2. Evidence submitted by Action against
Medical Accidents (PPI 40)
1. SUMMARY
This memorandum sets out the views of the charity
Action against Medical Accidents (AvMA) on the issues around Patient
& Public Involvement in Health (PPI) under consideration by
the Committee. In particular, AvMA expresses its concerns about:
— Independent Complaints Advocacy Services
(ICAS) not being delivered in accordance with the legislation
which established the new system of PPI to replace Community Health
Councils (CHCs), and not being integrated with the new PPI structures
such as Patients Forums (now referred to as "Patient &
Public Involvement Forums" (PPIFs), and LINks, as proposed
by the Government.
— The proposed methods of providing
staff support to the new LINks; the appointment of members; and
the absence of a statutory right to inspect NHS organisations.
AvMA believes the proposed arrangements for LINks fail to take
on board the lessons and experience from CHCs and PPIFs, and would
lead to LINks failing to be effective or enjoy public confidence.
2. ABOUT ACTION
AGAINST MEDICAL
ACCIDENTS (AVMA)
AND THE
AUTHOR OF
THIS MEMORANDUM,
PETER WALSH
2.1 Action against Medical Accidents (AvMA)
is a patient centred charity with considerable experience, now
stretching back 25 years, of working with local and national bodies
providing patient and public involvement in the NHS. This included
close working with CHCs and ACHCEW before their abolition, as
well as the current system of CPPIH, Patients Forums and ICAS.
The arrangements for patient and public involvement have a real
impact on the beneficiaries of the charity and our own work. We
are able to draw on considerable experience of what works best
and what is needed.
2.2 The author of this memorandum, Peter
Walsh, is chief executive of AvMA. Prior to his appointment in
January 2003 he was the Director of the Association of Community
Health Councils in England & Wales (ACHCEW) and chief officer
of a local CHC. As Director of ACHCEW he was closely involved
in the development of plans for the new system of PPI and the
legislation leading to its establishment and the abolition of
CHCs through work with the Transition Advisory Board, with Department
of Health officials and Ministers.
3. INDEPENDENT
COMPLAINTS ADVOCACY
SERVICE (ICAS)
3.1 AvMA is very disappointed that ICAS
has been given scant attention in the new vision for patient and
public involvement. The complaints support function of CHCs was
a highly valued part of their role, and in the debates leading
to the establishment of the new system ministers gave assurances
that ICAS would be an integral part of the role of Patients Forums,
with ICAS being delivered by staff of PCT patients forums. This
would have safeguarded the availability of a local "one stop
shop" for patients and the public. There has been strong
consensus on the need for this kind of integration. The NHS Reform
& Healthcare Professions Act 2002 made it a function of PCT
Patients Forums to provide ICAS:
16 Additional functions of PCT Patients'
Forums
(1) A Patients' Forum established for
a Primary Care Trust (a "PCT Patients' Forum") has the
following additional functions:
(a) providing independent advocacy services
to persons in the Trust's area or persons to whom services have
been provided by, or under arrangements with, the Trust; and
(b) making available to patients and
their carers advice and information about the making of complaints
in relation to services provided by or under arrangements with
the Trust, and NHS Reform & Healthcare Professions Act 2002.
3.2 AvMA believes that the failure to implement
this part of the Act has been detrimental to the ICAS service
itself and the system of local patient and public involvement.
There is no identifiable "one stop shop" where patients
and the public can go to get independent support with complaints
or concerns or get involved with local health matters. Patients
Forums are not benefiting from timely, detailed information about
issues gleaned from complaints and do not have their own staff.
3.3 AvMA, given its focus on patient safety,
is concerned that the lack of integration between ICAS and the
monitoring role of patients forums (or LINks in the future) will
weaken the potential of both to recognise potential problems and
make interventions to reduce risks to patients.
3.4 It was always accepted (both in the
debates about abolition of CHCs and in the multi-agency work of
the Transition Advisory Board) that ICAS needed to be completely
independent of the NHS and of the Department of Health. However,
ICAS continues to be controlled and directly commissioned by the
Department of Health even though its delivery is via three voluntary
organisations. Five year contracts have been awarded to these
organisations despite the fact the legislation stipulates ICAS
should be provided by PCT Patients Forums.
3.5 ICAS is also being provided in an inconsistent
way across the country by three quite different providers who
are not formally linked in any way to patients forums. There has
been no independent evaluation of the current arrangements for
ICAS.
3.6 We recommend that the opportunity
is taken in developing LINks to integrate with them the provision
of ICAS by providing them with the staff to deliver ICAS through
an easily identifiable, local one stop shop. This would have
the benefits of:
— ensuring that the monitoring work
of the LINks is informed by intelligence from complaints about
various NHS providers in their "patch"; and
— providing economies of scale and
helping with recruitment and retention of staff.
Although CHCs were under-resourced, the fact
that their complaints support function as well as the administrative/management
support for the organisation were provided by their own staff
meant that they did not have to rely solely on externally provided
data on complaints (which without fuller context is not that useful
anyway). It also meant that staff working with CHCs were able
to multi-task and support each other in the various tasks. This
made them more efficient and cost-effective than the current unwieldy
and costly system where the functions have been split up and hived
off.
4. LINKS
4.1 AvMA has a number of concerns about
the way that LINks are currently envisaged. Whilst we agree with
the importance of focussing on commissioning and taking a strategic
view on behalf of local communities, we disagree with the abandonment
of monitoring services. One of the strengths of CHCs was that
they combined these functions. The understanding of the nature
of services and patients' experience gained by monitoring them
informed the work they did on commissioning and planning of health
services. We recommend that LINks are given statutory rights
to inspect NHS providers in the same way that PPIFs do and CHCs
had.
4.2 We are concerned at the intention stated
in A Stronger Local Voice that "how members are appointed
will be decided at a local level". This is bound to lead
to inconsistency. We believe that there needs to be consistency
in the way that LINks operate including the appointment of members.
We recommend that a consistent, national approach to appointing
members is adopted, even if this is operated locally. Members
of LINks should also all be bound by the same Code of Conduct.
4.3 We believe that the proposed "tendering"
by local authorities for "host organisations" would
lead to great inconsistency and fundamentally would mitigate against
having a strong, credible local voice for patients and the public.
We have seen how a similar process for "forum support organisations"
has not worked for patient forums and in fact has diverted resources
away from the coal face. What LINks will need is to have their
own staff, for the members and staff to be part of a movement.
It is the combination of high quality, dedicated staff working
with the appointed members as part of a national movement that
made some CHCs so effective. Local organisations operating contracts
to "host" LINks will not deliver that. Such an arrangement
would also add an unnecessary extra level of bureaucracy and additional
costs. Organisations tendering for such contracts clearly need
to make additional income for the core functions of their own
organisation as well as deliver the contract. It is for these
reasons that Parliament agreed in the NHS Reform and Healthcare
Professions Act 2002 to the staff of Patients Forums being employed
by the CPPIH and deployed to Patients Forums. This is another
piece of the legislation which has not been adhered to:
20 The Commission for Patient and Public
Involvement in Health
(2) The Commission has the following
functions—
(d) providing staff to Patients' Forums
established for Primary Care Trusts, and advice and assistance
to Patients' Forums and facilitating the co-ordination of their
activities,
4.4 We recommend that LINks are provided
with their own staff (either employed through their local authority
or employed centrally by the national body and deployed to local
LINks offices) rather than putting contracts for support of LINks
out to tender.
Peter Walsh
Chief Executive
Action against Medical Accidents
January 2007
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