Select Committee on Health Written Evidence

32. Evidence submitted by West Essex PPI Forum (PPI 29)


  1.  The draft Local Government and Health Bill includes provision for the abolition of Patient and Public Involvement Forums on the basis, it seems, that Forums have not achieved the full scope of local interaction envisaged, and that when there are relatively few members there is a risk that personal agenda may be pursued.


  2.  As a Forum we have been aware of the difficulties that arise at the interface between Health and Social Care, with a division of responsibility and accountability which may often be to the detriment of the patient or client. We would therefore support measures to promote a seamless spectrum of care, particularly for the aged. It is apparent that this is the motive behind the creation of LINks, which are to be based on the administrative areas of Social Services, which are effectively co-terminous with County Councils.

  The "devil", however, "is in the detail" and there are features in the draft Bill which we believe not only to be unnecessary but actually to be counterproductive.


  3.  We firmly believe that the proposal to disband and abolish PPI Forums is absolutely in the category of unnecessary and counterproductive measures The preferred option is to retain the new Forums with their existing statutory powers and responsibilities, revise their terms of reference and incorporate these Forums as integral to the core of the larger LINks.


  4.  PPI Forums were formed after the earlier (and controversial) decision to abolish Community Health Councils. The change over has been quite difficult in some places, except where there was already in place an effective User Group. In Epping Forest this was the case, but our first Forum Support Organization went bankrupt and had to be replaced at short notice by a body with no health service experience, which in turn had also to be replaced. It took a good two years for our Forum to get "up to speed" and our experience was by no means unique.

  5.  Important Differences from CHC's were the removal of responsibility for individual patient complaints and alignment with an individual Trust.The latter change, associated with the Purchaser/Provider split caused some confusion and difficulty in situations where both PCT and Provider Forums had a legitimate interest. Cross communication and co-operation were essential, but magnified the complexity and time involvement for Forum members. As a result there has been considerable turn-over in membership of many forums, but with Forum function reaching a steady state, a nucleus of very dedicated individuals, quite often with some relevant health related expertise, has emerged.


  6.  Further local upheaval has been brought about by the amalgamation of Primary Care Trusts (13 down to five in Essex), the "scrambling" of Forum Support Organizations, and now the fore-shadowed abolition of Forums with the formation of LINks (with an elongating time scale now likely to extend to 2008). We have already seen significant "haemorrhage" of experienced Forum members, who, in spite of official protestations, feel undervalued and stifled. This means the loss of useful personal and local knowledge built up by the dedication of Forum members.

  This "haemorrhage" is likely to become a flood if confidence is not restored.


  7.  The West Essex PPI Forum, together with that of our local acute Trust (Princess Alexandra Hospital), believes that the best way to achieve the increased representation expected of LINks would be to retain the presently reduced number of Forums as the nucleus of LINks, with their statutory powers intact, but with revision of the terms of reference to remove the overlap of activity.

  8.  The locality focus of the existing Forums has made a real difference to health care. We do not see a problem with the creation of Foundation Trusts as we believe there is a need for patient and public involvement from the Purchaser/Commissioning aspect to have "arms length"" inspection and monitoring powers linked with those of the Governing Body

  9.  We understand that the Government has already indicated a willingness to consider the retention of monitoring and inspection rights, but only for a core group, properly vetted and trained. We would suggest that this could most easily be achieved by retaining the existing Forum structure as a basis. This would go a long way to alleviate concerns about the loss of vitally important "local input" into health care planning and provision.

  10.  We hope that the Select Committee will give this serious consideration before the legislation is "set in stone", and that the members appreciate that an early pronouncement could bolster morale amongst the voluntary supporters of the health service, morale which presently is ebbing steadily.

West Essex PPI Forum

January 2007

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