Select Committee on Health Written Evidence

67. Evidence submitted by the National Consumer Council (PPI 114)

  Further to your correspondence of 18 December regarding the Committee's inquiry into Public and Patient Involvement in the NHS, I am pleased to respond with further information.

  I am attaching two reports which detail key recommendations further:

    —  Final Report from Having My Say Taskforce, which met in October/November 2005 to find ways to promote people's `say' in health and social care so that services develop in ways that are genuinely responsive to their needs and choices. I chaired the Taskforce in my capacity of Chief Executive of the National Consumer Council (NCC).

    —  Department of Health Concluding the review of patient and public involvement: Recommendations to ministers from Expert Panel, which reported in May 2006.  I co-chaired this panel. [47]

  For ease of reference I am detailing the main recommendations from each report.


  1.  The ability of people to have a say is essential to ensure that high quality health and social care services are available to meet their future needs.

    —  People, as active or potential service users and as members of the public, want to be able to have a better say in relation to health and social care services. Those services are better all round when the views and experiences of people using them are systematically taken into account. Without such a say, they are significantly less effective.

    —  Service users should have a say through the individual choices they make and encounters they have with professionals. But they also need a say in shared ways, to shape what choices are on offer and to ensure that more vulnerable users do not lose out.

  2.  The right kind of involvement is needed at every stage of the design, delivery and evaluation of services.

    —  There should be an involvement with service users and the public at every level at which decisions are taken in health and social care.

    —  The responsibility for giving service users a say should rest with the decision makers responsible for commissioning and providing services.

  3.  The quality of involvement matters but can achieved in different ways.

    —  Arrangements to engage people need to be simple, visible and consistent across local services. And they need to include the voices of more vulnerable service users, who may not always be heard.

    —  An effective way to promote a culture of involvement is to build more inclusive governance into programmes of health and care.

  4.  There needs to be a systematic way of encouraging decision-makers to listen and to respond to what they hear.

    —  There should be a less prescription on the structures decision-makers use to engage, to allow for more creative approaches, but an increased focus on their accountability, through scrutiny, inspection and regulation, for the quality of engagement and their responsiveness to it.

    —  There is a need to recognise and support the independent voice of voluntary organisations in shaping services for users.


  1.  We recommend a more flexible framework for supporting public and service user voices in health and social care at the local level. This should draw on the strengths of voluntary and community organisations and on interested individuals, build wherever possible on existing or developing involvement structures and be more closely connected with the scrutiny function in local government.

  2.  We recommend the removal of the legislative requirements for Patient Forums. We recommend that a Local Involvement Fund is established to support a stronger public and user voice, with a clear mandate, adaptable to local circumstances. The mandate will be for the creation of what we call Local Involvement Networks (LINks) for health & social care.

  3.  Our preference is for non-statutory bodies, but we understand that it is not possible to achieve the formal relationship we want the LINks to have with statutory bodies such as OSCs and PCTs unless the LINks are defined in law. We recognise that the LINks will need to have some statutory basis for them to have rights of involvement and consultation drawn from the duties placed on PCTs and Local Authorities. If new statutory bodies are set up we strongly recommend that statute defines function rather than form.

  4.  We also recommend that a specific relationship is established between the LINk and the OSC—the LINk should have a formal right to refer matters to the OSC.

  5.  We recommend that OSCs should focus their reviews on the decision-making activities of PCTs and local authorities, in particular scrutinising how well they have met the requirements of the revised duties to involve, consult and respond.

  6.  We recommend the creation of capacity for a stronger voice for patients, service users and members of the public at the national level.

  7.  We recommend that commissioning organisations across health and social care should have a duty to involve and consult their communities at all levels.

  8.  We recommend that these duties to involve and consult should be clearly set out in the forthcoming commissioning guidance.

  9.  We recommend commissioners should be required, as part of their existing planning arrangements, to develop a forward plan for engaging service users and the public.

  10.  We recommend the commissioner should have a duty to respond to the community, as well involve and consult them.

  11.  We recommend that S11 is strengthened and its scope extended. The new section should require every body which is responsible for delivering health and social care services (commissioners and providers) to involve, consult and respond to users and the public.

  12.  We endorse the White Paper recommendation that duties to involve patients and service users should be extended to cover independent sector providers.

  13.  We recommend the simplification and rationalisation of the legislation around health service consultation.

  14.  We recommend that the legislation merging the regulators should set out how the single organisation will both regulate stronger voice and how it will involve users of services and the public and to put their interests at the heart of its regulatory activities.

  15.  We recommend that explicit assessment criteria are established to enable regulators to assess the performance of commissioners.

  I hope that you will find this information useful and please do not hesitate to contact me if you require clarification on any issue.

Dr Ed Mayo

Chief Executive, National Consumer Council

10 January 2007

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