Select Committee on Health Written Evidence

30. Evidence submitted by Epsom and St Helier University NHS Trust PPI Forum and Sutton and Merton PCT PPI Forum (PPI 93)


  Forum members from Epsom and St Helier University Hospitals NHS Trust and Sutton and Merton PCT PPI Fora have agreed on this response regarding the proposals in the DoH Document "A stronger local voice" to abolish Fora (and CPPIH) and replace them with Local Involvement Networks (LINks).


  Before listing our specific concerns we wish to make some general observations. There is much talk, and presumably some intention, to provide a "Patient Led" NHS. However in the area served by our Trust/PCT (ie the London Boroughs of Merton and Sutton and a goodly slice of Surrey) there is great concern amongst the general public, patients and staff about the direction of future health care. We appear to have abandoned an exciting re-organisation (known hereabouts as "Better Healthcare Closer To Home"), the Trust CE has departed abruptly and both the Trust and PCT face massive financial deficits.

  In response to this we are aware of three potentially conflicting "strategies":

    (1)  At the highest level we read of the Department proceeding with plans to focus on Regional Centres of excellence, in addition to reducing the number of A&E departments nationally.

    (2)  At the Regional level we know London Region is processing a strategy which is rumoured to consider there are "too many" hospitals in (South West?) London (we also know the South Coast Region are contemplating "re-organisations"/closures?) across Surrey.

    (3)  Locally the Trust is re-organising to both put its own house in order and respond to financial pressures. Thus it has re-aligned emergency and elective surgery, and is moving on to change Women's & Children's services. Further changes involve the introduction of cold meals and improving patients' Length of Stay.

  The point we want to make to the HoC Committee is that we do not see how Patients can directly influence any of these decisions? Of course when a change is considered a "significant change of service" (and this is undefined) we enter a period of (imperfect) public consultation. However the Committee will appreciate the patient and publics are only being asked to discuss what has already been determined and/or decided!

  Empowerment (or a patient led NHS) needs to address this and also the welcome proposal that the HealthCare Commission Healthcheck evaluate exactly which changes have been made as a direct result of public/patient suggestions?


  The purpose of LINks, as stated, is to create a larger group involving wider representation of patients/public/community. (eg MENCAP/Age Concern/Pensioner's Forum). This larger group, the LINk, will be organised along Local Authority (LA) boundaries (where the LA has responsibility for social services): One LINk for each LA.

  This implies that the Fora have been unsuccessful in fulfilling their remit to engage with the community, and to reach especially the disadvantaged and marginalised. In our experience, that same aspiration applies to the work of a plethora of public statutory and voluntary agencies. We have all made attempts to broaden involvement in this way, with disappointing results. This is not for lack of effort, so we wonder what is being built in to the LINks' initiative to give it a better chance of success in this context. Why could the same resources not have been applied to the existing PPIF structures instead of the expense to be incurred in dismantling CIPPH/PPIFs and creating another forum to do similar work?

  The proposal to establish LINks co-terminus with LAs, is going to leave hospital trusts in a very curious position. One of the PPIFs contributing to this response currently has a direct and sole responsibility to work alongside the Epsom & St Helier Hospital Trust as a clear independent voice for patients and the public who come from a number of neighbouring PCTs, (and some others further away whose GPs recognise the specialisms of the hospitals and what they offer their patients). The majority of patients, however, come from the Sutton & Merton PCT, or the Esher and East and Mid Surrey PCT localities. The existing two-way pull on the Trust will become greater, particularly, as the main existing acute hospital (St Helier) is at the northern end of a long narrow Trust area remote from its Surrey residents. The need will be, therefore, for the public in all the Trust area (ie both London and Surrey ends) to be represented by a body capable of putting forward coherent Trust-wide representations. This is preferable to three separate LINk bodies one of which, will be occupied with much wider responsibilities, including another major hospital Trust, thus reducing its focus on the E&StH Trust.

  Already the Surrey end is under-represented in the Epsom and St Helier Forum and it has been exacerbated by the re-organisation of Surrey into one huge PCT. The current proposals do not appear to be designed to give the Surrey end a more balanced representation. If anything, it is likely to have a weaker (less-focused) voice to the detriment of the residents of the Trust's Surrey end.

  The assumption appears to be that this LINk would be properly funded (up to £150K) and organised (eg in our locality by a well staffed "Sutton CVS"), hopefully with a prominent and visible LOCAL presence.

  However our discussion decided:

    —  the new larger group (LINk) might have more clout; but

    —  would be more difficult to organise;

    —  would have more diverse views; therefore

    —  more difficult to determine/agree priorities, prepare action plans etc.

  One problem our existing Fora anticipate is: that if we are to be de-coupled from our existing organisational responsibilities(Trust & PCT), and the LINk is based on a (social services) Local Authority, this could lead to the creation of up to three (rival?) LINks (eg a Sutton LINk, a Merton LINk and a Surrey LINk). The Trust, which is retaining responsibility for Sutton AND Merton, might not appreciate having to deal with all this.

  As a consequence of this de-coupling it appears the LINk is to focus on the health and social care needs of the community, and the range and quality of the "providers". The present activities of inspection and visits will be removed. The intention is that in future this "inspection" work will be undertaken as part of the Health Commission Healthcheck. This is a waste of two and a half year's work when the Epsom & St Helier Hospital Trust Forum has formed an excellent relationship with the Trust, and carried out several "visits" to specific units/departments of the hospital(s). Our members enjoy the visits and contacts with patients to discuss aspects of cleaning, catering and care. There will be a sense of "loss" which will influence members' desire to continue. Even so current members have been dissatisfied and frustrated by the lack of time and resources to enable them to carry out this important "hands-on" monitoring aspect of their role. There is a danger that the new proposals will produce an even less effective and meaningful system and, not as is implied, a stronger one.

  There is an existing (Section 11) responsibility for Trusts to involve and consult PPIF in the planning and development of health services and how they operate. The impression from the latest document is that the Commissioning of local health services (by a variety of bodies eg PCT and PbC) from a variety of providers (eg EDICS and ESTH) will be monitored by the LA Overview and Scrutiny Committee. The LINk's work will be focused on monitoring the effectiveness of the delivery of these (commissioned) services, referring concerns (as now) to the OSC.

  Each Forum currently wades through masses of paperwork and other material such as emails which CPPIH appears to produce quite regularly but not always in a focused fashion. This is often background information which requires sifting and analysing. The local Forum Support Officer has introduced a system of alerting us to relevant material without inundating us with it. However, it has taken time for this system to evolve and depends on the Officer understanding and appreciating our roles and responsibilities. The LINk will likewise be required to analyse and interpret a great deal of information—eg patient surveys, local experiences, and community priorities. This monitoring of "delivery" (by provider A) would seem at variance with the need to decouple from provider A. In any event cutting back on resources will result in the new body being unable to do its work actively.

  Presumably the new PPI Resource Centre and Social Care Institute for Excellence (SCIE) may assist in research but clearly each LINk will need a properly funded research person, in addition to a person devoted to identifying relevant community groups and visiting them to publicise the LINk and establish the issues that need to be discussed. This is much more of a community development role and certainly not just an administrative function.

  The emphasis on the OSC involvement with Commissioning implies the OSCs will be trained in this topic. LINk training on Commissioning, the financial arrangements of the NHS and the Resource Centre is also vital.

  Our Fora have been actively involved in several far reaching public consultations and "Open Days". It is unclear how future LINks might be active in this way?

  Local Authorities are required to arrange the tendering process for the new "FSO" activity. We feel strongly that the people for whom this FSO function is to benefit, should be involved in the tendering process also. Are the present Forum/LINk members to be involved?

  There appears to be no direction or guidance in place or in the pipeline regarding the practicalities of how the LINk will be convened, managed, function on a day to day (or periodic) basis. If the new FSO (equivalent) is to determine this, it is all the more vital that the PPIF/LINk members have a say in how this is organised. At very least, those members of our Fora who have stayed the course, have acquired a great deal of working knowledge about the complex nature of the Health Service and the procedures and processes employed locally to ensure it functions adequately. It will be a massive waste of public resources if this experience is now jettisoned.

  With a new (London) Strategic Health Authority, new PCT boundaries and responsibilities and new providers emerging one can see some logic in having a "new PPI"? However an alternative might be to maintain an element of continuity by using the contacts and experience of existing PPI structures and persons as the kernel of new activity?

  The document concludes by mentioning a new National Network (how will this relate to the evolving PPI Forum network?) and the need for "users" (is this newspeak for patients?) to be more involved in regulation? Both topics need further explanation.

  This review of the functioning of Fora need not have resulted in their execution. We have indicated several reasons for believing that PPI Fora have accumulated a great deal of relevant knowledge and skills and are a resource too valuable to discard.

  What the reorganisation does provide is the opportunity to look at the multiplicity of patient and specialist representative groups before the PPIFs came into being. Our PCT had already launched its own PPI in common with any other PCTs and Trusts. Inevitably there has been lack of clarity regarding the roles of the different bodies and potential confusion about responsibilities and authority.

  A very positive statement (on p 18) is that "commissioners will publish regular reports of WHAT THEY HAVE DONE DIFFERENTLY as a result of what they have heard (from LINk) and say WHY they might not have taken forward some (LINk) suggestions.  

  We look forward to seeing the first of these reports and noting how things have improved.

Jas Weir

Chair, Epsom & St Helier NHS Trust PPI Forum


Nick Pizey

Chair, Sutton and Merton PCT PPI Forum

10 January 2007

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