Select Committee on Health Written Evidence

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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