29th January 2016

• MPs remove controversial medical negligence clauses from innovation Bill
• Cross-party health and social care commission debated by MPs
• General surgery workforce stocktake published
• Commission on Urgent Care for Older People sets out principles for care redesign
• Devolution Bill becomes law
• CQC consults on its future

MPs remove controversial medical negligence clauses from innovation Bill

The follow-up to Lord Saatchi’s Medical Innovation Bill, the Access to Medical Treatments (Innovation) Bill, was debated today in Parliament. The Bill aims to expand access to innovative treatments for patients, and originally included clauses on changing the law on medical negligence to encourage clinicians to innovate more often, and creating a database of innovative treatments.

Amendments were made at this stage to remove the controversial clauses on changing the legal framework for medical negligence for the sake of medical innovation. The RCS briefed MPs at earlier stages of the Bill, as we believed that these clauses would at best confuse doctors about the law on medical negligence, and at worst risk harming vulnerable patients with the potential to change the legal standing of the doctor-patient relationship. The College, along with organisations representing doctors, patients and medico-legal experts, welcomed the amendments to remove these clauses, and called on MPs to support them during the debate. However we questioned whether legislation was necessary to establish the proposed database of innovative treatments, and called for more details from the Government on the data it envisages collecting. 

George Freeman MP, Life Sciences Minister, expressed his support for dropping the medical negligence clauses, and for the provision of establishing a database of innovative treatments, including treatments used in clinical research, which remains in the Bill. MPs voted in favour of dropping the medical negligence clauses, and adding the provision of more easily enabling the use of off-patent drugs. The amended Bill was agreed to, and will now go to the House of Lords for consideration.

Cross-party health and social care commission debated by MPs

Following calls from Norman Lamb MP, and former Health Secretaries Stephen Dorrell and Alan Milburn, to establish a cross-party commission on health and social care, the proposal was debated by MPs on Thursday. Despite failing to gain support from the Government or Labour’s Shadow Health Secretary, Heidi Alexander MP, the proposal to set up a cross-party commission was agreed to by MPs. This was a non-binding decision made in the House of Commons, however lends support to Norman Lamb MP’s continued campaign. 

The RCS strongly supports the establishment of a commission, as there is evidence that under current funding the NHS is facing significant pressures, and we remain sceptical about the ability for the NHS to fully meet the expected efficiency targets. We also need to urgently review how we better provide and fund the care of older people in the community. An independent cross-party commission would allow these issues to be scrutinised and solutions aired.

General surgery workforce stocktake published

The Centre for Workforce Intelligence (CfWI) has published Securing the future workforce supply: general surgery stocktake, a review commissioned by the Department of Health (DH) and Health Education England (HEE), and to which Mr Ian Eardley, Vice President of the RCS, and Bill Allum, Chair of the Joint Committee on Surgical Training (JCST), contributed their expertise and the College’s view. The review looks at the number of general surgeons likely to be necessary to meet patient demand up to 2029.

The review finds that there will be a 67% growth in expected patient demand for general surgery by 2029. In order to rebalance demand and supply, the report recommends that general surgery ST3 recruitment is maintained at around 111 trainees per year until the end of 2018 when suggestions should be made for appropriate levels for 2018/19 onwards; that assessments of the impacts on surgeon productivity from skill mix initiatives and new surgical care models and pathways. CfWI recommend an updated review on the workforce stocktake from 2018, and a future review of the vascular surgery workforce. 

Commission on Urgent Care for Older People sets out principles for care redesign

The Commission on Improving Urgent Care for Older People has this week published its final report. The NHS Confederation launched the Commission in March 2015, to produce guidance on designing care for older people.

The report, Growing Old Together, sets out eight key principles for ensuring that older people’s needs are met, to be considered when services are redesigned. Most importantly, it advocates that care should being driven by, and thus tailored to, the individual. The key principles also recommend a focus on proactive care; a single connection to ensure care coordination; greater use of multi-disciplinary teams; and metrics that truly reflect the care experience.

A focus of the report is the need to tackle delayed discharge from hospital. The report notes the dramatic increase in delayed transfers of care over the last few years, attributable to both difficulties in arranging social care packages and the availability of non-acute care in the NHS. The likelihood of over-65s being discharged into re-ablement or rehabilitation services also varies considerably depending on where patients live. The report cites examples of Trusts, such as Sheffield Teaching Hospitals NHS Foundation Trust, that have reassessed their discharge process to significantly reduce their numbers of delayed discharges.

Devolution Bill becomes law

The Cities and Local Government Devolution Bill received royal assent on Thursday, officially passing into law and coming into force immediately. The Act is an enabling law, allowing for the Secretary of State to transfer some central government functions to local combined authorities under devolution deals to be agreed with the Government. 

Health and social care is among the new powers able to be devolved, and the Chancellor, George Osborne MP, has already agreed a deal with Greater Manchester to take control of integrating health and social care services locally, and further deals have been agreed with Cornwall and the North East combined authorities to establish plans for integrated care.

Under the new law, combined authorities would be required to adhere to national standards and accountabilities for health services, the Health Secretary will retain responsibility for regulatory and supervisory functions for the NHS in England, and NHS England will continue to commission specialist services.

CQC consults on its future

The Care Quality Commission (CQC) has published proposals on the future of health and social care regulation. Responding to changes in the health service as well as demographic change with increasing numbers of older patients, the CQC is proposing to implement a ‘single shared view of quality’. This new framework is intended to help providers better understand their quality of care and improve data sharing with the CQC. 

The regulator is also consulting on a new programme of more targeted inspections, and heavier reliance on data use to support a risk-based approach. This would see the CQC making less frequent inspections on services with better ratings. The consultation will close on 14th March and the new CQC strategy will be published in May.