Select Committee on Health Written Evidence

122. Evidence submitted by Trevor Gash (PPI 146)

  I am submitting this response as an individual, but notify you that I am Chairman of the PPI Forum for the Luton and Dunstable Hospital.

  An issue, which is not offered for consideration is the proposed title for the new organisations. At a recent "Getting ready for LINks" event I tested the matter with various Local authority, FSO, NHS, voluntary organisation and Forum colleagues and received a unanimous agreement that it follows the pattern of both preceding organisations in conveying little or nothing of the role or purpose to the public.

1.   What is the purpose of patient and public involvement?

  1.1  It should provide an effective replacement in public services of the customer power exercised through purchasing choice in a free market.

  1.2  It should represent, as far as practically possible, the balanced view of the population within an area and not an assembly of the views of special interest groups.

  1.3  It should be a voice for patients in all matters of concern other than issues of individual complaint.

2.   What form of patient and public involvement is desirable, practical and offers good value for money?

  2.1  Volunteers recruited after widespread, clear and honest publicity working within a professionally managed organisation under uniform systems and codes of practice.

  2.2  Organisations with which commissioners and providers are obliged to engage in a meaningful way in clearly understood areas of involvement.

3.   Why are existing systems for patient and public involvement being reformed after only three years?

  3.1  Because of substantial mismanagement by Government/Department of Health from the outset evidenced by decision to abolish Commission just five months after setup of Forums and inability of DoH to understand frontline reality, most clearly indicated by John Reid statement relating to MRSA policy.

  3.2  Absence of material and productive input from the Director of Patient and Public Involvement in Health.

  3.3  Absence of compulsion [on a level of importance equivalent to targeted functions] on NHS Units to fully and actively engage with Forums.

  3.4  Confusion with regard to the roles of other organisations in the matter of representation.

4.   How should LINks be designed, including

Remit and level of independence

  4.1.1  If the declared aim of an integrated approach is to be achieved, then remit should include all areas of healthcare and healthcare related social care, even if, direct involvement is proscribed as is claimed to be for valid reasons in regard to Children's Trusts, so as to avoid failures at margins or interfaces.

  4.1.2  Whatever associations Members have, LINks should be totally independent of NHS, local authorities, voluntary organisations and special interest groups.

Membership and appointments

  4.2.2  Membership should be confined to individuals, it is totally unacceptable for organisations to be members.

  4.2.3  The matter of CRB checking in relation to the very necessary right of entry and possible contact with vulnerable individuals, suggests that two classes of membership should be available so that those who chose not to be involved in "monitoring" are able to do so, but clearly identified.

Funding and support

  4.3.1  Funding must be on a uniform basis, achieved by whatever bureaucratic, but transparent process is available, but a review should be undertaken to establish the appropriateness of adjusting local funding within a national framework to account for matters such as the additional costs involved in translation work in areas of high ethnic diversity/recent immigration.

  4.3.2  Support organisations should have to demonstrate a sound basic understanding of the structures, systems etc with which members have to engage.

Areas of focus

  4.4  No comment

Statutory powers

  4.5.1  The right of entry has apparently been accepted. It is essential.

  4.5.2  All commissioners and providers should be compelled to operate under an obligation of ongoing informal consultation as well as substantial change and major public consultation rules.

  4.5.3  Guidance/rules should make it clear that normal route of referral to DoH or Monitor should be via Overview and Scrutiny, but option should be available for time critical issues to be referred directly.

Relations with local health Trusts

  4.6.1  Obligations to achieve a "social contract" with Trusts should be incorporated, forcing Trusts to fully engage with LINks and obliging LINks to behave considerately, constructively and consistently with Trusts.

  4.6.2  The Health Select Committee should review the DoH policy in this area. Inverted logic seems to be applied in regard to the impact of "Choice". Specialist Hospitals with national catchments and Ambulance and Mental Health Trusts with catchments crossing local authority boundaries seem ill-served.

National coordination

  4.7.1  Unlike a number of Forum Members, I do not perceive a need for a significant organisation, but a small secretariat able to collate input, identify nationally shared significant concerns, facilitate liaison and report to DoH or Monitor or issue Press Releases on a national basis on such issues could be valuable.

  4.7.2  KMS has been a cumbersome disaster, but a national website within which individual LINks would have pages reached via a search on the homepage or direct keying [eg] plus a site purely accessible to LINks for seeking those with similar experience for example administered by the Resource Centre would be very valuable.

5.   How should LINks relate to and avoid overlap with

Local Authority structures including Overview and Scrutiny Committees

Foundation Trust boards and Members Councils

Inspectorates including the Healthcare Commission
  5.1.1  The roles appear distinct: OSC—review of substantial changes

Trust Boards & Members Councils—service delivery

Inspectorates—achievement of professional standards

Local authorities & PCTs—adequate provision of care

LINks—representation of public interests/concerns

  So long as each is charged with recognising and respecting the roles of the others and obliged to work cooperatively the matter should be clear.

  5.1.2  There is no mention here or in the "stronger local voice" procedure of the patient focus/representative etc. groups established by GP practices and Hospitals. Since these are not independent they should be seen as valuable assistance to the provider and not adequate discharge of PPI responsibilities. They have been a good option for those not wishing to take on the more arduous responsibilities of Forums and may offer recruitment opportunities as indicated in 4.2.3. It is their role that needs definition in NHS guidance or in legislation.

Formal and informal complaints procedures

  5.2.1  The starting point should be the NHS complaints procedure, which fails patients in a significant way. Patients should be able and encouraged to make "comments" about matters good and bad. The system should make it easy for this to be done at the time of treatment/care or later. Where individual case facts are not relevant matters should be pursued on anonymous basis. Patients should be made aware of LINks and given the opportunity to pass details [anonymously if required] for the possible future benefit of others.

  Internally, adverse comments should be given equal status for statistical and review purposes as complaints. Formal complaints should be distinguished only for procedural purposes. All "complaints" should be reported anonymously in a statistical analysis that is adequate enough to give a reasonable picture of area and type of complaint and response time. The report should be made regularly to the appropriate LINk.

6.   In what circumstances should wider public consultation (including under Section 11 of the Health and Social Care Act 2001) be carried out and what form should this take?

  6.1.1  The matter of significant or substantial is well understood at the highest level in the NHS, but not apparently in some areas, if proper dissemination of the principle takes place, the first question is answered. The form should always be—for engagement at the earliest practical opportunity, with communication in plain English in as brief a manner as reasonably describes the issues. At that time or shortly thereafter, supporting facts, opinions, statistics etc. should be provided. Where it is evident that consensus exists opportunities to curtail procedures should be available. All authorities should be encouraged to explore more enterprising ways of notifying the public.

Trevor Gash

Chair, Luton and Dunstable Hospital PPI Forum (comments are made as an individual)

January 2006

previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2007
Prepared 6 February 2007