Select Committee on Health Written Evidence

66. Evidence submitted by the NHS Centre for Involvement (PPI 129)


  1.1  The NHS National Centre for Involvement is a consortium of The University of Warwick, The Centre for Public Scrutiny (CfPS) and LMCA—an alliance of patient organisations. The Centre is hosted by The University of Warwick. The Centre aims to support the NHS as a whole, at local provider, regional and national levels to lead and sustain patient and public involvement in delivering NHS services to improve the quality of care and the efficiency and responsiveness of healthcare organisations.

  1.2  The Centre was awarded to the consortium based on an EU-wide competitive tender with the results announced by Rosie Winterton on 23 May 2006. The set-up phase of the Centre started 1 June 2006 and the formal launch took place in London in November 2006.

  1.3  The NHS Centre for Involvement welcomes the invitation from the Health Select Committee to submit evidence to its inquiry into patient and public involvement (PPI).

  1.4  We recognise the circumstances in which the Health Select Committee is carrying out its inquiry. The committee called for evidence at the end of November 2006.  Since then, the Government has published its response to "A stronger local voice" as well as the Local Government and Public Involvement in Health Bill.

2.   What is the purpose of patient and public involvement?

  2.1  The NHS Centre for Involvement believes that there are different categories of Patient and Public involvement (PPI). These range from working on an individual basis around treatment decision making, involvement in teaching and learning for health and social care professionals, setting research agendas and participating in the process, quality assuring healthcare education and training and evaluating service provision and developing services (including commissioning). All of these different categories are dependent on developing relationships across communities but with a change in emphasis from just providing feedback to being able to be involved and influence practice, process and strategic decision making. The Centre recognises the primary purpose of involving patients and the public at an early stage is to ensure that all those who manage and deliver healthcare services—as commissioners, providers or the Third Sector—take into account their needs and concerns in carrying out their role.

  This must include PPI work at "service improvement" level (in directorates, teams, areas, etc) and at a corporate/strategic level. It is essential that this approach is based on an understanding that health and social care should meet the needs of patients and the public.

  Those organisations commissioning and providing services should be flexible and responsive to the needs of patient and the public within the parameters of organisational capacity and budgetary constraints.

  2.2  The Centre also believes that effective PPI should enable a publicly accountable model facilitated through an ongoing "accountability relationship" whereby patients and the public and healthcare managers, professionals, staff and organisations have opportunities to "give and receive accounts" of the service. This should include formal and informal opportunities for patients and public, whether as individuals or groups, to voice their needs and concerns directly and indirectly to managers and clinicians at all levels of healthcare provision Including professional training.

3.   What form of patient and public involvement is desirable, practical and offers good value for money?

  3.1  Effective PPI should be nurtured so that it grows organically within and around healthcare organisations as part of a "public facing" culture. Opportunities need to be provided for patients, carers and the wider public to have clear and flexible opportunities to be involved (directly or indirectly), share experiences and influence the future services and learning in a range of ways:

    —  As individuals—through relationships with clinicians as "expert" patients—and through more formal complaints procedures/advocacy arrangements

    —  As groups or communities of interest (based on geography or medical condition)—through opportunities to advance particular causes or concerns in relation to available services and treatments

    —  As representatives of local communities and the public—as non-executive directors/governors and elected representatives on Trust boards or Health Overview & Scrutiny committees or in other relevant bodies

  3.2  An appropriate relationship between individuals and groups with and through elected or appointed representatives is one mechanism for ensuring the practical approach and best value for money. Other forms of accountability, however, are also essential.

  3.3  It should be recognised that practical patient and public involvement is not just about techniques, nor is it about structures. The Centre suggests that it is dependent on clarity of aims and objectives and making sure that changes result on the basis of the involvement. Patient and public involvement activities and the impact they have on service provision must be understood in the context of high quality evidence.

  3.4  All staff whether providing or commissioning services, or supporting health and social care services must be trained and supported to do high quality PPI. This will ensure that their work is shaped by the views experiences and priorities of patients and the public.

4.   Why are existing systems for patient and public involvement being reformed after only 3 years?

  4.1  The NHS Centre for Involvement believes that the implementation of the Health and Social Care Act 2001 has resulted in more effective local authority health overview & scrutiny committees. The proposed system reform is an opportunity to rebuild in the light of experience and ensure greater clarity of complementary roles and responsibilities across the health and social care spectrum.

  4.2  The Centre believes that once the reform of the system takes place it will require a period of stability in order to be integrated into everyday practice in the NHS and Social Care, generate trust from local people and health and social care professionals and attain its full potential for driving locally responsive high quality service provision.

5.   How should LINks be designed?

  5.1  The Local Involvement Networks (LINks) should be designed within a framework which allows for as much local discretion as possible for LINks to operate effectively.

  5.2  The purpose of LINks is to ensure that in each locality there is a network which patients and the public can join, and which healthcare organisations can consult with to make sure that local needs and concerns are communicated as and when appropriate eg in relation to commissioning, new service provision, service reconfiguration, service evaluation, addressing local health inequalities.

  5.3 Each LINk should have as a minimum a local co-ordinator with an appropriate level of administrative support and a permanent and visible base. Each LINk should then agree what formal arrangements are needed to operate effectively. If needed a number of options for good governance of LINks could be made available, eg organising committee/board/local chair. LINKs should provide regular formal opportunities for local discussion and debate about local health issues. LINks should also be required to generate annual priorities, in conjunction with relevant NHS/Social Care organisations and in partnership with their community. This would offer a balance of being able to meet national health and social care priorities together with satisfying perceived local needs.

  5.4  LINks should not be formally connected to any one health or social care organisation but should be independent of all. Their remit should be to advance the voice and concerns of patients and the public in response to local need and experience. Local health and social care organisations should approach LINks as part of their duty and responsibility to consult patients and the public.

  5.5  As a network organisation, each LINk through its co-ordinator, will connect with existing local and regional voluntary and community groups involved in health and social services as well as local authority community development organisations. It is likely that these groups will be in a position to generate support and practical advice which LINks can tap into to become a robust local voice for patients and the public. These organisations should have a range of forms from charitable trusts through to user-led groups.

  5.6  LINks should be a key source of information about local services, from public, private or voluntary sector organisations, to the regulatory authorities (the Healthcare Commission and the Commission for Social Care Inspection).

6.   How should LINks relate to and avoid overlap with other organisations?

  6.1  LINks should be regarded as a body that strengthens local public accountability for local health and social services. The LINk should develop constructive working relationships with all NHS social care bodies including Foundation Trusts and the Health Overview & Scrutiny Committee.

  6.2  LINks must also build on and use existing information available in their locality. For example, large amounts of information is already gathered through PCT and Trust patient surveys, the Annual Healthcheck conducted by the Healthcare Commission, public health data and health plans from NHS organisations.

  6.3  LINKs need to be well positioned to strengthen the interface between service and workforce development by ensuring that the views and experiences of patients and the public inform and influence education commissioners.

7.   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?

  7.1  The NHS Centre for Involvement believes that key to commissioning high quality health and social care services is the involvement and understanding of the needs of local communities. We believe that every opportunity should be made available for patients, the public, carers and users of health and social care services to be involved at the start of any changes to services and to help shape those changes.

Ian Brittain

NHS Centre for Involvement

January 2007

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Prepared 6 February 2007