Select Committee on Health Written Evidence

81. Evidence submitted by Peterborough Primary Care PPI Forum and Peterborough and Stamford Hospitals PPI Forum (PPI 3)

  Members of the Peterborough Primary Care Patient and Public Involvement Forum (PPIF) and the Peterborough and Stamford Hospitals PPIF are very concerned that the government is proposing to replace PPIFs with Local Involvement Networks (LINks). As you will know this policy change was promulgated in the Department of Health document "A stronger local voice", and comes after the very short period of existence enjoyed by PPIFs. We have already responded to the DOH document.

  We firmly believe that the proposals for LINks reduce the effectiveness of any Public and Patient involvement when compared with their predecessor organisations (PPIFs).

  We list below the differences that we perceive between PPIFs and LINks.

  A PPIF has statutory responsibilities which include:

    —    monitoring and reviewing the services provided by the trust;

    —    canvassing the views of patients, users and carers about these services; and

    —    preparing reports and recommendations to the trust about those services, based on the views of patients and the public.

  A PPIF has statutory powers which include...

    —    the power to collect information relevant to its functions from particular NHS organisations and other authorities and to require such organisations to respond within 20 working days; and

    —    the power to enter an inspect premises owned or controlled by the PCT.

  The proposed LINks appear from the consultation document to have no statutory powers or responsibilities. We firmly believe that without statutory powers or responsibilities the LINks will not be effective and could be considered as "toothless".


    —    Forums set their own agenda and devise their own work plans and priorities without political or commercial interference; and

    —    LINks will have an agenda which, as proposed, appears to be susceptible to the influence of politicised or special interest groups.

  The independence of an agenda is essential if the organisation is not to be perceived as following directions imposed by powerful lobbyists or special interest groups to the detriment of representing the patient base impartially.


    —    PPIFs were funded independently of local authorities or the local NHS.

    —    LINks will rely on the local authority to pass on funding.

  Where funding is controlled by a body which may be influenced by local politicians there is a danger that funding might be delayed or curtailed if the funded body raises politically embarrassing issues. If local funding is unavoidable then it must be clearly and irrevocably `ring fenced'.


    —    PPIFs have generally been able to attract members because they offer the potential to "make a difference". The PPIFs' roles and structure were clearly defined and attracted members who have gained knowledge and experience since joining.

    —    LINks will attempt to build a membership drawn from local organisations with specific interests. By their nature these organisations attract members who have a specialist interest in a specific aspect of health or social care. The ill-defined terms of reference and lack of `clout' will make LINks less attractive to independent volunteers.

  Many of our existing members have serious doubts whether they wish to be part of what could easily become a "talking shop". They also do not wish to have patient and public involvement steered by special interest groups, which by their very nature and purpose were created to represent a specific cause

Monitoring Quality of Service and Standards

    —    PPIFs had a major role in monitoring services and processes within the health and care organisations. This role was clearly a major responsibility of the PPIFs.

    —    LINks seem to be vague on this pivotal subject. The key powers of access and response to enquiries are absent from LINks and it is difficult to envisage how they can effectively monitor quality and standards without these powers.

  Existing forum members see monitoring of quality standards as a key role. One of the major enablers for effective monitoring was the statutory framework in which PPIFs worked. The need to CRB check members who may perform inspections was given as a reason why this enabler is not present in LINks. It is possible to have patient and public representative bodies that embrace both CRB checked individuals and those who decline to be checked. There is no reason why inspections should not be limited to those who have been checked.

  It is also likely that some voluntary groups will have CRB checked members. We, therefore, cannot accept the Government's position that inspection can no longer be allowed.

The Voluntary Sector

    —    As already stated many voluntary sector groups represent specific single issue groups of people. That is why they were founded and that is their legitimate purpose. It is difficult to envisage that such representation can take a broad neutral view of health and social care issues in the way that PPIFs have sought to do.

    —    There is a presumption within the document "a stronger local voice" that all the voluntary sector groups are constituted on the same basis. This is not true. Whilst large well organised groups eg Age Concern have full time staff who may be able to devote some time to a LINk many groups are run on a self help basis by sufferers and their family member carer. These people work extremely hard at their group and in providing care to their partners. They also do much unheralded pastoral work. We question whether such groups could provide effective membership of a LINk.

    —    This forum has invested a massive amount of its time to seeking to make links with the voluntary sector in this City. This has been met with minimal success.

    —    We believe that our greatest success in working with the voluntary sector was in co-opting advice and information from a voluntary sector group when we undertook a piece of work relevant to that body's area of interest.

    —    We suggest that that level of link up is the right way forward and that widening the representation on PPIFs as currently constituted will provide the best way forward.

Section 11

    —    This forum welcomes the strengthening of section 11 regarding consultation as a progressive and beneficial reform.

Single Area Body

    —    The proposal to establish a single body to oversee one area based upon a social services area as proposed is a constructive move as for many health patients the treatment pathway spans both PCT and Acute trust services.

  We believe that the PPIF organisation was just getting into its stride and possibly is now a victim of its own success, hence the intention to replace it with a `watered down' version. If we are to avoid this, pressure must be brought to bear before the proposals are put before parliament.

Peter Edwards


Peterborough Primary Care PPIF

Annette Beeton


Peterborough and Stamford Hospitals PPIF

11 December 2006

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