Health and Social Care Bill

Memorandum submitted by the Royal College of Paediatrics and Child Health (HSR 21)

1. The Royal College of Paediatrics and Child Health (RCPCH) is a charity established by Royal Charter in 1996, with over 12,000 members in the UK and overseas. We are responsible for the training and examination of paediatricians in the UK. The RCPCH is integral to leading the way in child health and the pre-eminent body setting standards for UK paediatrics.

2. The Royal College of Paediatrics and Child Health (RCPCH) is pleased to have the opportunity to comment on clauses of the Health and Social Care Bill that have been recommitted for examination by the Public Bill Committee. We have paid particular attention to clauses of the Bill that we feel may have particular implications for children’s health.

3. Arrangements for provision of health services (Clauses 9-11)

3.1. RCPCH agree with the proposed amendment to Clause 9 which extends the responsibility for each clinical commissioning group (CCG) to commission services for "every person present in its area". This will ensure that CCGs serve their entire populations, and not just patients that are registered with primary care. CCG must takes particular care to serve the needs of the 22% of their population that will is under 18, and in particular those that are most vulnerable and hard to reach by primary care, such as travellers, asylum seekers or those in the youth justice system.

4. NHS Commissioning Board (Clause 19)

4.1. We support the establishment of clinical senates to advise clinical commissioning groups and the NHS Commissioning Board. As the NHS Future Forum suggests, the establishment of a clinical senate centred around the needs of children and young people will be an essential element of this framework. The placement of these senates within the NHS Commissioning Board, and with an advisory role with respect to clinical commissioning consortia is an important step in assuring that the complex needs of children are not overlooked.

4.2. We support the amendments to the Bill suggested that embed the involvement of patients more firmly in the work of the NHS Commissioning Board. We would like to draw particular attention to the need to engage children and young people’s views of provision of care, a previous blindspot identified by the Future Forum:

4.2.1. "We heard particular anxiety about involvement of children by the NHS or rather its absence, which respondents thought contributed to poorer outcomes for children (in some childhood cancers for example) than in other comparable countries and the high rates of inappropriate admissions to hospital." (Patient Involvement and Public Accountability: A report from the NHS Future Forum, p15)

4.3. The RCPCH has particular expertise in participation with this particular group as set out in our recent publication Not just a phase and would hope to be involved in development of this programme

4.4. The involvement of secondary care clinicians on clinical commissioning groups is also an important step to ensuring joined-up commissioning and that the pathways are appropriate for those with complex needs, such as disabled children with multiple conditions. However, we share concerns voiced by other commentators that the recruitment of a nurse or secondary clinician to consortia with no ‘conflict of interest’ may be problematic in practice. Clinicians would be appointed as professionals on the panel and a more realistic approach could be for any potential conflict of interest to be openly stated and worked around as happens in other institutions, for example non–executive directors.

5. Abolition of SHAs and PCTs (Clauses 28-29)

5.1. As the Future Forum report suggests, transition arrangements to deal with the loss of deanery functions from Strategic Health Authorities (SHAs) need to be put in place as soon as possible. While the DH response to the Future Forum report offers assurances that arrangements will be put in place, we seek clarity at the soonest opportunity as to what these will entail to mitigate any destabilisation of the system and impact on trainee morale and aspiration.

5.2. Similarly, the relaxation of the timetable is welcome, but again, commissioning arrangements need to be robust to ensure that in areas where clinical commissioning consortia are not fully developed by April 2013 services remain integrated.

6. General duties of Monitor and choice and competition (Clause 56)

6.1. We support the adjusted role of Monitor, and support choice and competition where they drive better care for patients. However, we retain concerns that these principles may not be appropriate for many children’s services, as their complex nature means that integration and cooperation are far more beneficial to smooth and efficient care pathways than choice and competition.

6.2. We particularly welcome the introduction of a clearer duty on Monitor to secure appropriate clinical advice in carrying out its functions.

7. Public involvement (Clauses 178-180)

7.1. As outlined above, we believe the lack of planning for involvement of children and young people in decisions about their health has been a particular weakness of the reforms so far. We require assurances and more importantly frameworks and explicit detail about how their views will be represented on HealthWatch England and local HealthWatch, as well as informing the work of the NHS Commissioning Board and Health and Wellbeing Boards.

8. Joint Strategic Needs Assessments (JSNAs) and Health and Wellbeing Boards (Clauses 189-193)

8.1. We welcome the clarification of the role and responsibilities of the Health and Wellbeing Boards in the government’s response to the NHS Future Forum. However, Health and Wellbeing Boards offer an excellent opportunity to make a real impact on children’s health in local communities, but the Boards duties in this area need to be made more explicit to grasp this. While the membership of the Health and Wellbeing Board is not statutory, we believe the presence of a community paediatrician on the Boards would be vital in ensuring a child-focused public health strategy, in line with the recommendations around early intervention by the Allen and Field reviews. As elsewhere, whilst we welcome the new duty to involve users and the public on boards, we believe greater clarification of these duties with regard to including children and young people is required.

July 2011

Prepared 11th July 2011