121 Evidence submitted by Tony Fletcher,
Scout Enterprises (PPI 60)
Over the last two years we have operated in
an atmosphere of uncertainty about the future of PPIF's, and the
wider purpose of Patient and Public involvement. I have witnessed
an array of ideas and possible solutions from the DoH, none of
which have yet to come to fruition.
The level of details about how Local Involvement
Networks (LINks) will operate (and be judged to be successful)
seems to be rather vague. Membership is intended to cut across
a wide spectrum of areas, and may vary from individual members
to those with organisational interests. In my experience of PPIFs,
governance arrangements have been key to underpinning their success,
along with a clear and achieveable work plan. Under the current
proposals (and I apologise for paraphrasing this description of
partnership) it seems to be the indefinable in pursuit
of the unachievable.
As you will see from the attached information
provided there are still many questions arising from the proposals
for LINks. However I do feel FSOs are uniquiely placed to assist
in overcoming these and making any new system a success.
I sincerely hope that your inquiry will be able
to deliver its terms of reference, and that Patient and Public
involvement in Health will once again be seen to offer good value
for money to the taxpayer.
1. Summary
1.1 In March 2005 the DoH published its
response to the consultation exercise on the Future support arrangements
for PPI in Health (gateway ref: 4629). Within it were very clear
ideas for the future direction of Patient Forums after the abolition
of CPPIH. The NHS Appointments Commission was to recruit members
and in particular appoint Chairs. FSO contracts were to be awarded
on a regional basis and Forums were going to be reconfigured into
PCT areas. It even set out a timetable for the process to follow
from May 2005 to August 2006.
1.2 However by the time the "expert
panel" arrived in February 2006 the whole document appears
to have been shelved, and we are now facing nowhere near the level
of detail previously shown. It feels like any lessons learnt from
the abolition of Community Health Council's (CHC's) have been
quickly forgotten.
1.3 The DoH need to recognise that Forum
Support Organisations are uniquely placed to support LINks, and
continue the development of a Stronger Local Patients Voice. They
have the relevant experience and potential to guide LINks through
their developmental stages into becoming successful organisations.
2. Introduction
2.1 I am a Manager of a Forum Support Organisation,
which has been providing support to 19 Patient Forums across the
South West Region since September 2003.
2.2 We set up and ran these Forums in four
contract areas (Cornwall, Plymouth, Gloucestershire and Bristol)
with a range of skilled staff from both NHS and other professional
backgrounds. I set out to employ such people as I felt a combination
of experience would prove valuable in performing a support role.
This has proved its worth over the last three years and I feel
has contributed significantly to our success as an FSO.
3. Information for the Committee
3.1 FSO's provide and maintain the direct
support for Forum members. This support is now increasing as the
result of CPPIH greatly reducing it's staffing complement. Governance
issues are now expected to be dealt with locally by FSO staff
rather than previously by CPPIH staff. Whilst this may help develop
our expertise, it presents a fundamental shift in our relationship
with the members.
3.2 PPIF members receive a "postcode
lottery" of support due to the original process of competitive
tendering. All FSO's now having a national service specification
yet receive very different amounts of money to perform those duties.
I welcome the idea of having a transparent process that allocates
money to an area on a clear formula, with the emphasis on the
"Host" organisation to prove its added value as an established
organisation.
3.3 What is the financial benefit to the
tax payer of the new system? Given the costs of dismantling CHC's,
setting up CPPIH (and now running that down), Parliamentary time
for setting up LINks, transition costs etc, these must be considerable.
It is the DoH's stated aim that there must be evidence that their
policy's will improve the delivery of Health and Social care.
Where is the evidence to say PPIF's have failed?
3.4 FSOs have built up the relevant knowledge
and structures that should be used for future support of LINks.
Any loss of this expertise will severely curtail the development
of LINks and presumably the Governments desire to strengthen the
Patients voice.
3.5 Can a "Host" organisation
have the relevant infrastructure to support LINks at a local level?
Until recently (2005) the DoH was advocating regional contracts
for FSO's on a similar model offered to ICAS providers. The tension
in the new system will be the ability to provide a service that
can reflect local knowledge and expertise, with an infrastructure
to support a wide range of functions.
3.6 We have been through extensive performance
monitoring exercises but have never been asked to monitor Forums
performance. If LINks are to be seen to be successful by patients
and public they will need to have well publicised critical success
factors. Who (and how) will performance manage LINks?
3.7 CPPIH are now the largest FSO with their
in-house teams, which is testament to the failure of numerous
FSO's to provide an acceptable level of support. It is also indicative
of a systems failure that would have ensured they were better
prepared to support members correctly from the out set. By setting
out a clear service specification for the new Host organisations
which builds on the best FSO performance, this could be prevented.
3.8 FSO tenders are now extremely short
term (the latest being six months) and so it's very difficult
to recruit and retain staff. This will never enable support organisations
to provide a consistent and professional service to its membership.
4. Recommendations
4.1 In order for LINks to be professionally
supported there needs to be absolute clarity about the roles and
responsibilities of Host staff.
4.2 There needs to be reliable financial
information about the budget available and clear lines of responsibility
for its expenditure.
4.3 A clear governance structure needs to
exist for each LINk to ensure a fair and transparent approach
is adopted and maintained across the country.
4.4 Existing skills/staff should not be
lost to future Host organisations due to the inability to plan
for a proper transition, and allow continuity across the two systems.
4.5 Contracts will need to be of at least
three years duration with an agreed inflationary uplift.
Tony Fletcher
Forum Support Organisation Contract Manager
Scout Enterprises
9 January 2007
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