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members wanted the Bill to be withdrawn, and following a further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.
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