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RCS health bill statement: RCS calls for more detail on clinical involvement in commissioning

10 October 2011

The Royal College of Surgeons has today (Monday 10 October, 2011) published a comprehensive briefing on the Health and Social Care Bill, ahead of the Bill’s Second Reading and Committee stages in the House of Lords.

President of the Royal College of Surgeons, Professor Norman Williams said:

"The College broadly welcomes the aims of modernising the healthcare system by cutting bureaucracy, giving patients more choice over the treatment they receive and placing clinicians at the centre of commissioning. The College also encourages the Bill to be implemented without unnecessary delay, otherwise we believe that delays to this process will ultimately be to the detriment of patients. But the College highlights a lack of detail on many of the proposals, including those for a clinician-led health service and how the future of medical education and training will be integrated into these health reforms."

"After a summer of scrutiny on the Health and Social Care Bill and discussion with our members, the College has a number of concerns on the Bill which need to be highlighted as the Bill enters these next stages in the House of Lords."

Among the areas the RCS hope will be debated are:

  • Role of secondary care in Clinical Senates: There is still a lack of detail around how the proposed clinical senates will be involved in advising the NHS Commissioning Board and Clinical Commissioning Groups (CCGs) and conversely how accountable the Board and CCGs will be in terms of how they take forward recommendations made by clinical senates.
  • Safeguard integrated care: The College believes that any provider must commission a complete service, including emergency provision; train and educate their workforce and participate in clinical audits and the publication of audit outcome information. The College’s briefing outlines the Any Qualified Provider blueprint for commissioning surgical services, which we believe would also prevent 'cherry-picking' and fragmentation of services.
  • Commissioning of rarer conditions: The NHS Commissioning Board will be responsible for making arrangement for the provision of rare conditions, more detail is needed on how the Board will take into account the recommendations of clinical networks and senates.
  • The relationship between Monitor and clinicians: Monitor has extensive powers, to decide what is anti-competitive, setting the national tariff and defining quality – all powers which will need significant clinical input. Yet there is no detail on how Monitor is to secure such clinical and public health advice and what degree of involvement there should be from these health professionals. The College believes that extensive involvement with surgeons and other clinical and public health professionals, patients and the general public is necessary by Monitor in exercising these powers and seeks assurances from the Government on this point.
  • The importance of medical education: The future structure of medical education and training has been marginalised during the passage of this Bill. Inadequate consideration and planning on the future of this vital aspect of our health service could be disastrous for medical trainees in the system or those about to start their training. Training should be safeguarded by the Medical Royal Colleges providing governance and quality assurance.

The briefing may found here


Notes to Editors:
1.    The Royal College of Surgeons of England is committed to enabling surgeons to achieve and maintain the highest standards of surgical practice and patient care. Registered charity number: 212808. For more information please visit

2.    If you have any queries please contact:
Elaine Towell        – Email:; T: 020 7869 6045
Matthew Worrall    – Email:; T: 020 7869 6047
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