Thank you for writing to me regarding the Health and Care Bill, currently making its way through Parliament. I welcome the Bill, and I particularly welcome its aims and objectives to provide the best possible health and care to everyone in this country. However, to achieve that, things must change in the legislation. It must have 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 with COVID.
On this basis, I have tabled a number of amendments to the Bill, in areas that I believe need strengthening. I will be speaking on these in the Chamber both later today and tomorrow.
Research + Innovation
Research is critical to the continued treatment of medical conditions in the UK, with our world-leading life sciences sector playing a critical role. However, the system is currently fragmented, and researchers struggle to access patients for use in clinical trials. This means that joined up research to address national health challenges/emergencies is difficult. It is also difficult for research to access patient groups across ICS footprints in order to develop rare and ultra-rare treatments.
To address these gaps;
- Each Integrated Care Board (the new CCGs) should be required to put in place a research strategy to enable them to proactively engage in or support research into local healthcare issues/challenges and to enable participation in national research projects.
- To ensure operational delivery of this strategy, each ICB should be obliged to consider any request for a local or national clinical trial which benefits the local patient community or supports national NIHR research programmes. They should then undertake appropriate patient recruitment and obtain the necessary consent.
- Each ICB should be required to publish annually the research it has undertaken in that year which should be included in their annual report. NHSE should be obliged to collate this information and present it to Parliament.
Innovation is an ongoing iterative process which every ICB should be aware of to ensure patients have access to the most efficient and effective healthcare solutions of the day. To that end, I have tabled an amendment to obligate ICBs to formalise the obligations of the board to horizon scan for the latest innovations (approved by regulatory bodies) in order to cover the population that they cover. This new clause requires the appointment of an innovation officer and places an obligation on the board to perpetually review innovative medicines and devices as they become available.
Currently, CCGs limit the types of medicines and medical devices they provide to patients in order to remain in budget whilst optimising patient outcomes. This results in a postcode lottery across the country to life improving and lifesaving drugs. To tackle this, I believe that ICBs should:
- Be required to ensure all NICE approved medicines/devices are available and promoted to their population because the cost of these drugs are already covered by the VPAS reimbursement scheme agreed between the NHS and pharmaceutical industry.
- If a treatment is unavailable in one ICB footprint, they should be required to commission the required treatment from another ICB.
- Promote uptake of Nice-approved medicines and report uptake of new medicines annually.
Governments of all persuasions over recent years have spoken regularly about the desire to achieve parity of esteem between mental and physical health, including in the NHS 10-year plan. However, for this to be meaningful there must be a legal obligation to that effect supported by reporting mechanisms on inputs to the mental health system (money and people trained/training places), outputs resulting including the number of mental health appointments/services made available/uptake, and the outcomes (i.e. patient numbers discharged from care).
Domestic abuse is a scourge on our society. While a crime it most often first manifests itself in GP surgeries not at police stations. Currently there is no training for GPs or other health professionals enabling them or expecting them to be able to spot, treat an individual suffering from mental or physical abuse or instruct them how to engage with police. Devon is the only health system to have a dedicated individual on the CCG board and a health and care strategy for victims of abuse. It has improved health and care outcomes through training and other interventions. This should be the case nationally and therefore I’m pushing to have it replicated.
The changes to the social care cap announced last week as an amendment to the Bill were done so at the last minute and without detail (which was finally published over the weekend). Having looked at the detail, I am concerned by the lack of proper impact assessment of the proposals and also the apparent need to rush this amendment through. Given it is amending the Care Act, it could simply be enacted via Statutory Instrument (SI) at a later date once we have seen and been able to digest the forthcoming social care proposals. Therefore, I do not believe now is the right time to be making this change and will be abstaining on this amendment.
Turning to ‘privatisation’, the use of private providers and the voluntary sector in the delivery of NHS services is not a new concept, with previous Governments introducing the independent sector and competition into the NHS between 1997 and 2010. After all, GPs are themselves private businesses. This Bill has a number of areas where it can be improved, as I have outlined, but the notion that it will lead to wholesale privatisation of the NHS is simply misleading.
To oppose the Bill, as some have suggested, would be a complete dereliction of duty, bypassing the opportunity to improve the provision of health and social care services for Teignbridge residents. It is an opportunity to make much needed improvement to the system that currently exists, and I will continue to raise the issues I believe need addressing, such as the ones outlined above.
The full list of amendments can be found here: https://publications.parliament.uk/pa/bills/cbill/58-02/0183/amend/health_day_rep_1122.pdf
Thank you for taking the time to write to me.