Health & Social Care Bill 2011
A Briefing for Action for Advocacy members
In December 2010 we issued a briefing on the Government paper, Liberating the NHS:
Legislative framework and next steps which set out Health Service reforms originally
announced in the consultation paper Equity and excellence: Liberating the NHS (July 2010).
Action for Advocacy responded to the consultation.
This briefing is about the Health & Social Care Bill, (‘the Bill’) published in January 2011. As
the Bill paves the way for reforms set out in the earlier papers, our briefing is essentially an
update of the one issued in December.
Have your say
The Bill has passed its second reading and is now being scrutinised by a Public Bill
Committee. This Committee has called for evidence from anyone with an interest in health
and social care and the provisions of the Bill. It will stop taking evidence at the end of March
2011. You should submit comments as soon as possible. Click this text for more information
on this call for evidence and how to submit it.
A4A would like to submit evidence from advocacy schemes about how the reforms will
impact on advocacy services and users. We would welcome your views, comments and case
studies. Contact Phil Jew: phil@a4a.uk.net / 020 7921 4395 and or take our straw poll –
click this text to take the straw poll: Will putting GPs in control of commissioning put
individuals at the heart of decisions about their healthcare?
A4A’s former chair Jonathan Senker has already aired his views in a Guardian article: click
this text to read the article.
The Bill
The Bill proposes to:
Give new GP consortia across England the task of commissioning the healthcare with an
£80bn budget
Make the NHS more accountable to patients and the public by establishing
HealthWatch, a new independent body that can look into complaints and scrutinise the
performance of local health providers. It will involve the transformation of Local
Involvement Networks (LINks) into local HW bodies. These will be funded by local
authorities with enhanced funding available. They will be supported by HW England
(itself part of the Care Quality Commission). HealthWatch will be established by April
2012. Local HW will be able to escalate issues and complaints to HW England.
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Compel all hospitals in England to become foundation trust hospitals – which makes
them semi-independent and able to earn more money from private patients. About half
are foundation trusts.
Establishing a new body, called Public Health England, aiming to improve public health
and reduce health inequalities between the richest and poorest
Cut NHS bureaucracy by abolishing the 151 primary care trusts (PCTs) and 10 strategic
health authorities by 2013, cutting management costs by 45% and reducing the number
of quangos.
Key issues for Advocates
GP commissioning consortia will be in place by April 2012 and have statutory responsibility
for commissioning health services from 2013. This change has caused the most controversy.
Apart from general concerns about how this might lead to a postcode lottery, there are real
concerns about whether GPs have sufficient knowledge of specialist needs and services – for
instance around mental health and learning disabilities. A Rethink survey found that 31 per
cent did not feel equipped to commission mental health services. Over half said they found
people with severe mental illness hardest to engage with. A group of mental health
organisations including MIND and Rethink have issued a briefing on the Bill and called for a
duty on GP consortia to undertake a full needs assessment with local authority partners.
Click this text to read the briefing.
HealthWatch (HW): Local HW will have a role in NHS complaints advocacy but will not
necessarily provide it. The Government has listened to opposition to proposals that local
HW should be the provider of advocacy services. Local authorities may therefore
commission local HW or another organisation to deliver complaints advocacy. They will be
given funding to procure advocacy, advice and information services but the amount will not
be prescribed. The change from the Independent Complaints Advocacy Service (ICAS)
arrangements to local authority commissioned services will take place in 2013. Current ICAS
contracts are likely to be extended for a further year.
Local HW will have a role in ensuring all views and particularly those of socially marginalised
and vulnerable people are heard in NHS commissioning processes. It is therefore important
that Advocates exert some influence on local HW, bringing their unique insight into
experiences of health care.
Responsibility for commissioning Independent Mental Health Advocacy will pass, as
expected, from Primary Care Trusts to local authorities from 2012. This will be separate
from the NHS complaints advocacy services that local authorities will commission. The role
of supervisory body regarding hospitals under the Mental Capacity Act Deprivation of
Liberty Safeguards (DOLS) will also pass from PCTs to Local authorities.
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The Department of Health will publish a transition plan for local authority commissioning
of advocacy in 2011.
Personal Health Budgets will be piloted. An evaluation will report in October 2012. The Bill
includes the power to extend direct payments for health care nationally if the pilot is
successful and Parliament approves. Click this text for more information.
Patients will be given control over their health records to enable them to be more involved
in decisions about their treatment or care.
The new NHS outcomes framework includes several ‘domains’ including:
Ensuring people have a positive experience of care and treatment and
Caring for people in a safe environment and protecting them from avoidable harm
The outcome framework will underpin commissioning by GP consortia and will be translated
into a commissioning outcomes framework and form part of commissioning guidance.
Advocates have a key role to play in achieving such outcomes. We will need to influence
development of the framework and guidance by the NHS Commissioning Board.
The Bill place a duty to secure continuous quality improvement on GP consortia. This
relates to the effectiveness, safety and broader experience of treatment and care. Again,
advocates can make a big contribution to continuous improvement.
Contact at Action for Advocacy:
Phil Jew
Head of Policy
phil@a4a.uk.net
020 7921 4395
February 2011
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