137. Evidence submitted by Mike Tiernan
(PPI 110)
1. Focus of this Response
This response deals with the three initial broad
questions posed by the Committee, and touches only briefly on
some of the more detailed questions. The original consultation
on the "Stronger Local Voice" proposal has already produced
a wide response to many of the detailed issues but this Inquiry
has introduced these three fundamental and very pertinent questions
which the original consultation largely overlooked.
2. Source and Perspective of this Response
The writer is a Mental Health Service User Involvement
Coordinator employed by a PCT, with four years experience in this
post and six years in a previous post as Service User Involvement
Coordinator employed by a specialist Mental Health NHS Trust.
The views are those of an individual, but are reflective of many
people working in the field. The absence of any notification of
this Inquiry through expected channels such as CSIP/NIMHE has
precluded a collective response.
3. What is the purpose of patient and public
involvement? Also, to what extent is it being achieved?
PPI has several key purposes, with varying degrees
of value, feasibility and success. The DoH sentence, "service
users should be centrally involved in the evaluation, monitoring,
design and delivery of services" includes two of the most
important (evaluation and monitoring) plus two of the most difficult
(design and delivery). Evaluation and monitoring are the most
successful functions, but following through on rectifying deficiencies
is more problematical. Design of services in true partnership
with service users is in reality quite rare. Its feasibility is
restricted by; the limited capacity (in terms of numbers) of service
users motivated to be involved, power structures which are inherently
(though usually subconsciously) not really receptive to it, and
power structures working in a top-down system in which transformative
decisions are the exception rather than the norm. Delivery of
services by service users, although still very rare, is usually
very effective, eg service user run crisis houses.
Accountability to patient and publics, in terms
of participation and transparency, has been successful at changing
the previously endemic reluctance of organisations to disclose
the motivations behind their decisions.
4. What form of PPI is desirable, practical
and good value for money?
In the context of mental health and some other
specialities the soon-to-be dismantled system of independent PPI
Forums covering a NHS Trust footprint fulfilled these criteria
and should have been built on and extended, perhaps by linking
the Forums to the relevant Overview and Scrutiny Committees. Setting
up regional PPIFs with a statutory right/duty to report to the
regional SHAs would have been an effective next step towards a
national Forum.
Many people working in the field regard this
as a missed opportunity which will result in a "weaker local
voice" and a continued absence of a regional or national
voice for patients and public in mental health. The mental health
perspective will be diluted by:
(a) being subsumed by a generic Links Forum
and a generic Overview and Scrutiny Committee; and
(b) multiple smaller Links Forums which will
have difficulty, and perhaps no incentive, in working together
over a Trust footprint.
Building on the existing system would have been
more effective and more cost effective than the new system. If
the government persists in the new system, quite intricate, costly
and burdensome linkages would need to be in place to retain the
benefits of the previous system, let alone to improve on them.
Independent PPI Forums, working alongside other
patient and carer groups, have had moderate success in spite of
difficult circumstances. Mental health service user groups have
long advocated for support in facilitating regional and national
channels so that those many aspects of service design and quality
which can only be influenced at a national level would have better,
more regular and statutorily supported access to the real views
and suggestions of service users. An opportunity to move closer
towards that has been missed. Even acknowledging the one positive
benefit of a statutory link to OSCs it is difficult to see how
this proposal is even as good as "three steps forward and
two steps backward".
5. Why are existing systems for PPI being
reformed after only three years?
Why indeed? Only the government can answer this,
but the rationale in the "Stronger Local Voice" document
does not present a cogent argument. The government's continued
emphasis on the local dimension, whilst perfectly legitimate,
is often at the expense of the wider regional and national dimension,
through which alone certain things can be changed.
Certainly, for evaluation and monitoring the
local dimension is paramount, but for effecting significant change
in service design the sub-regional and national arenas are crucially
important. Ever since its inception patient and public involvement
has suffered from fragmentation, but Trust footprint based PPI
Forums were an effective step in the right direction. That step
is about to be reversed and it is difficult to see how that can
benefit even the generic acute hospitals services, let alone the
mental health sector.
After a sustained period of increased investment
in mental health it would have been wise to build on effective
patient and public participation and scrutiny to ensure that money
was achieving the desired improvements. The fait-accompli manner
of consultation on this proposal (which asked basically how it
should be done rather than asking whether or not it should be
done) causes widespread perceptions of either ambivalence or poor
judgement.
Mike Tiernan
Voices in Partnership Coordinator
10 January 2007
| 
