Select Committee on Health Written Evidence

13. Evidence from Canterbury City Council Health Scrutiny Panel (PPI 113)


  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.


  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.


  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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