Health and Social Care Bill

My Lords, I shall speak to three amendments in this group. The purpose of Amendment 203B is to ensure that any healthcare provider to which a commissioning group gives a contract allows its clinicians enough time to work for the benefit of the NHS and its patients. The work to improve patient care does not just take place in a clinician’s own place of work. A great deal of background planning and preparation must be done in order for patients to see improvements in their care. Developments in service improvement, clinical standards, research, education and training only happen because clinicians and others are able to contribute their time and expertise to work outside their own organisations for the benefit of the wider NHS. There is always an understandable pressure to make service delivery the priority, but clinicians are increasingly finding it difficult to find the time from their employers to participate in activity outside their own organisation. This includes work such as developing clinical guidelines, setting standards, ensuring research ethics, developing and providing educational curricula and assessments, and providing expert clinical advice for a range of regional or national bodies, including the Department of Health itself. Most national bodies now report that they find it increasingly hard to secure clinician input to their work. Given the importance of their contribution, I do not think it unreasonable to ask all healthcare providers, including private providers who have won contracts with commissioning groups, to allow their clinicians reasonable time to help the NHS and its patients in this way. The active engagement and leadership of clinicians underpins the Government’s reforms. New structures, such as clinical senates and clinical commissioning groups, require the active involvement of clinicians, but this will not happen unless clinicians are supported and given the time to participate in this work for the benefit of the wider NHS. This is work to improve patient care, and patient care will suffer if it cannot be provided. The Academy of Medical Royal Colleges, of which I am a past member, would like to see the Bill contain a duty on employers to facilitate staff involvement in defined work on behalf of the wider NHS outside their own organisations. I will now speak to Amendments 210 and 217. The purpose of Amendment 210 is to place on the NHS Commissioning Board a specific duty to issue guidance on the production of joint strategic needs assessments. Should that amendment be accepted, Amendment 217 places upon clinical commissioning groups a specific duty to demonstrate ways in which they have taken into account such guidance on production of JSNAs when presenting their commissioning plans. The Bill in its current form places a duty on the NHS Commissioning Board to publish guidance for commissioning consortia on the discharge of their commissioning functions. This is inadequate since it does not place upon the board a specific duty to produce guidance on the production of JSNAs. The transfer of commissioning from PCTs to clinical commissioning groups is arguably the most fundamental change in the Bill. Commissioning carried out by clinical commissioning groups must accurately identify and meet the needs of patients with mental illness and their carers. It is vital that the JSNAs that inform their commissioning decisions are of a high quality and capture as well as practically possible the prevalence of mental health problems within populations and the needs of people with mental health problems within those populations. JSNAs are currently carried out by local authorities. Many local authorities acknowledge a lack of data available to them regarding the prevalence of mental health problems and learning disability in the populations they serve. For example, in 2008 the Cambridgeshire Joint Strategic Needs Assessment for mental health reported: "““There is a lack of good-quality local data on mental health prevalence and national data is used to calculate the estimated prevalence of mental ill health in the local population using the population statistics””." Or take Barking in Dagenham in 2010-11: "““The next JSNA needs to explore more specific data and actions for people with learning disabilities and people with autism. A recent self-assessment carried out by the trust highlighted this as a major gap””." Or take Southwark: "““There are limited data available about the prevalence of mental illness and the demographic profile of sufferers in Southwark””." Often, particularly in relation to moderate mental illness, there are little—if any—locally collected data, and estimates have to be used. In Part 5, the Bill outlines the framework for joint strategic needs assessments and sets out a joint responsibility between local authorities and clinical commissioning groups. Commissioning plans are formulated on the basis of joint strategic needs assessments, and if we look at the organisations that will be involved with drawing up the commissioning plans, the problems are clear. Many local authorities acknowledge their difficulties with obtaining adequate and robust prevalence data on mental health issues and learning disability, while clinical commissioning groups will lack any experience of carrying out this kind of audit. As a result, patients with mental health problems and their carers may have little confidence that the commissioning plans produced with local authorities, under the Bill’s provision as it currently stands, will reflect the true prevalence of mental health problems and learning disability in the population of which they form part. There is some existing guidance on the construction of joint strategic needs assessments, produced in 2009 by the National Mental Health Development Unit. It said that, "““population level mental health needs assessment has not yet featured prominently in the joint strategic needs assessment process””." The toolkit was designed to, "““allow a wider range of local partners to become more aware of how mental health needs and issues””," should be addressed. It went on to say that it would hope to, "““facilitate more joint working at a local level to deliver better outcomes for the population””." However, this organisation no longer exists and I do not think the Department of Health currently has any such guidance. It is dangerous to expect that clinical commissioning groups, which have no prior expertise in this area, will, in undertaking joint strategic needs assessments, stop the problems which local authorities have already encountered. Amendment 210 would ensure that the NHS Commissioning Board is required to produce annually revised, up-to-date guidance for clinical commissioning groups, including examples of good practice on how to conduct a JSNA so that it best captures the current and future needs of their entire population. Amendment 217 would ensure that clinical commissioning groups are required to demonstrate that they had taken this guidance into account when conducting their joint strategic needs assessments.