Select Committee on Health Written Evidence


103. Evidence submitted by West Sussex PPI Forum Chairs (PPI 67)

1.   Does Patient & Public Involvement (PPI) make a worthwhile contribution to the NHS?

  In principle, both PPI Forums and the CHCs have provided a continuous monitoring of NHS activity. Providing that it is independent and constructive, monitoring of Trust activity allows members of the public to examine changes to services (sometimes small, but significant to a group of patients) and to identify weaknesses revealed in Board reports. This monitoring, including the ability to question directly those responsible for the service, has always been supported by the ability to inspect NHS facilities.

  An experienced PPI Forum member has been able to act as a patient advocate, particularly in areas of patient care, rather than clinical treatment.

  A particular weakness has been the inability to directly monitor GPs, who are in the main contracted to the NHS, but guard their independence vigorously. Under the existing system they can only be questioned through their PCT or inspected by QOF inspection. However even this ability may be lost under LINks.

  There are dangers of duplication, which may well place undue pressure on NHS staff. The Trusts' own PPI activity and possibly that of HOSC do, at times, cover the same ground, but lack the independence that both the CHC and PPI Forum system have enjoyed.

2.   Do PPI Forums represent the population and would LINks be better?

  The answer to both these questions is no. Inevitably the majority of members will need to have time available and the ability to understand a complex organisation. LINks may be paternalist and have a membership from those with the widest possible range of backgrounds. This has been a problem and weakness of both CHCs and PPI Forums, but there is no reason to believe that LINks would change this and there is a greater risk of potential bias.

  There has never been a rush to join either the PPI Forums or CHCs and it is difficult to see how LINks will attract a greater membership. Younger people are particularly difficult to enrol because most meetings and research work has to be done during normal working hours.

3.   Can the relationship with the voluntary sector be strengthened?

  The answer to that is that it should be. However, the CHCs were established to include direct membership of voluntary organisations and in West Sussex at least, had difficulty in recruiting people with sufficient time and interest. Our PPI Forums have endeavoured to gain support and input from voluntary organisations, but generally unsuccessfully. Voluntary organisations and their active members are concerned with their "cause". Trusts do consult and include them in specific subjects but there is no evidence to suggest that their members feel isolated from the NHS or would wish to broaden their contribution to it. They should clearly be consulted when particular services are under review eg Diabetes, Cardiac, Geriatric care etc.

4.   Is the Healthcare Commission a replacement for the present PPI system?

  No. It has a relatively small staff (about five people in our area), who examine the performance of Trusts on a broad performance basis with occasional visits or discussions. If they do inspect, it is a snapshot sample or in response to a particularly serious incident identified by the media or even a PPI Forum.

  PPI Forums provide a continuous review of services and, in particular, can identify minor problems of a very local nature. The quality of this depends on the range of contacts that PPI Forum members have in their community. However PPI Forums have the same basic objective as the Healthcare Commission and should be more closely associated with it. In particular, PPI Forums should have the right to refer problems to it, when these have not been resolved or answered by the Trusts. This is more practical than the right to refer to the Secretary of State, which should be retained as a last resort.

5.   Co-terminousity with local authorities and social service providers

  In our case this has two fundamental weaknesses. West Sussex is quite large, both in area and population (approx ¾ million), so that it is impossible to regard any patient organisation as local. However, the critical care hospitals in Brighton, Portsmouth and Redhill are, in fact, in neighbouring local authority areas while the Princess Royal in Haywards Heath is the responsibility of Brighton and Sussex University Hospitals Trust. (The other acute Trusts are Worthing & Southlands, Royal West Sussex in Chichester and the Queen Victoria Hospital Foundation Trust in East Grinstead).

  The Sussex Partnership (for mental health, learning difficulties and substance misuse) in fact covers three social service providers, East Sussex, West Sussex and Brighton & Hove. Clearly no one patient group can cover this ill-defined area, so it would naturally be organised into specific areas of responsibility. These are PPI Forums, which are about to be destroyed, even though they have developed considerable experience and strong links with the West Sussex HOSC and Healthcare Commission.

6.   Are LINks practical and credible?

  The membership and recruitment process seems nebulous, but it appears that there will be a core membership with the ability to summon into membership others who might be interested in a particular subject. LINks will not be attached to any NHS Trusts but will still have powers to inspect and presumably monitor all the Trusts within the area and those outside it who serve the population. The idea of the wider membership is presumably (and understandably) to give LINks a more democratic basis, although this is surely provided by the local authority HOSC. The range of tasks, which appears to include social services, seems far too large a burden to place on volunteers, especially those who take on responsibility. Some structure will therefore need to be created to link with particular activities eg mental health.

7.   Administration of LINks

  This is to be provided by a HOSC body, possibly part of a voluntary organisation appointed by the HOSC. Budgets will apparently be limited overall to that provided for the CPPIH, although it will not be ring-fenced. It is difficult to know whether this is practical, however there is a need to establish connections with a wide membership, to train them and to keep them informed. Our PPI Forums in West Sussex have, until very recently, been supported by a voluntary organisation (contracted by the CPPIH), over which the members had no control, either in terms of finance or the use of staff resources.

  The CHCs had a dedicated staff, with a clear budget, the whole being managed by a small group of members responsible to the Council. This was a more satisfactory and responsible arrangement. Using voluntary organisations with limited expertise in the activities of the NHS is paying lip service to voluntary organisations, which in practice is not justified.

8.   Patient Involvement in Primary Care

  There is a danger with LINks that attention will be focused on acute care in hospitals as this tends to draw the attention of both the media and the public. However, as the Government frequently emphasises, the focus should be on Primary Care and Care in the Community. GPs are mostly independent of the NHS, yet contracted by it. PPI Forums have some influence through the related PCT and should have representation on the GP Commissioning Groups which, it is assumed, will gradually assume responsibility for community hospitals and nursing services. There is no apparent provision in the LINks scheme to have even this level of influence.

  Some GPs have their own patient groups, but some of these are more like supporters' groups than constructive critics. GP practices are also subject to QOF assessments but the detailed results are confidential. Mental health services, likewise, do not attract the same attention as hospitals yet need to be carefully monitored, particularly as it is an area too often disregarded.

9.   Recommendations

(a)  Structure of LINks

  Can we find a better name? The structure needs to be better defined, in particular the exact nature of its relationships with the local authority as the social services provider and with the NHS Trusts. The problem in a large county area is different to that in urban areas. In order to engage the public some local organisation is essential, reporting to the main LINKS. In our area, the problems in Crawley, Worthing and East Grinstead will vary.

  (These questions are raised in pp 13-16 of the Government response to `A stronger local voice' published in December 2006.)

  (b)  Services should be provided by a dedicated staff appointed by the local HOSC. The management should be the Executive Manager, HOSC and Healthcare Commission representatives and three members of the LINks within the HOSC area.

  (c)  Members should be recruited locally and be appointed by a group of at least three, including the Manager and a representative of the appropriate PPI Forum.

  (d)  Training should be organised by the Healthcare Commission and should also be available to HOSC members.

  A reasonable amount of finance should be identified to publicise the existence and activities of the LINks and to establish better connections with the voluntary organisations. The aims, so far described, suggest a need for significant communication expenditure eg publication & distribution of newsletters etc.

  Members of LINks should be nominated to serve on Commissioning Groups, Primary Care Trusts and all the NHS or Foundation Trusts, which should have a responsibility to advise the LINk of any service changes. Monitoring is a two-way activity—an informed membership with wide community contacts. (see pp 26/7 of DoH response.)

  The Government response paper describes a very ambitious set of proposals, which will take time to implement and develop. It should be accepted that no significant change will be made for at least five years to give the plan a chance of success.

Stuart Henderson

Chair, West Sussex PCT Independent PPI Forum

Robin Kemp

Chair, Sussex Partnership PPI Forum

Anthony Preston

Chair, St Richards (Royal West Sussex) PPI Forum

Derek Richardson

Chair, Woking and Southlands Hospitals PPI Forum

January 2007





 
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