30. Evidence submitted by Epsom and St
Helier University NHS Trust PPI Forum and Sutton and Merton PCT
PPI Forum (PPI 93)
A. BACKGROUND
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).
B. GENERAL CONCERNS
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?
C. SPECIFIC POINTS
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
and
Nick Pizey
Chair, Sutton and Merton PCT PPI Forum
10 January 2007
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