APPENDIX 15
Memorandum by Commission for Patient and
Public Involvement in Health (FT31)
The Commission will consider this issue at its
first Board Meeting in March 2003. However, in view of the timing
of the consultation and decision making process on this matter,
the Chair and Commissioners wish to ensure that their strong views
on this issue are taken into account as part of this process,
in advance of their formal consideration of the matter.
BACKGROUND:
1. Foundation Trusts (FT) are a new approach
to developing social ownership and rooting the NHS in the communities
it serves. The Commission has been advised by the Department of
Health however, that Foundation Trusts will not be required to
have a Patient and Public Forums (PPF), but that FT's should instead
liaise closely with the local Primary Care Trust Patients' Forum.
The mechanism for this is unclear.
2. The Commission for Patient and Public
Involvement in Health (CPPIH) was established on 1 January 2003.
It is charged under the NHS Reform and Health Care Professions
Act 2002, with establishing a new and comprehensive system for
patient and public involvement in health, and this system will
supercede the Community Health Councils system after 1 September
2003.
3. The Commission is an independent non-departmental
public body, which will have responsibility for advising the Secretary
of State on arrangements for patient and public involvement throughout
the NHS, and for representing the views of patients nationally.
At a local level, it will establish and support independent PPF's
for every Primary Care and NHS Trust.
4. Patient and Public Forums will have a
number of functions. In this context, the most important of these
is that they will each elect a full board member to the NHS Trust
Board, and will monitor the services of the Trust from point of
view of patients and the public. Crucially they will feed back
information to the Commission enabling it to develop a national
overview of the delivery of services.
THE CASE
FOR PATIENT
AND PUBLIC
FORUMS IN
FOUNDATION TRUSTS
5. The intention to exclude FT's from the
requirement to have PPF's appears to represent confusion between
different purposes. The proposed elected governors' prime function
is to improve accountability and to create a sense of ownership
of the Trust. Patient and Public Forums however are about user/carer
involvement in service development and provision, with the aim
of service improvement. It would be more logical to scrap NED's
on the Management Board of FT's in view of the presence of elected
Boards of Governors, rather than scrap PPF's, since it is there
that the duplication lies.
6. There is a distinction to be drawn also
between the proposed powers of elected governors and PPF's. Boards
of Governors, of whom only some will be patients and public, will
be advisory to the FT Management Board, whereas PPF's will elect
a member to their Trust Board—a much more powerful approach
to empowering patients and the public.
7. A further distinction can be drawn between
the level of involvement expected of elected governors as compared
to PPF's. Governors will make policy, and are not expected to
be involved on a day-to-day basis, and will meet only occasionally.
The work of PPF's however will be ongoing and "hands on",
with a work programme steered and supported by CPPIH, facilitating
the detailed involvement of users in the practical delivery of
services.
8. The establishment of the Commission for
Patient and Public Involvement in Health gives the opportunity
to develop a consistent national framework for patient and public
involvement in decision making at all levels. To exempt Foundation
Trusts from the new PPF network would:
8.1 Disadvantage patients and carers in Foundation
Hospitals who will not have access to the same support for involvement
as other NHS Trusts. Central to the role of CPPIH is its mission
to involve previously excluded groups in health related decision
making. How this is to be accomplished in the absence of PPF's
in FT's is a serious issue in our view.
8.2 Undermine the Commission's ability to
advise the Secretary of State about the arrangements for public
involvement, or to obtain a comprehensive overview of the national
picture on a range of issues, including PPI arrangements and their
effectiveness. CPPIH's "coal face", the Patients Forums,
will simply not exist in FT's.
8.3 With no formal involvement arm under
the umbrella of CPPIH, the FT's may become "no go" areas
for CPPIH. A key argument for CPPIH was the need to adopt a more
strategic approach to patient and public involvement.
8.4 Reduce the user derived, as opposed to
management provided, information available to external stakeholders
and regulators eg Overview and Scrutiny Committees and the Commission
for Healthcare Audit and Inspection via PPF's.
8.5 Give a confusing message to the public,
as the CPPIH becomes high profile in Autumn 2003, with mass recruitment
to PPF's in all other PCT's and NHS Trusts. Communications with
the public about this substantial task will be the more challenging
if it must be explained that some hospitals will not have PPF's.
8.6 Lead to the fragmentation of patient
and public involvement and inhibit the transfer or learning about
best practice in Patient and Public Involvement in the NHS, if
some Trusts are outside of the system—at the very time when
a new and comprehensive system is being established.
8.7 Create a "blind spot" for the
important new PCT PPF's , who will have membership from every
other PPF of NHS Trusts from which services are commissioned by
the PCT. This will be damaging in relation to their provision
of ICAS, and reduce the value added by an effective complaints
mechanism for FT's.
8.8 As more and more FT's are created, only
PCT PPF's will remain.
THE ALTERNATIVE—PPF'S
ADDING VALUE
TO FT'S
9. The view of CPPIH is that if FT's are
the future, then the new system of Patient and Public Involvement,
supported by a strong national Commission, could complement and
support the role of Foundation Trust members and Governors, and
could help them to meet their obligations to the wider patient
and public. They could:
9.1 Help recruitment to the FT "membership
communities", by raising awareness and encouraging people
to become members, especially traditionally "hard to reach"
groups.
9.2 Provide an important and supportive reference/advisory
group for elected governors, with the aim of ensuring a more accountable
and responsive service.
9.3 Provide a role for the membership community
between presumably infrequent elections, by encouraging the membership
community to become involved in the ongoing activity of Patients'
Forums and so use their knowledge and develop their skills.
9.4 Assist in holding the Board of Governors
to account to the membership.
9.5 If the FT PPF's were to be elected from
the patient of the membership community, then this, in the first
wave of FT's, would offer 12 or so pilot/ pioneer models to test
for a possibly more radical or representative model of PPF's for
eventual extension elsewhere in the system.
February 2003
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