorities are required to report on how they have had regard to the most recent joint strategic needs assessments and joint health and wellbeing strategy.

7.8. On page 153 after clause 180(2) line 13 add (3) A local authority must report annually to the health and wellbeing board and NHS commissioning board on discharging its duty under section 116B of the 2007 Act, and this report should be made public.

February 2011


[1] Reference: