13. Evidence from Canterbury City Council
Health Scrutiny Panel (PPI 113)
EXECUTIVE SUMMARY
1. Our submission reflects our concerns
that the suggested move to LINks representing a geographic area
based on the local authority with social services responsibility
(in this case Kent County Council) will not be able to truly reflect
the concerns of local people when it is covering a population
of 1.4 million. It also responds to the issue of funding, and
the power that will be invested in the LINk.
INTRODUCTION
2. Canterbury City Council is a district
council in the east of Kent. The district has a population of
approximately 140,000, split between the three main urban areas
of Canterbury, Whitstable and Herne Bay, with a sizable rural
population.
3. Although the City Council does not have
statutory powers to scrutinise the NHS, our Councillors take a
keen interest in health issues and see this area as fundamental
to the well-being of the district. As such the Council has constituted
a Health Scrutiny Panel which has been in existence for two years.
The panel have been involved in joint working with the Kent County
Council NHS Overview & Scrutiny Committee, and have close
ties with the relevant PCT (Eastern & Coastal Kent PCT), and
the associated PPIF.
EVIDENCE
4. We do not wish to respond to all the
points contained in the terms of reference, just the specific
terms of reference set out below:
5. What is the purpose of patient and public
involvement?
6. We consider that patients and the public
should be involved in designing and checking the services they
receive. It is only when services are designed from the perspective
of the end user that they can be truly fit for purpose. It is
often only the end user that will be able to identify areas of
weakness in the treatment they receive, this is why it is essential
that the patient and publics are involved.
7. What form of patient and public involvement
is desirable, practical and offers good value for money?
8. It is important that the practicality
of patient and public involvement is kept at the fore when designing
the new system of involvement. It is the practicality of the proposed
LINk system that has concerned Canterbury City Council Health
Scrutiny Panel.
9. Prior to the reconfiguration of Primary
Care Trusts last year the people of Kent were served by nine PCTs
and four Acute Hospital Trusts, each one with their own Patient
and Public Involvement Forum (PPIF) to monitor and help improve
the patient experience, and inspect services where relevant. In
the case of the Canterbury district this meant that a PCT serving
165,000 people (Canterbury and Coastal PCT) had a PPIF representing
the public voice, whilst another PPIF fulfilled the same role
for the East Kent Acute Hospital Trust (which incorporates our
district).
10. Moving to one body, co-terminous with
the local authority with social services responsibility, means
that this LINk will be tasked with providing a stronger local
voice for 1.4 million people in Kent. We fear that a single body
will struggle to represent the differing localities in a population
of this size. There have been occasions in the recent past when
decisions on relocation of services effectively placed the residents
of East Kent in competition with those of West Kent. It could
easily be seen that the concerns of both sets of residents would
not be taken up as they would not be of "major importance
to a whole population" (as detailed in Department of Health
publication "Government Response to A Stronger Local Voice"
p18: para 1.35).
11. It seems strange that a PCT and Acute
Hospital Trust that each cover a population of 700,000 should
not have a LINk of their own which they could turn to to ensure
the involvement of the patient and publics. The panel would like
to suggest that an alternative would be for each PCT to have an
associated LINk, which is independent, and funded accordingly.
12. The bureaucratic structure that will
need to be put in place to service a LINk serving 1.4 million
people will be large, and will hamper the speed with which the
LINk will be able to respond to issues as they arise. Also it
will, by necessity need to have a central base, which will be
difficult to access for large sections of the population. All
these elements point to a body that will be dominated by well
resourced organisations and their representatives, further reducing
the input of ordinary members of the patient and publics.
13. It would seem that the aspirations of
involving local groups as the eyes and ears of LINks will be hard
to reconcile with the size of the area and populace that they
are intended to serve. Practically it will be impossible to address
the often competing concerns of the varying local groups. It will
not often be the case that even groups concerned with similar
conditions will have the same concerns in all parts of the county.
14. Why are existing systems for patient
and public involvement being reformed after only three years?
15. The panel are concerned that there appears
to be little justification for the reformation of a system that
has been in existence for only three years, and which was just
beginning to function effectively. A further concern is the apparent
lack of planning that has seen a reorganisation of PCTs without
a simultaneous reorganisation of the patient and public involvement
bodies, this has led to a situation whereby the existing PPIFs
have had to reorganise themselves to match the new PCT structure,
at a time when their future existence is limited. This lack of
planning is further highlighted by the lack of clarity over the
timescales. Originally the CPPIH was told that it and the PPIFs
it supported would be abolished in June 2007, however it has now
been told to continue its work until at least December 2007.
16. However, the panel is pleased that the
new LINks will be urged to build on the work of the PPIFs, and
encourage an element of continuance with PPIF members.
17. How should LINks be designed, including:
Remit and level of independence
18. The panel is pleased that the remit
of the LINk will include social care as there are many areas of
overlap between health and social care, and these are increasing
all the time.
19. It is important that the LINk remains
independent of both the Health Service and the local authority
which is tasked with creating it. This is explained further in
the response to the question of funding. Despite the need for
independence, the panel felt that it would be important for the
LINk to be able to draw upon the expertise of the NHS and local
authorities.
Funding and support
20. The panel feels that it is imperative
that the LINk is properly funded to do its job. As outlined above
(para 12), the size of the county of Kent and its population size
suggest that a large supporting structure will be necessary to
ensure the LINk can even come close to being effective. Of concern
then is the fact that the Department of Health in conjunction
with the Department for Communities and Local Government have
agreed that "resources to provide for support to LINks will
be allocated as a targeted, but not ring-fenced, specific grant"
("Government Response to A Stronger Local Voice"
p14, para 1.25).
21. This lack of ring-fencing in effect
means that the local authority with social services responsibility
will be able to decide exactly how much funding the LINk will
receive. The two main concerns here would be that in a period
of financial challenge in the local authority sector (Gershon
responsibilities, Lyons review and CSR07) it is conceivable that
the full grant will not be allocated to the LINk, but may be swallowed
up by other priorities within the local authority. Also, it is
again conceivable that if an effective LINk started to raise concerns
over the social care aspects of their remit, then the local authority
could reduce the funding to that LINk in order to reduce its ability.
Statutory Powers
22. The panel feels that it is imperative
that the LINks retain the power of inspection that was afforded
to the PPIFs, and that this role, whilst complimentary to the
power of the regulatory bodies concerned with health, should be
independent of such bodies.
23. How should LINks relate to and avoid
overlap with:
Local Authority structure including Overview and
Scrutiny Committees
The panel are keen that district authorities
in a two-tier system are not isolated from the LINk system. It
is often Councillors representing district wards who are the first
point of contact for constituents with concerns. This role will
be further enhanced by the Community Call for Action which is
included in the Local Government Bill. At present it is unclear
how the relationship between the LINk and the Community Call for
Action will develop, and the panel would appreciate some clarity
from the government on how district Councillors should be expected
to work with LINks.
Canterbury City Council Health Scrutiny Panel
10 January 2007
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