46. Evidence submitted by the Keep Our
NHS Public Campaign (PPI 66)
INTRODUCTION
Keep Our NHS Public is a non-party political
national campaign. Its principle aim is to resist the privatisation
and commercialisation of the National Health Service and to promote
its future development as a truly public service. It brings together
medical professionals, health service unions, academics, user
groups, concerned citizens and politicians such as former health
secretary Frank Dobson.
SUMMARY
We welcome the opportunity to comment in the
light of new government proposals for patient and public participation.
The proposals in their current form significantly curtail the
statutory right of patients to participate in strategic decisions
affecting their health services. Under them, patients and the
public will undergo a fundamental shift in status—from citizens
empowered with legal rights to participate in strategic decisions
affecting their health services—to consumers, merely able
to comment about the services on offer and possibly with more
choice to shop around, if they are able to afford transport costs.
The new proposals go hand in hand with privatisation and mark
the end of the NHS as a democratic institution
EVIDENCE
1. What is the purpose of patient and public
involvement?
The purpose of patient and public involvement
is to ensure that the needs and wishes of patients and potential
patients are taken into account in the planning, development and
provision of hospital, primary care and community health services.
2. What form of patient and public involvement
is desirable, practical and offers good value for money?
2.1 Any system of public /patient involvement
must provide patients with a strong, independent, collective voice
and clear statutory rights to ensure the interests of patients
are not swept aside by short term financial, political or corporate
considerations. Many in the field consider that CHCs were far
stronger in this respect than their replacements.
2.2 The essence of consultation is the communication
of a genuine invitation to give advice and a genuine receipt of
that advice. All NHS bodies should be required by law to observe
this principle, otherwise consultation will continue to be a sham
and a waste of money. The government itself has a poor record
in this respect. For example, the proposed new law requiring PCTs
to publish "regular reports of what they've done differently
as a result of public opinion or explain why they are unable to
respond" gives managers a statutory right to ignore public
opinion. Similarly, the Secretary of State's decision to back
NHS managers wanting to make unpopular closures and service reconfigurations
(HSJ 30 N0vember 2006)) and to foist Independent Treatment Centres
into areas that don't want or need them ( Health Committee report
Volume 1 para 131-134, 13 July 2006), belies the official support
for patient and public involvement.
3. Why are existing systems for patient and
public involvement being reformed after only three years?
3.1 According to the government, greater
emphasis on services being provided in the community and being
developed and commissioned jointly with local government requires
a new system—one that will focus on strategic commissioning
and the "whole person experience" rather than on individual
provider organisations, as with patients' forums (Response to
"A Stronger local voice", December 2006). However, an
anonymous health expert has told the Local Government Chronicle
that the new proposals are all to do with the marketisation of
the NHS and the need to "prevent people who are critical
of private sector involvement from making inspections and using
them to cause trouble" (Local Government Chronicle 20 July
2006). Many aspects of the new arrangements support the latter
view (see below).
4. How should LINks be designed?
4.1 Remit and level of independence
4.11 LINks, primarily, will be consumer
bodies, gathering the views of local groups and individuals in
the community about their experiences of the health services on
offer and conveying those views to commissioners, providers, and
official regulators (Government response to "A stronger local
voice `December 2006). Their remit is therefore much narrower
than that currently enjoyed by Patients" Forums with respect
to individual trusts (NHS Reform and Health Care Professions Act
2002,s.15(1).-(3) ).
4.12 We believe the remit of LINks should
be broadened to include a duty to monitor and review at first
hand the range and operation of services provided by NHS trusts
and private providers in their area; to provide advice and information
about those services to patients and their carers; to provide
advice and support to patients wishing to make a complaint and
to promote public involvement in consultation processes.
4.13 LINks must be seen to be independent
of NHS management, to restore trust and encourage public participation
in their activities. Instead, current proposals require LINks
to act proactively with commissioners and undertake research and
evidence collection on their behalf, where practicable. They will
have a duty to co-operate and co-ordinate their activities with
official inspectors and regulators. Their right to visit and inspect
health service premises will be restricted to that of "a
tool for validating the evidence they've collected elsewhere".
In addition, the new health and adult social care regulator will
be able to intervene to prevent inspections which "could
impose an unreasonable burden on the institution providing care".
And if a LINk becomes a single issue campaigning group, their
host organisation could be liable to sanctions or removal of their
contract for failing to ensure that the LINk represents the views
of the whole community.
We believe these restrictions, which effectively
give NHS organisations the upper hand, compromise the independence
of LINks and should be removed.
4.2 Membership and appointments
We support the proposal for LINks to have a
wide diverse membership that includes nominees from voluntary
and community groups as well as individuals who put their own
names forward. But we believe local political parties should also
be allowed to make nominations. Such individuals are likely to
have good contacts with their local communities and be willing
and able to make a positive contribution. They are no more likely
to show bias than existing eligible groups such as members of
foundation trusts, trust-based patients groups or voluntary providers
of NHS services.
4.3 Funding and support
Local authorities should receive extra, ringfenced
funding to support the setting-up and effective running of LINks.
Host organisations should be independent of the government and
the local authority and this independence should be guaranteed
in their contracts. They should not be discouraged from implementing
agreed LINk policies through fear of losing their contracts.
4.4 Areas of focus
LINks should be able to focus their activities
on any area relating to the provision or commissioning of health
care services in their geographical area. Their actual agenda
should be determined locally, reflecting their own priorities
or areas of concern. LINks should not necessarily be required
to take into account the priorities and plans of other organisations
as this could lead to duplication and a tendency to miss important
aspects of their own research.
4.5 Statutory powers
We believe LINks should have the same visiting
rights and rights to information currently enjoyed by the patients'
forums. They should also have the right to be informed of and
consulted over plans affecting the planning, development and provision
of services. However, under the current proposals, LINks will
have reduced statutory powers compared to patients' forums. For
example, they will have the right to require NHS organisations,
including private providers, to provide them with information
and to respond to their recommendations. but they will only be
able to enter and inspect NHS health care premises (not private)
under limited and tightly controlled conditions.
4.6 Relations with local health trusts
LINks should form good working relationships with
local trusts but, to safeguard their independence, they should
not be funded or permitted to undertake research or other work
on their behalf.
4.7 National coordination
LINks should be funded to set up a national group
that would co-ordinate their findings and provide them and their
host organisations with support and advice, along the lines of
ACHCEW, the Association of CHCs for England and Wales.
5. 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?
5.1 Under current law, NHS organisations
are required to involve and consult:
(a) The overview and scrutiny committee of
the local authority on any proposals for substantial development
or variation in the provision of the local health service
(b) Service users and potential service users
either directly or through their representatives in the planning,
development and operation of services.
(Health and Social Care Act 2001, section 7 and
11 respectively).
5.2 We support the fact that formal consultation
on substantial changes requires a health authority or PCT to publish
a consultation document that contains sufficient information and
allows enough time to enable the public to make an intelligent
response. We also support regulations under section 7 giving overview
and scrutiny committees the right to refer disputed consultations
to the Secretary of State or, in the case of foundation trusts,
to the Monitor. We believe section 11 should provide patient representatives
with the same right of appeal, to ensure managers cannot disregard
the results of a consultation without political accountability.
5.3 Unfortunately, the government has recently
legislated to repeal Section 7 of the Health and Social Care Act
2001 that provides for regulations on consultation with overview
and scrutiny committees (National Health Service (Consequential
Provision) Act 2006, Chapter 43). The latter comes into force
in March 2007. In addition, it has introduced a new bill which,
if enacted, would limit consultation under section 11 to (a) the
planning of the provision of services and (b) to changes that
significantly affect the range or manner of delivery of services
at the point of use. (Local Government and Public Involvement
in Health Bill November 2006).
5.4 Such legislation would allow an NHS
organisation to by-pass public consultation on substantial changes,
including the awarding of contracts to multinational corporations,
if managers could argue that the proposals would not affect the
delivery or range of services on offer at the point of use. We
deplore the move to significantly curtail the right of the public
to statutory consultation.
Keep our NHS Public
January 2007
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