Commissioning: further issues - Health Committee Contents

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.[63] Our vision is of a world where no-one dies prematurely of heart disease.

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[64] on detailed legislative amendments relating to patient, public and multidisciplinary involvement in commissioning, and local scrutiny.


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[65] 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 failure.


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 experience.

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[66].

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 more information.

February 2011

63  Back

64   Age UK, Alzheimer's Society, Asthma UK, Breakthrough Breast Cancer, Diabetes UK, National Voices, the Neurological Alliance, Rethink and the Stroke Association. Back

65   The Information Centre for Health and Social Care (2010). National Heart Failure Audit 2010. Leeds: The Information Centre for Health and Social Care. Back

66   BHF (2010), BHF Specialist Nurses - Changing the face of cardiac care. Back

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Prepared 5 April 2011