On Wednesday, I had the opportunity to briefly speak during the Second Reading debate for the Health and Care Bill currently making its way through Parliament.
I welcome the Bill and its aims and objectives to provide the best possible health and care to everyone in this country. However, to achieve that, the legislation needs to be changed and, in places strengthened. It must make explicit provisions for mental health, not just physical health. It must also include provisions for children’s social care, not just adult social care, and provide for the commissioning of not just medical services (doctors, nurses, infrastructure and hospitals) but medicines and devices, which we know have been crucial in the fight against Covid. Commissioning is the mechanism by which the NHS purchases the services and products we all benefit from.
How are we going to do that? First, we need to include “parity of esteem clauses”, one for mental health and one for social care. That is to say, clauses that make it very clear that we value equally how we provide care for mental health problems and how we provide care for physical health problems, will fund them accordingly and will measure how successful we are at improving health outcomes for both. Currently there is no such promise enshrined in law. Likewise, we need to commit in legislation to the fact we value both health and social care equally and will do what it takes to ensure the quality and quantity of social care provision is as good as it is for health care.
We also need a proper workforce plan, which must cover not just health but social care. Currently the bill only refers to a workforce plan for health. If we want to deliver a workforce which is truly integrated across health and care we need to look at common training objectives, career paths and training programmes. When training as a nurse for example we need to train individuals to work across both systems and to have work experience in both before they qualify. This must also lead to fair pay across the two sectors, which is certainly not true now. And we need to look at developing new careers and roles and build in flexibility to the curriculum so at a time of crisis more people have more of the general and acute care skills needed, so they can be redeployed.
Currently, which treatments and medicines patients receive is a postcode lottery. The legislation on medicines and devices last year only covered the licensing of medicines and devices, the system that ensures their safety and efficacy. It did not address how, once licensed, patients get access to them. This is a decision by those that buy drugs within the NHS. Patient choice depends on those buying decisions. The new Integrated Care Boards (ICS) in each area will make that decision. Then each hospital will have its own subset of those drugs authorised by the ICS. If the drug you need isn’t on those lists you won’t get it without paying – and what you pay will be different depending on where you live. This is a particularly big problem for those with rare conditions. This has to change to make patient choice meaningful.
Within the bill, there is provision quite sensibly to enable better sharing of data across but only within the NHS. Right now it can be difficult to bring together all a patients notes across primary and secondary care. But that while a brilliant ambition is not enough. There is a huge amount of clinical data generated about how patients react to new drugs in clinical trials. That information could be life-saving but it is outside the NHS. This needs revisiting.
Much to do – this will be a bill debated for some time!
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