Select Committee on Health Written Evidence

70. Evidence submitted by Norfolk & Norwich University Hospital PPI Forum (PPI 27)

What is the purpose of PPI?

  1.  Just what it says—to involve the wider public in the decision making, provision and monitoring of everything involving health and social care. Also to obtain an outside view of the rather enclosed world of the NHS—we are told that this is very valuable.

What form of PPI is desirable etc?

  2.  At the very least, the form that the best PPI forums were able to build up during their short lifetimes. A "critical" friendship where the PPI viewpoint is sought , respected and valued. Also, the PPI Forum should be responsive to national and, more importantly, local needs and perspectives which may vary from one locality to another.

Why are the existing systems for PPI being reformed?

  3.  A very good question, because Forums, after a great deal of hard work, are already monitoring their areas and gathering public opinion; plus building relationships across the voluntary sector. But the extension to cover Social care is very welcome, although many Forums were already, quietly, doing just that. The emphasis away from organisations is damaging especially in the case of Acute Trusts, and more especially PFI Acute Trusts like ours. The new reforms should build on the best PPI experience by bringing the less efficient and effective Forums up to the same standard—in effect many Forums are already acting like LINks.

How should LINks be designed?

  4.  Firstly, with a great deal of care and thought—especially about what has been achieved and what were the mistakes of PPI Forums. Guarantee a long term with incremental improvements based on experience—not major change after three years as per change from Community Health Councils to PPI Forums.

Remit and level of independence

  5.  At least the same remit as PPI Forums to cover Social Care as well as Health. A critical friend plus statutory duties to monitor services and gather public opinion. With rights of inspection. Independence is vital especially from political pressures or the NHS itself.

Membership and appointments

  6.  Membership should be as open and inclusive as possible; but to involve younger working members, special arrangements must be made—perhaps giving consideration to companies to allow their employees to drop in and out of LINKS. There might need to be a two tier system of appointments for members who are able to carry out inspections with a fairly formal interviewing process. Consideration of paid appointees to guarantee that members who commit to longer than average hours get additional benefit (eg Chairs) and thus provide continuity.

Funding and support

  7.  This should be ring-fenced, robust (not able to be plundered by local government for other things in times of need) and upfront unlike that for PPI Forums; it should be adequate to allow for more publicity than PPI Forums had; and if working members are to contribute to allow for this. Also to allow for such things as meetings in public to be successful. Support is very important for arranging meetings, research and collating; and for general administration. But, more support is needed for marketing and publicity and perhaps less on the knowledge side.

Areas of focus

  8.  The whole patient pathway including social care provision. With special emphasis on under-represented and/or under-funded areas like mental health and care of the elderly. Also looking at commissioners and actual providers of care such as hospitals and homes, including the private sector (if things are not on the commissioning list they won't get funded, so these people are key).

Statutory Powers

  9.  At least as strong as for Forums to include social care and the private sector; and to be well publicised. Government should undertake to act on clear recommendations made across the board, otherwise there will be little point in the whole exercise. It's all very well to listen but that is not always enough, as has been proved often under the current regime. If volunteers can see that it is worth their while, they might be less reluctant to come forward. Lack of funds should not always be enough reason for Government to reject ideas/proposals.

Relations with local health trusts

  10.  The same as for Forums—to be included as equals in planning and decision-making (but Forums have learnt that trust and respect has to be earned).

National coordination

  11.  Vital for national campaigns like Foodwatch and for support, networking and training, but with more member input and fewer regulations. Again, results of such campaigns should carry more weight at Government level.

How should LINks relate to and avoid overlap with:

Local Authority structures including OSCs

  12.  Many OSCs are either unable or unwilling to cover health in breadth or depth and the LINks could play a major part in filling that gap; but workplans must be shared and where possible co-ordinated.

Foundation Trust Boards and Members Councils

  13.  There would seem to be more reasons for than against dual membership and sharing views etc.


  14.  It is important that each knows what the other is doing and where possible that the two areas liaise/co-ordinate and do not overlap or clash. Make it a statutory obligation for Healthcare Commission (and others) to consult and/or liaise with LINks.

Formal and informal complaints procedures

  15.  It is important to be able to identify trends so it is beneficial if the Complaints departments give regular reports to the LINks/Forums and complaints have actually worked together to solve problems.

In what circumstances should wider public consultation be carried out?

  16.  When any change is proposed that will seriously affect the public—for example reconfiguration of services (eg bed closures, moving units, rebuilding) and any changes in PCT policy like patient records, rationing drug regimes and so on. It should not have to wait for the circumstances outlined in the white paper—such as, the unrealistic requirement for a high percentage of people to complain or show concern about a proposed change before that issue can be taken up.

Anthea Nicholson

Chair, Norfolk & Norwich University Hospital PPI Forum

5 January 2007

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