Select Committee on Health Written Evidence

46. Evidence submitted by the Keep Our NHS Public Campaign (PPI 66)


  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.


  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


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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