72. Evidence submitted by North Tyneside
Patient and Public Involvement Forum (PPI 51)
1. How should LINks be designed
1(a) Remit and level of independence
LINks should be clearly independent from both
Local Authorities and the NHS. Their remit should be to monitor
health and social services in a geographical area relating to
local authority boundaries. They could be commissioned jointly
by a consortium of Local Authorities to give a wider view and
provide economies of scale. Where possible, the host organisation
should have a proven track record, a clear understanding of Patient,
Carer and Public Involvement and knowledge of the local health
economy. To ensure impartiality, the selection of the successful
host organisation should be decided by a group of people representing
the Local Authority, the Community and Voluntary Sector, and possibly
local PPI Forum members.
1(b) Membership and appointments
The host organisation (whatever its setup) will
have guidelines in the form of their constitution, standing orders
or Memorandum of Association. Membership should be by adherence
to these guidelines. Therefore allowing for different levels of
commitment and involvement by individuals and groups, This will
enable LINks to further build on the experience gained by forums
over the past three years and to recognise the contribution of
those already involved. Ideally this will achieve true local engagement
and independence but will require a process of evolution.
LINks must become the lead in the organisation,
and have a central committee supported by the host organisation.
This central committee democratically elected and unwavering in
its duties would be responsible for guiding the whole range of
activities agreed by LINks members.
1(c) Funding and support
Funding should come via the Local Authority/(ies)
commissioning LINks. Additional funding could be applied for to
carry out specific pieces of work within the area. To establish
the independence of LINks, funding should not come from any part
of the Local Authority that delivers Social Services.
Support should be from the host organisation
commissioned to deliver the LINks by the Local Authority. When
deciding on levels of funding, there needs to be an acknowledgement
that if LINks are to be successful they must have appropriate
funding. Reaching marginalised groups and individuals is expensive,
and the funding must reflect this. Funding must allow for travel
expenses, money to cover child care and carer expenses, and the
cost of translators, interpreters and signers if these are needed.
Such funding needs to be realistic and sustainable, recognising
the importance of LINks.
It would be hoped that funds available be controlled
and held accountable by the central committee locally and the
host organisation, and not another national arms length body.
1(d) Areas of focus
The area of focus should be any area of service
delivery provided by either the Local Authority, the NHS or commissioned
private providers of services within the region.
1(e) Statutory powers
Although the local credibility of the LINks
will be fundamental to how successful they are, it is important
that some statutory powers are retained. This will ensure that
Trusts, local authorities and commissioned private providers of
services respond to LINks. Without the statutory powers, there
is the possibility that some bodies will keep LINks at arms length
and not treat their work with the importance and consideration
it deserves. Retaining the statutory powers will enable access
to all reasonable information and the expectation that service
providers respond to formal reports when submitted.
The monitoring visits of the Forums have been
one of the most successful aspects of the their work to improve
conditions for patients and the public, eg monitoring of the local
hospital wards staffing levels working jointly with the hospital
forum looking at infection control rates in the local area.
1(f) Relations with local health Trusts
LINks should be a "critical friend"
to the Trusts, Local Authorities and commissioned private providers
of services they relate to. Service providers must have an obligation
to respond to LINks at an agreed level in order for the LINks
to be effective. LINks will be more productive where a positive
relationship is developed between the LINk and the Trusts. This
can be demonstrated over the past three years by the levels of
trust and co-operation reached by many forums with their related
NHS Trusts, this positive relationship has formed many partnerships
and networks which must not be lost.
1(g) National coordination
A National overview for LINks at the very outset
would be useful, One of the problems with the PPI Forums has been
the difficulty in having a common voice on National issues. This
organisation should not be an arms length body such as the CPPIH,
but a "resource" with minimum staffing but having no
powers over managerial or budgetary issues and exists to give
support and guidance to both host organisations and LINks members.
This organisation must work in partnership to give the best support
to the LINks.
2. How should LINks relate to and avoid overlap
2(a) Local Authority structures including Overview
and Scrutiny Committees
LINks and Overview and Scrutiny Committees should
complement each other in the work that they do. There will be
areas where they can work together, using their different statutory
powers to undertake pieces of work that cannot be successfully
done separately. Sharing work plans, experiences and skills will
be essential. In this area ppifs have worked jointly with the
OSC's on issues such as changes to maternity services, dentistry
and diabetic podiatry, using their powers of inspection and access
to information unavailable to the OSC's.
2(b) Foundation Trust boards and Members Councils
However effective members' councils are, they
are not independent, having a level of corporate responsibility
to the Trust to which they belong. It is essential that LINks
work with members' councils in their areas, to give an independent
view of issues within the Trust. For LINks to be really effective
this is crucial, to enable the relationship with service providers
to remain objective and as an independent critical friend.
Trust members may be able to contact LINks if
they have particular areas of work they want to address. They
can then use the statutory powers of the LINks to follow up on
these issues or to carry out surveys or focus groups locally.
2(c) Inspectorates including the Healthcare Commission
The input of the LINks into the annual health
checks for Trusts will continue to be important. The Healthcare
Commission should not assume that the LINks are there to work
on behalf of the Healthcare Commission, and the LINks must be
free to decline to work for the Healthcare Commission if they
feel it is inappropriate. LINks should be recognised by outside
organisations as a place to be objective, to seek improvement
in standards and to recognise and highlight improvements when
achieved.
As an example of good practice, forum members
held an informal visit to the regional Out of Hours service to
find out if local negative press was true. The visit revealed
this was not the case and a public meeting with the Chief Executive
of Northern Doctors Urgent Care, who explained about this service
dispelled many fears raised by the unfavourable press reports.
2(d) Formal and informal complaints procedures
When the various responsibilities of the Community
Health Council (CHC) were split up, there was an understanding
that they should link together to provide a co-ordinated Patients
and Public Involvement structure. This has not happened with the
Independent Complaints Advocacy Service (ICAS) which has been
patchy to say the least.
In the shorter term, LINks will need to relate
to PALS and ICAS, but in the longer term it would be good to see
these two services transferred back to the host organisations
that support the LINks.
3. 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?
It is not so much the circumstances, but that
consultations are "meaningful" to those who take part
in them. For this to be effective, it is essential that those
involved in consultations do not feel that decisions have been
made before the consultation has taken place. Adequate time must
be allowed for the process, and where possible, consultations
should not take place over holiday periods (summer and Christmas
holiday times) when deadlines cannot easily be met.
In addition, people who have contributed to
consultations should receive feedback so they know the outcome
of their involvement.
4. Local accountability
Although this is not an area for comment, the
meetings the forum has attended stress the need for local accountability.
There appears to be no firm idea on how this will work in practice.
It would be a great mistake to allow the work of the last three
years and the relationships built, by forums with various Trusts,
groups and networks to be lost and the forum would urge that this
good work be recognised.
Obviously the host organisation will be accountable
to the Local Authority in its delivery of the contract. The LINk,
however needs to be accountable in a different way and would suggest
that in the same way as membership and appointment of membership
is governed by the constitutional arrangements of the host organisation.
This could also work in terms of accountability of LINks to the
community. Membership of the LINks would be open to community
and voluntary organisations and individuals. The host organisation
should open the membership as widely as possible and their accountability
would come through the membership. This would happen through Annual
General meetings and other meetings of the membership.
North Tynside PPI Forum
3 January 2007
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