Select Committee on Health Written Evidence

102. Evidence submitted by Westminster PCT PPI Forum (PPI 102)

1.   What is the purpose of PPI?

  The purpose of PPI is to ensure that the views and experience of patients and the public inform and influence decisions by NHS commissioners/providers about the planning, delivery and monitoring of healthcare provision.

3.   Why are existing systems for PPI being reformed after only three years?

  One of the reasons given is the need to widen the membership of PPI organisations. However, this could have been done under the existing system by having recruitment for new/expanded PPIF membership reach out to representatives from voluntary and community organisations. Another reason given is that the increasing emphasis on commissioning within the NHS requires that PPI organisations be established for a geographical commissioning area rather than for a specific organisation. That is probably valid, although it should be noted that PPIFs for PCTs (such as ours) in effect already serve a commissioning jurisdiction. A third reason cited is the inconsistency in effectiveness of PPIFs across the country. However, "effectiveness" will not automatically be improved simply by changing the structure of the PPI organisation. So in the formation of LINks, there should be emphasis not only on identifying "good practice" among existing PPIFs, but also on understanding the reasons for sub-standard performance so that can be avoided in LINks. The comments of the Expert Panel to the DH (12/5/06) that "PPI has suffered badly from ... stop-start policy" should be heeded so that LINks do in fact build on the strengths of the existing PPIF system in holding commissioning organisations to account, where such experience exists.

4.   How should LINks be designed, including

  (a)  Remit and level of independence. The remit should focus on PPI in commissioning, with the understanding that good commissioning encompasses consultation with users on planning services, performance monitoring of providers and assessing patient experience with services. We think that the proposal in the 11/12/06 DH feedback on the Stronger Local Voice consultation, to have working groups within a LINk to address the various parts of its remit— commissioning, provider monitoring, specialist providers—is good.

We think it is essential that LINks be independent of the DH, Local Authority, NHS, Host and any other organisations.

  (b)  Membership and appointments. The DH documents talk about both "organisation and individual" members of LINks, but it is not clear how these different categories of membership might work. There is also nice-sounding language about LINks being not just a group of people but "networks" and about how membership decisions will be up to individual LINks instead of being prescribed centrally. But we think there is still a big piece of work to be done on how the individual/organisational membership structure of LINks might be operationalised. We think that this needs to be addressed before LINks are unleashed to tackle this on their own. One way of doing this is to ensure that the early adopter sites go through a period of being a "shadow" LINk (as suggested in Annex A of 11 December 2006 DH document) and develop various models for membership. We reiterate our comments on the Stronger Local Voice consultation that each LINk go through a "shadow" stage, with perhaps a committee of two PPIF members who want to transfer to the LINk and the Host being responsible for selecting initial LINk members. Questions of member suitability, time availability, expertise, experience and people mix also need to be considered. In addition, we recommend that consideration be given to paying volunteer members of LINks a stipend as a way of attracting membership, particularly among younger people.

  We are pleased that the Minister's covering letter to the 11/12/06 DH document explicitly states that "it is not our intention to abolish patients' forums ... until LINks can be established." We think this is essential. However, doubt is cast on this assurance by the worrying language in para 1.10 of the DH document that refers to "minimising the gap" between systems.

  (c)  Funding and support. Funding should not be any less than at present and should be ring-fenced. We are pleased to see in 11 December 2006 DH document that detailed specifications for the qualifications and level of support to be offered by Host organisations are being developed. We note that one reason often cited for poor PPIF performance has been the poor performance of their FSOs. We think it cannot be assumed that LAs will automatically be more effective than CPPIH in selecting effective Hosts, even in view of their greater local knowledge. Therefore, this procurement process needs very careful management and guidance. We think it is essential that the LINk participate in interview panels for new Host staff and in formal assessment of Host performance.

  (e)  Statutory powers. We think that these powers should not be less than for PPIFs and are pleased to see in 11 December 2006 DH document that it has been decided to give LINks the right of access to monitor and inspect services. LINks should also have the power that PPIFs have to hold NHS organisations to account by commenting on their declarations of compliance with HCC standards as part of the Annual Health Check.

  (f)  Relations with local health Trusts. Forming a good working relationship with local health Trusts is desirable to permit joint working to improve PPI and the quality of health services. LINk members should participate, as PPIF members do now, as "critical friends" on Trust Boards, committees and working groups.

5.   How should LINks relate to and avoid overlap with

  (a)  LA structures including OSCs. LINk members should not be members of OSCs but should be given the opportunity to contribute to OSC investigations. LINks should retain the same ability to refer issues to OSCs that PPIFs now have. In this regard, we are concerned that section 157 of the Local Government and Public Involvement in Health Bill provides for referral of social care matters to the OSC but not healthcare matters.

  (b)  Inspectorates including the HCC. LINks should be given the opportunity to contribute to HCC and other inspections.

  6.  Wider public consultation (including section 11). The requirements now placed on Trusts to consult with patients and the public on planning and proposing changes to healthcare services should remain. This should include the opportunity for LINks to provide a formal response to such consultations. LINks should build on and strengthen existing PPIF work to hold NHS organisations to account for conducting —and acting on—appropriate consultations under section 11. While we are pleased to see inclusion in the Local Government and Public Involvement in Health Bill of section 163 regarding the duty of NHS Trusts to consult about planning/changing health services, we are concerned that the language refers only to "significant" changes, thus potentially diluting the effect of the current section 11 duty.

Tera Younger

Co-Chair, PPI Forum for Westminster PCT

Brigitta Lock

Co-Chair, PPI Forum for Westminster PCT

10 January 2007

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