34. Evidence submitted by Gateshead Hospitals
PPI Forum (PPI 2)
1. What is the purpose of Patient and Public
Involvement?
To ensure that delivery of health services meets
local needs & desires and is not solely subject to national
targets and directives.
2. What form of PPI is desirable, practical
and offers good value for money?
A system which allows local people to be involved
in:
— Determining local priorities.
— Mapping existing provision and
identifying gaps.
Designing the service specification—including
methods & locations for service delivery, as well as quality
levels and monitoring.
— Includes significant lay involvement
in the actual monitoring of the services.
This obviously requires a fairly small group
of people with knowledge of the local health economy, supported
by paid staff, who can interact with a wide range of people and
bodies.
Value for money is a relative judgement. If
the government believes—as it claims—that local people
are best placed to determine what health and social care needs
exist, then it has to pay a reasonable sum to ensure involvement
is effective. This is surely better value than the amounts which
are spent on external consultants whose reports rarely fit into
local needs.
Expenditure on supporting the Commission for
Patient & Public Involvement and PPI Forums has been significantly
reduced in the last year and is further reducing in 2007. This
is significantly weakening the resolve and capability of PPI Forum
members.
3. Why are existing systems for PPI being
reformed after only three years?
No idea!!
There is considerable evidence that PPI Forums
were beginning to make an impact locally, regionally and nationally.
If there are parts of the country where PPI is not as effective
as it is elsewhere the effort should have been put into improving
these areas—not destroying the rest of the system.
In addition to the actual impact on health service
provision PPI Forums are also increasing their contacts with local
groups, effectively creating the networks that LINks are designed
for.
CPPIH and Forums were destabilised from the
beginning with the Dept. of Health announcing a Review of Arms
Length Bodies just after Forums were formed. Almost as soon as
this announcement was made there were rumours that CPPIH would
be abolished and Forums were facing an uncertain future.
PPI should have been given at least five years
to mature and make the desired impact. The NHS is a very complex
structure and the vast majority of people have no idea of the
difference between primary and secondary care. They are not even
concerned about this distinction and, as far as they are concerned,
they deal with the NHS as a single body. If significant changes
about the way the NHS works are being introduced—as is the
case—and more emphasis is being put on "local"
services, it becomes obvious that patient and public input needs
to come from people with a reasonable understanding of the implications.
In many cases this means PPI Forum members who have spent 3 years
building up knowledge.
4. How should LINks be designed?
Remit and level of independence:
— To identify local priorities
and concerns;
— To be totally independent of
both the NHS and local authorities, so that the public perception
is that LINks are there to represent them and not the vested interests
of public bodies or politicians;
— The remit and responsibilities
should be made clear from the outset because they will in part
determine the structure and organisation of LINks and affect how
membership is determined .
Membership and appointments:
— Membership should be open to
anyone who has knowledge of, or an interest in, local health service
delivery;
— However, members should have
a wide perspective on health issues and not be allowed to promote
a single group or individual condition;
— Decision making should be by
consensus and anyone with a potential conflict of interest should
declare it (eg someone who represents a group who are or will
be applying for contracts to supply services to the NHS or local
authority OR represents a group which campaigns for a particular
condition);
— People falling into this category
should bring information and expertise to the discussion but not
take part in the actual decision making;
— Each LINk should decide how
it wants to operate and this will inform how members are appointed;
— The exception to this is, as
is currently the case with PPI, senior officials and managers
of NHS Trusts and local authorities, as well as local politicians
involved in Health and Social services scrutiny.
Funding and support:
— Funding should be guaranteed
and available for a minimum of five years (subject to performance);
— Funding should be at "full
cost recovery" and include increases for inflation and salary
progression;
— It should include sums for publicity
and, as necessary, employing specialist consultants;
— It should include a reasonable
sum for training LINks members and reflect the fact that there
will be considerable turnover—so training will be ongoing;
— Support should reflect the fact
that LINks members will be volunteers with limited time and the
support cannot be purely administrative. It has to include research
and an understanding of policy and strategy.
Areas of focus:
— Geographically, primarily within
a local authority area but, because the NHS makes many decisions
at a sub-regional, regional and national level LINks must be able
to interact and do the same;
— Specialist NHS Trusts such as
mental health, ambulance and rare conditions need to be responsive
to all of the associated LINks—possibly through the Commissioning
process.
— The focus in terms of services
should reflect the priorities and concerns of local people.
5. STATUTORY
POWERS
— It is crucial that LINks have
the ability to require information and monitor/inspect as part
of the assessment of the actual delivery of services;
— There is no point in spending months—even
years—involving people in the design of a service and then
stopping them seeing how well it is being delivered;
— This becomes even more important
when dealing with services commissioned from the independent sector.
The public is paying for these services and expects to be able
to make the same demands on the private sector as it does the
public sector.
— "Commercial confidentiality"
has nothing to do with the quality of service delivery and independent/private
sector providers should be subject to the same accountability
as the NHS or local authority;
— Nor should LINks only be allowed
to exercise these powers under the direction of another body (eg
the Healthcare Commission). LINks need to be able exercise these
powers as they deem fit to carry out their own duties, not someone
else's.
6. RELATIONS
WITH LOCAL
HEALTH TRUSTS
— It makes perfect sense for LINks
to work constructively with the NHS (and local authorities). LINks
need to understand the pressures placed on these bodies by central
government and this can only be achieved by open and honest discussion;
— However, where LINks identify
a problem, they should be free to highlight it and seek corrective
action from the NHS or local authority. In the absence of acceptable
remedial action LINks need to be able to raise their concerns
at another level;
— As indicated above, there are
NHS Trusts which cover a number of local authority areas and their
accountability should be to all the LINk areas they serve.
7. NATIONAL CO
-ORDINATION
— LINks need to be able to identify
best practice from around the country AND make enquiries to see
if a problem they have identified is purely local or, in fact,
has arisen in a number of areas;
— There is also the possibility
that the issues identified by LINks are the result of a national
policy and the only way they can be resolved is if that policy
is amended or scrapped;
— In the absence of a national
"route" for LINks this is unlikely to happen.
8. HOW SHOULD
LINKS RELATE
TO AND
OVERLAP WITH
Local Authority structures including Overview and
Scrutiny Committees:
— There are different powers and
concerns for these bodies so they each have to recognise these
differences and try to establish suitable relationships;
— Both LINks and OSCs will have
work programmes and, at the very least, they should share these
with each other;
— In doing this they would know
whether an issue which has been brought to the attention of a
member of the LINk or OSC is already being considered and whether
or not there is scope for joint working;
— Unfortunately you cannot force
LINks and OSCs to work co-operatively, even where this would be
sensible. There are issues of capacity (OSCs have work passed
to them by local Cabinets, as well as having a statutory duty
to look at particular LA policies) and they may not be able to
take on extra work. Equally, LINks will have competing demands
on their time and face the same problem;
— This reinforces the need for
a national route for LINks—if OSC declines to investigate
a topic the LINk thinks is appropriate for the OSC the LINk needs
an alternative way of tackling it.
Foundation Trust Boards and Member Councils:
— Until such time as a Foundation
Trust Board can demonstrate that it uses its membership fully
and effectively to identify local priorities and needs it should
be required to work constructively with LINks;
— Even when Foundation members
are active and fully engaged the LINk could continue to provide
an additional source of information to the Trust;
— Foundation governors have a
different remit from LINks and, in fact, have very limited "powers"
when compared with the current PPI Forums. Exchanging views and
information—in the same way LINKs and OSC should—would
encourage constructive engagement with the Trust as a whole;
— Gateshead Health NHS Foundation
Trust is a good example of what can be achieved where the PPI
Forum has the right to appoint a Governor and this individual
is able to take issues back and forward between the Governors
and PPI Forum and identify the best route to investigate and resolve
problems.
Inspectorates including the Healthcare Commission:
— Information from inspectorates
can be very useful to LINks;
— Equally, the views of LINks
could act as a prompt for inspectorates to investigate certain
aspects of a Trust's service delivery in more detail;
— However, LINks should not, and
cannot, be a tool of inspectorates. Where a LINk has the desire
and capacity to help a particular inspectorate it should do so
but no inspectorate should be able to force a LINk to do a particular
piece of work.
Formal and informal complaints procedures:
— The volume of complaints, looking
at social services and primary and secondary NHS delivery, would
overwhelm a LINk;
— The NHS and local authorities
have their own complaints systems (both formal and informal) and
the role of the LINk should be to ensure these are widely publicised,
easy to use and that the public can have faith in them;
— LINks should, however, have
access to details of the types and numbers of complaints because
they are an indicator of how the public perceives the service
sunder consideration.
10. In what circumstances should wider public
consultation (including under Section 11 of the Health and Social
Care Act 2001) be carried out and what form should this take?
In the absence of details about the "strengthening"
of Section 11 it is difficult to comment.
— The current requirement is that
NHS Trusts consult over the introduction of new services or where
there is "a proposal to make a significant variation"
to an existing service. There should be a single national definition
of the term "significant" and it should be agreed by
patients as well as the NHS;
— It is important to ensure that
Section 11 includes restructuring and reorganisation of the NHS.
At the moment the NHS does not have to consult over these because
they about "management" not service delivery. This is
patent nonsense since changes to management structures have a
direct bearing on an organisation's ability to deliver services;
— For example the recent PCT reconfiguration
exercise. Some PCTs in the North East were merged but others,
because of public opinion, were retained. However, those which
did not merge were forced to make an equivalent management saving
and have undergone a de facto merger whilst retaining their original
names. The board and management structures, commissioning arrangements
and HR functions have all changed;
— Consultation should take place
over a reasonable period of time and take many forms to ensure
that the widest possible audience is reached;
— Once consultation is concluded
and decisions are made details of public comment obtained during
the exercise should be released so that it can be shown that the
NHS organisation took the comment into account;
— This should not be the Trust's
own interpretation of comments received but the actual comments.
Gateshead Hospital PPI Forum
14 December 2006
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