17th September 2021 // Amy Capper
Patient Advocacy and Policy Research Officer, Amy Capper tells us more about the Government's Health and Care Bill and what the proposed changes mean for myeloma patients living in England.
A new Health and Care Bill is currently being discussed and debated by Parliament. This new Bill sets out the key proposals to restructure the delivery and organisation of health services in England so that the health service is focused on improving health rather than simply providing a service. It proposes a range of changes to how the NHS is organised, how local spending decisions are made, and how organisations are held accountable for their outcomes.
It is hoped that these structural changes in decision making and accountability will lead to a more joined-up approach to patient care and help to reduce health inequalities.
But what are these changes, will it change anything for myeloma patients, and will it really help the NHS tackle the challenges it is currently facing?
At the heart of the changes is the formalisation of Integrated Care Systems (ICSs) making them mandatory and accountable for commissioning and delivering services to the patients in their local area. These systems bring together local NHS organisations, local government and public health organisations to deliver joined-up care for its local population.
Myeloma patients require support from different services at the same time. From diagnostic testing and imaging to treatment, pain relief and holistic support, every stage of the myeloma patient journey is dependent on multiple services and staff.
As a result, many patients have experienced gaps or unevenness in their care due to the complexity of being treated via separate departments and/or hospitals with different processes and guidelines that are not seamlessly linked.
These services, therefore, need to work together to provide coordinated care which meets individuals’ needs in a flexible way, and ICSs could offer a way of doing this.
The Bill also outlines a new model for the authorisation and planning of specialised services, like chemotherapy, radiotherapy, kidney dialysis and stem cell transplantation.
Specialised services are not available in every local hospital because they have to be delivered by specialist teams of doctors, nurses and other healthcare professionals who have the necessary skills and experience. Unlike most healthcare, which is planned and arranged locally, specialised services are currently planned nationally and regionally by NHS England. The new model proposed by the Bill could mean the commissioning of some specialised services for myeloma patients is moved to ICSs.
The new model will help ICSs ensure that primary, secondary and community services join up with specialised services to serve the needs of their local population, improve outcomes and reduce health inequalities.
This will be a key enabler for integrating care and it gives the flexibility to join up with other pathways of care.
Myeloma care includes both specialised and non-specialised services therefore much of their care is disjointed so we hope ICSs would be able to smooth this over by joining up different services within the patient journey.
We also hope it will help patients at smaller, rural hospitals more easily access specialised services and get seamless care when they do.
So, this change could lead to better outcomes and experiences for patients and less bureaucracy and duplication for clinicians and other staff.
This change should come into effect in April 2023, when NHS England will delegate the commissioning of some specialised services to ICSs, subject to “system readiness.”
NHS England will remain accountable for all specialised services, even those that are delegated, and national service standards and specifications will continue to apply across the country. Highly specialised services are likely to remain nationally commissioned, though work will be undertaken to ensure that those using these services can also benefit from more integrated care working with ICSs across wider pathways.
It is not clear which services those might be or what criteria will be used to decide this, although NHS England has stated that “highly specialised services” which serve very small populations of patients and are delivered in a small number of centres would remain nationally commissioned. For myeloma patients, it seems likely that services such as chemotherapy would be delegated to ICSs, and more highly specialised services like stem cell transplants and diagnostic services for amyloidosis would remain commissioned by NHS England.
Whilst the Bill takes us towards a more integrated and more equal healthcare service it doesn’t cover everything, and we still have questions and concerns.
A lot of these changes relate to the structure and processes within NHS England and how there are implemented will be key to the success of this reform. The Government need to ensure there are the necessary staff and resources to deliver it.
We are working with cancer coalitions, like One Cancer Voice, to make amendments to the Bill that will ensure the reforms have a positive impact on patients, people working in health and social care, and the wider public. For example, we support the amendment that would require the Secretary of State to publish a report on assessing and meeting the NHS workforce needs every two years, instead of every five years. This would require published assessments of the future health and care staff numbers required to deliver the work, taking into account changing costs of healthcare, the impact of technology and the rising prevalence of certain health conditions. We need this amendment because the workforce is a key limiting factor in delivering high quality integrated care. The Bill is a vital opportunity to establish greater accountability and transparency on workforce planning to ensure we meet the patient demand now and in the future.
We will continue to follow the debate and discussion on the Bill to ensure the changes help deliver the best possible care for patients.