Written evidence from the British Heart
Foundation (CFI 26)|
1. The British Heart Foundation (BHF) is the
UK's leading heart charity. We are fighting against heart and
circulatory disease - which is the UK's biggest killer and claims
around 200,000 lives each year.
Our vision is of a world where no-one dies prematurely of heart
2. This submission identifies a number of key
points in relation to the Committee's follow-up inquiry that we
believe must be addressed as proposals and legislation for NHS
reform are developed. We have made a joint submission to the Bill
Committee with nine other national health charities
on detailed legislative amendments relating to patient, public
and multidisciplinary involvement in commissioning, and local
3. In developing and implementing the ambitious
plans for the NHS, the Government's primary priority must be the
provision of high quality care, in accordance with national guidelines.
In December 2010, a national audit of heart failure
showed that guidelines on the treatment of heart failure patients
were not being followed and that patients were dying needlessly
because of lack of access to specialist care. Systems must be
in place, including through commissioning and national regulation,
to ensure that all heart patients have access to high-quality,
specialist cardiac care. The Bill must ensure that commissioners
and providers are held to account for the delivery of the new
NICE quality standards including those recently developed on heart
4. Patient and public involvement in commissioning
and service design is crucial to make "no decision about
me without me" a reality, to place patients truly at the
heart of the NHS, and to improve patient care and the patient
5. We would like to see stronger provision
in the Health and Social Care Bill to ensure that the NHS Commissioning
Board and GP consortia involve patients and the public in the
commissioning cycle. This must be clearly specified in the
legislation so that involvement is a right, rather than at professionals'
discretion. Patient and public involvement should be reflected
in the publicly available annual reports of the Commissioning
Board, and in consortia commissioning plans and the assessment
of consortia performance. Local HealthWatch should have a key
role in contributing to Joint Strategic Needs Assessment, commissioning
plans, and local scrutiny processes.
6. During this period of significant organisational
change, the voluntary sector remains a constant and lasting source
of expertise and evidence. We urge the Government to ensure
that the voluntary sector is fully engaged and involved throughout
the commissioning cycle. Health and Wellbeing Boards should
be responsible for ensuring that this happens, and should include
voluntary sector representatives.
7. We agree with the Committee that clinical
engagement in commissioning should draw from a wide pool of practitioners,
and that GP consortia should seek specialist involvement when
making commissioning decisions. The involvement of multi-disciplinary
health and social care professionals is crucial to enhance continuity
of care and improve quality.
8. Specialist heart nurses, for example, are
well placed to advise on the commissioning of high-quality, patient-centred,
cost-effective, multi-disciplinary services, and to achieve the
best outcomes across acute, chronic, and palliative care. BHF
specialist heart failure nurses monitor symptoms and medication,
and support patients to understand and manage their condition
and to stay in their homes. An evaluation found that heart failure
nurses reduce all cause admissions by an average of 35%, saving
approximately £1,826 per patient.
9. The Health and Social Care Bill should
require the NHS Commissioning Board and GP commissioning consortia
to involve multi-disciplinary professionals in commissioning.
The current duty to 'obtain advice' from health professionals
should be strengthened to ensure integrated working.
10. Local scrutiny is a crucial aspect
of democratic legitimacy and must be carried out by a structure
that is independent of decision-makers. The Bill gives local authorities
greater flexibility in how they carry out the scrutiny of local
services, and there is no longer a requirement for this to be
done by Overview and Scrutiny Committees. We are concerned that
the lack of detail around best practice will allow less transparency
and accessibility for the local population. The Bill should
require scrutiny to be led by locally elected representatives
within a strong, independent structure in the local authority.
11. The increased competition between
providers must not impede networking and the delivery of integrated
high quality care. Clinical networks play a valuable role in promoting
integration, as well as engaging patients and carers in commissioning,
and providing expert clinical advice and support for commissioners.
The Government should ensure that the increasing competition
between providers and the financial challenges facing the NHS,
do not threaten the vital work of cardiac and stroke networks.
12. Research must be regarded as a priority by
commissioners and providers, and given appropriate status in the
new market-orientated system - the Bill should ensure a duty
to promote research. As the principal budget-holders and commissioners,
GPs will need considerable support to recognise the importance
of commissioning research activity and to ensure patients are
aware of clinical trials and similar opportunities.
13. We would welcome the opportunity to support
the Committee in its inquiry and would be pleased to provide any
63 www.heartstats.org Back
Age UK, Alzheimer's Society, Asthma UK, Breakthrough Breast Cancer,
Diabetes UK, National Voices, the Neurological Alliance, Rethink
and the Stroke Association. Back
The Information Centre for Health and Social Care (2010). National
Heart Failure Audit 2010. Leeds: The Information Centre for Health
and Social Care. Back
BHF (2010), BHF Specialist Nurses - Changing the face of cardiac