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The Royal College of Psychiatrists Improving the lives of people with mental illness

The Health Bill passes

It was with a somewhat heavy heart that I watched the controversial Health and Social Care Bill clear its final Parliamentary stages yesterday. 426 days after it was first introduced to the House of Commons, the Bill now awaits Royal Assent – despite an extraordinary level of opposition from many organisations.

Your College has voiced significant concerns about the reforms and we have actively engaged with civil servants and parliamentarians to try to improve the Bill. We recognised that many members wanted the Bill to be withdrawn, and following a further membership survey early this year we clearly reiterated in February our inability to support a Bill that I have described as being fundamentally flawed.

We have, through our work with the Academy of Medical Royal Colleges, been considering the overarching effects of the Bill especially competition and education, as well as producing specific briefings on particular amendments, often in coalition with other mental health charities.

I am pleased for example that, following an amendment supported by the College, the government has agreed that the provision of after-care services in the community for patients who have been detained because of their mental health, and for those on community treatment orders, should continue to be a joint responsibility between health and social services.  It also removes the possibility that certain services currently provided free under Section 117 of the Mental Health Act cannot be charged for.  

Our support for other briefings and debates has also resulted in follow-up meetings with ministers on issues such as commissioning for less common conditions.

However, as the government has been so strongly committed to this legislation, we did not expect to succeed in securing all the changes to the Bill which we would have wanted.

One issue I was not prepared to move on was parity of esteem for mental and physical health, something that the government has committed to in the Mental Health Strategy. An amendment was tabled in the Lords by Lord Mackay of Clashfern to place this commitment on a statutory footing.  This makes it clear on the face of the Bill that the Secretary of State for Health has a duty to improve the nation’s mental health services and the prevention, diagnosis and treatment of both physical and mental health.

The amendment was originally opposed by the government, but thanks to lobbying from the College and our partner organisations the amendment was taken to a vote following a debate in the Lords and won by a very small, but nonetheless very significant, majority.   

Following further briefings and discussions with ministers and civil servants we were able to further consolidate the case for parity and convince the government to support this amendment when the Bill returned to the Commons. Health Minister Simon Burns said during last night’s final debate, "I would like to thank my noble Friend Lord Mackay for his work in developing amendment 1, which inserts the words “physical and mental” into clause 1 in order to promote 'parity of esteem' between physical and mental health services. In response to the Royal College of Psychiatrists’ concerns, I would like to offer the reassurance that the definition of 'illness' in section 275 of the National Health Service Act 2006 would continue to apply to section 1, meaning, for example, that learning disabilities, mental disorders and physical disabilities would continue to be covered by the comprehensive health service....Mental health is a priority for this Government, so I commit to considering further the role that the mandate, the NHS and public health outcomes frameworks can play in driving improvements in mental health services."

Whilst I’m only too aware that a single amendment in a large piece of complicated legislation cannot solve all the issues associated with mental health care, it gives us a platform to work from as we continue to push for more integration, better service-user and carer involvement and reductions in health inequalities.  Paul Burstow, the Minister for Care Services, is keen to work with us and other key stakeholders to make parity of esteem a reality, and this will be a key priority for me in the months ahead.

I hope that the amendment will, more broadly and over time, influence positive changes in attitudes to mental health, and in knowledge, priorities, professional training and practice, all of which are necessary to reduce the stigma experienced by those with mental health problems and to improve the assessment and care they receive.

I still have serious concerns about the effect that the new legislation will have on the NHS, and I can assure you that the College will continue to engage and work with government, the opposition, key stakeholders and colleagues across the medical profession to ensure best care for patients and the future of the health service we are all so committed to.

The College will be continuing its important work to provide guidance to clinical commissioning groups, local authorities and PCTs in transition through co-chairing with the RCGP the on the innovative Joint Commissioning Panel for Mental Health, which works with a wide range of key mental health partner organisations to produce descriptor guides for commissioning a range of mental health services.

I am also looking forward to our forthcoming Resilience and Recovery campaign. I will give you more information soon and hope many of you will get involved at Divisional, Faculty and local levels.

If you would like to post a response to Sue's blog, please email your message to the Website Manager, who will be pleased to upload it to the website.


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