Health and Social Care Bill 2011 – a lot to get right

The much-anticipated Health and Social Care Bill was published on Wednesday. Although it contains few surprises, the sheer size of the document, and the monumental changes within it, cannot fail to invoke strong feelings and opinions, and, of course, many questions.

Will it be possible to carry out such a huge task without plunging the system into chaos? Will it improve services and empower patients, service users and staff? Will it save money? In short, will it be worth it? But this is only the beginning; much of the vital detail won’t emerge till later. And most of the big questions will not be answered until several years down the line, at best.

The most pivotal provisions of the Bill set out the new commissioning arrangements for health services. In JRF’s responses to the consultation process, which began last summer, we argued for making user involvement a central part of commissioning both health and social care services. It is practices such as these that make the wider agenda of personalisation, self-directed support and choice in health and social care real.

Recent research shows that user involvement in commissioning health and care services has been a mixed success, and the reality of user involvement has been variable and often poor. Commissioners have often been found ill-equipped to engage with service users. With GP consortia taking on this role, the Government cannot assume that the required skills, knowledge, established practice, as well as organisational culture and attitudes of effective engagement, will be available as a matter of course. These will need developing, supporting and, just as much, they will need time.

The worst case scenario, still all too commonly found, would be ‘tick box’, cynicism-inducing consultation exercises, resulting in a belief by service users that user involvement has little to do with finding out what users want and value. This would seriously undermine the core intent of putting patients and service users in control, and is to be avoided at any cost. Getting it right, however, will require a lot of effort, patience and skill, rooted in a recognition of the sheer diversity of service user groups.

But it is worth getting it right.