Select Committee on Health Written Evidence

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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