31. Evidence submitted by South East Essex
PCT PPI Forums (PPI 136)
1. What is the purpose of patient and public
involvement?
The members view is that their primary purpose
is to be aware of the health needs of their local population,
to communicate these needs to the relevant organisations, and
to assist all organisations connected with the provision of local
healthcare services to match those needs in a timely, affordable
and practical fashion. This assistance will include advising these
organisations on the steps needed to be taken to assist the local
population to manage their own and their families heath and to
"live healthily". Members are expected to be aware of
the needs of all groups including and not limited to ethnic minorities,
young people, the elderly, hard to reach groups including commuters,
a particular problem in south east Essex.
In detail:
— To provide help with the design of
services and commissioning.
— Ensure that the right services are
developed and result in the best outcomes for the local population.
— To capture experience of using services.
— To hold the local services to account.
2. What form of patient and public involvement
is desirable, practical, and offers good value for money?
Members believe that the present model, that
is the local patient and public involvement forums in southeast
Essex fulfil these criteria. Members believe that their remit
needs to be expanded to include social care. Members are not paid
for their work. They are dedicated to the task of improving local
health. They are effective. They have many years of valuable experience
of the local area and service providers and their organisation
works. The costs of running the forum is low and is confined to
members' expenses, which are modest, the forum support organisation,
space, and office equipment. We understand that the forum costs
are approximately £30,000 pa Members do not need an expensive
headquarters organisation to support them, just good locally provided
support. It has taken about three years to reach this position.
On the grounds, if it is not broken, don't fix it; members believe
that with some relatively minor changes, the current model can
be made even more effective.
3. WHY
ARE EXISTING
SYSTEMS FOR
PATIENT AND
PUBLIC INVOLVEMENT
BEING REFORMED
AFTER ONLY
THREE YEARS?
Members consider that they have done a good
job and are becoming more effective with the passage of time.
Members do not understand why their forum is perceived to have
failed and consequently are unable to answer the question with
authority. To the members, it is change for change sake. Members
are even more mystified why a change is being proposed when the
replacement organisation has not been defined
4. How should LINks be designed, including:
Remit and level of independence
The remit must include social services in a
similar way to health services. Members get similar numbers of
complaints about social service provision as they do about NHS
service problems. The boundary between health services and social
services strikes members as artificial, and not helpful to the
local population. Otherwise the remit should be similar to that
of the existing forum remit. Members believe that they should
not have conflict of interests which in any way reduces their
independence from local service providers (including charitable
organisations) and local pressure groups including local politicians.
Membership and appointments
Members are not happy with the present arrangements
for appointments. Members are aware of the long period of time
taken by CPPIH to appoint new members and believe that a local
mechanism has a lot to commend it. Ideally, forum members would
like to see a local democratic process to recruit members and
for forum members to be part of the selection process. We suggest
that we should work with the local voluntary organisation to advertise,
select and recruit. The evidence suggests that this process has
worked well. The process of recruiting can be modified with experience
gained.
Funding and support
Note forum includes LINks or similar title.
Each forum should budget its proposed costs,
then hold its own budget and report on expenditure and achievement
annually. The funding should cover: rental and operation of premises—a
small office and meeting room, forum support (usually one person
with limited arrangements for cover of holidays and illness),
office equipment including Internet access, stationery, postage,
telephones, lighting, heating and cleaning. Sharing premises with
a local charity would make a lot of sense. The forum will also
need capital for office equipment and running investigations.
The local authority seems the best organisation
to provide this money. We believe that there could be problems
with this arrangement, but alternatives seem potentially worse.
We believe that the Department of Health would be unwilling to
provide monies without an excessive amount of "red tape".
We believe that it would be sensible to gain
charitable status so that we would be able to raise money to support
the work of the members. We envisage it would take time and effort
to make this work satisfactorily and we would need pump priming
to get going.
We believe that the Department of Health might be
willing to pay for patient and health and social service surveys
and this source of revenue could be developed with time.
Areas of focus
— The patient journey experiences.
— Experiences of social services.
— Assisting with establishing practice
based commissioning.
— Reducing health inequalities.
— Determining local health issues and
recommending corrective action.
— Capturing and analysing the patient
experience and reviewing this with the relevant organisations
and follow up where necessary.
Statutory powers
— Similar to those of the patient forums.
— Sight of contracts for practice based
commissioning (subject to non-disclosure agreements).
Relations with local health Trusts
— Access to Directors, Chief Executives
and Chairmen.
— Work in partnership where possible.
National co-ordination
— Minimal—restrict to codes of
conduct and functional guidance. The emphasis is local at all
times.
— Informal links to other Forums.
5. How should LINks relate to and avoid overlap
with:
Local Authority structures including Overview
and Scrutiny Committees (OSCs)
As now. Work together. Forums pass issues to
the OSCs. OSCs get evidence from forums. Discuss common issues.
Forums second members to OSCs with non voting rights.
Foundation Trust Boards and Members Councils
Formally via the PCT and informal contacts.
Inspectorates including the Healthcare Commission
Pass reports on local experiences to the Healthcare
Commission.
Meet with the Healthcare commission when the commission
requests a meeting. Have a formal agenda and respond to requests
for information in a reasonable timeframe.
Regular contact with the commission to understand
commission objectives.
Report on the commission to the Department of
Health.
Formal and Informal complaints procedures
We believe that the existing mechanisms are
basically sound. Members should pass problems to the appropriate
PALS (as now) and refer complaints to ICAS (as now). We are aware
of public concern about complaints procedures, but believe that
with the current changes in the NHS, that all trusts will become
more responsive to complaints and for our members to get in the
way of this change will be unhelpful. Our role should be to provide
an evidence based big picture and not be another complaints handler.
Trusts will need to get their acts in order to maintain income.
We believe that this will result in the best outcome for all (patients
and care providers). We would like to see all trusts welcoming
complaints as a form of low cost marketing information and not
as a cross they have to bear.
6. CONCLUSION
Patient Forums are not perfect, but they are
not beyond repair.
To replace them with another organisation when they
have just got going is unhelpful to patients' interests.
Members agree that social care must be added
to the responsibilities of the forums. Members are already involved
in this area and can absorb the additional work.
Members believe that local is best and that
national organisations are unhelpful.
Members understand local issues. Use them where
they can be most effective.
Members believe that wider consultation under
Section 11 would be helpful and this should be performed now.
Harry Chandler
South East Essex PCT PPI Forum
January 2007
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