Letter to members from Dr Laurence Mynors-Wallis, Registrar

The Health and Social Care Bill was published on 19 January 2011. It is likely to be several months before, what is a very large and complex Bill completes its passage through Parliament. Whilst the College welcomes many aspects of the Bill it is concerned, along with many others, about the pace of change and is particularly concerned that in some areas the new structures will not have the skills or expertise to support Mental Health Commissioning.

The College has welcomed the following aspects of the Health and Social Care Bill:

• putting the patient at the centre of care
• the focus on clinical outcomes
•  increased involvement of clinicians in Commissioning (with a corresponding reduction in management costs)
• ring-fenced money for Public Health
• the aspiration for joined up Social Care and Public Mental Health outcomes.

The College believes, along with all the other Medical Royal Colleges, including the Royal College of General Practitioners, that clinical commissioning must involve a close working relationship between GPs and specialists. The College would be dismayed if psychiatrists were not closely involved with local consortia of GPs in the development of Mental Health services. The College will be pushing for an acknowledgement of this to be included within the Bill, together with an acknowledgement that specialist mental health expertise is needed at other levels of commissioning and scrutiny including the Commissioning Board and the Health and Well Being Boards.

The College is very concerned about the crude potential use of the concept of “any willing provider”. It is not clear exactly how this will be defined in the Bill, but, there is clearly a danger, despite assurances that competition will be driven by quality, that services will go to the cheapest provider at the expense of quality. The College is particularly concerned to avoid fragmentation of services with several providers delivering different aspects of a care pathway – these providers constantly changing as services are retendered.  he College, therefore, believes that there should be an acknowledgement that Commissioning should include commissioning for integration and continuity in addition to Outcomes. There is a real danger that if a multiplicity of providers are delivering different aspects of the care pathway, patients may fall between gaps in services. There also needs to be recognition of the expense of education, training and research or these will be lost in the drive to reduce costs.

The third area of concern for the College is to ensure that there continues to be an emphasis on the care of mental health patients with complex needs. The care for such patients is necessarily costly and is an area where individual GPs will have little expertise. It is important that the care of such patients is not compromised by the need to ensure good quality services for more common mental health disorders – the needs of the many must not overwhelm the needs of the few. Again this is an area in which psychiatrists need to be closely involved with commissioning decisions.

The College will be working with other organisations to persuade Members of Parliament of the importance of these key issues and to see, if amendments can be made to the Bill which helps safeguard these important aspects of Health Care. If anyone has any particular clinical examples, areas of good practice or areas of concern, that the College could use in this work please contact me at the College. Real examples can highlight very powerfully some of the key messages that need to be made.