Health Bill lacks crucial details, cautions peer

Baroness Barbara Young is under no illusion about the amount of work the 420-page Health Bill has dropped on her desk.

Baroness Young: 'The Health Bill needs to set out in detail consortia's roles and responsibilities'
Baroness Young: 'The Health Bill needs to set out in detail consortia's roles and responsibilities'

As a cross-bench peer and head of a leading health charity, there is little she can do to escape it.

'It is the biggest Bill anybody has had through Parliament in many, many years,' she says. 'It is massive. It's like a bloody telephone book.'

As chief executive of Diabetes UK, Baroness Young worries that patients will see services become less integrated as commissioning responsibilities are shared more widely.

'PCTs commissioned primary care, secondary care and a big chunk of tertiary care as well,' she says. 'Even with that, the integration of services wasn't exactly out of the top drawer.'

Health and wellbeing boards will take on health needs assessments and prevention work, and GP consortia will commission local services.

Tertiary care
But consortia will not take on the parts of tertiary care that PCTs previously dealt with, and it is unclear how these services will be commissioned, Baroness Young points out.

'All of that has to be joined up around the patient because at any stage they may need different parts of that pathway.

'I don't think that, intrinsically, it is absolutely impossible to tweak it. But it makes it more difficult, because you have a lot more players on the pitch.'

Baroness Young is determined that the importance of this integration is in the wording of the Health Bill itself, and not sidelined in secondary legislation and accompanying guidance.

'Some things that are incredibly detailed you wouldn't want in primary legislation,' she says.

'But high-level principles like "everybody in the sodding system ought to think about integration" don't seem to me to be an excessive burden on primary legislation.'

As a bloodied veteran of legislative debates in previous roles, she knows that such successes are possible.

'I've stuffed integration into so many environment bills,' she says. 'With the government resisting tooth and nail, but, after about five bills, it gives in and writes it into the bill in the first place.'

If the importance of integrating services is not written into the Health Bill, it will either have to be written into each piece of guidance to commissioners or may not happen, she says.

It cannot be assumed that integrated services will simply arise from a wider choice of services, she argues.

Not Meccano
Patients need to be offered an integrated care package, not a series of care components at different levels of commissioning.

'This is not a Meccano set, it is buying a train,' she says.

The Health Bill also needs to set out in detail consortia's roles and responsibilities, she says.

'There is nothing at all in the Health Bill about the governance arrangements for GP consortia except that they have to be authorised and they have to have a plan,' she points out.

'We would like the governance to be clear,' she says. 'We would like it to be prescribed. We don't want it left to local decisions.'

Requirements to include patients, as well as secondary care specialists and other health professionals need to be written into the Health Bill, she says.

'The government's view is that what it is designing is a system that is actually going to be much more responsive to patients. It wants patients at the heart of healthcare and the decisions about healthcare. But if we leave it to a thousand flowers blooming, it will be patchy.

'There needs to be a bit more requirement laid on consortia in terms of the legislation. Not least because the taxpayer is handing £80 billion over to consortia and saying: "By the way, could you tell us what your plans are?"'

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