88. Evidence submitted by The Royal College
of Radiologists (PPI 50)
THE ROYAL
COLLEGE OF
RADIOLOGISTS
1. The Royal College of Radiologists (RCR)
has approximately 7,000 members and Fellows worldwide representing
the disciplines of clinical oncology and clinical radiology. All
members and Fellows of the College are registered medical or dental
practitioners. The role of the College is to advance the science
and practice of radiology and oncology, further public education
and promote study and research through setting professional standards
of practice. The RCR currently has two Patients' Liaison Groups
(PLGs), one for clinical radiology and one for clinical oncology,
and a lay representative on its Council.
2. The RCR recognises the importance of
patient and public involvement (PPI) and has benefited enormously
from the work of the PLGs in the past. They are involved in all
new initiatives and we are intending to build on our current structures
to find ways of enhancing and maximising their involvement. To
this end the College has recently commissioned a project to review
the future development of patient and public involvement (PPI)
in the work of the College, with recommendations to be outlined
by July 2007.
3. The aim of the project is to consider
patient and public involvement and engagement within the RCR and
to raise the public profile of the College. This includes reviewing
current arrangements and developing a strategy for the future.
It should ensure that the proposed framework for patient and public
involvement within the College is fit for purpose and fulfils
the RCR objectives of patient involvement, which are:
— To provide a patient and public perspective
on all aspects of the activities of the College
— To meet wider patient and public
expectations
— To raise the awareness of the work
of the specialties and the College with the public
— To increase the political and professional
influence of the College
— To fulfil wider educational aims.
4. The remit includes looking at the topic
from a wider perspective, such as:
— Considering the overall framework
and structures of patient involvement in the work of the College
— Using patient representatives to
raise increased awareness of the two specialties and the profile
of the College with the public
— Recognising that at times the two
specialties may benefit from different approaches to patient involvement
— Raising the awareness of Fellows
and members to the value of lay representation.
The review may also look at more specific issues
around involvement of patient representatives within the College,
for example, recruitment methods, frequency of meetings, time
commitment, resources, administrative support and means of broader
patient consultation.
RESPONSE
What is the purpose of patient and public involvement?
5. It should be a fundamental tenet of organisations
that those paying for a service and those affected by it have
a moral and ethical right to be engaged in its design and development.
Public and patient involvement should be necessary for decisions
as to what services are provided, how they are provided, quality
setting and monitoring and the maintenance of standards. A service
can only be responsive to users if users are involved. PPI offers
service providers and commissioners the opportunity to better
understand the needs of patients.
6. PPI has never been more important than
it is now, at a time of reconfiguration and when crucial decisions
are being made by commissioners which impact on local services.
If providers are to purchase services on behalf of taxpayers it
makes sense that commissioners talk to them about the services
they buy and forge relationships with them so as to increase their
knowledge about the quality of the services for which they pay.
7. Responsibility for healthcare has come
increasingly to be seen as a partnership between professionals
and patients, with professionals becoming more publicly accountable.
Engaging patients in health policy decision-making helps to ensure
that policies reflect patient needs and preferences, and this
must ultimately make for more effective healthcare. In a publicly
funded health service, this serves to increase accountability.
8. The term patient and public involvement
encapsulates the two streams of lay involvement in healthcare
services. Patient involvement is the contribution of individuals
to their own healthcare, and public involvement the participation
of individuals or groups in the development, planning and provision
of services.
What form of patient and public involvement is
desirable, practical and offers good value for money?
9. Involving the patient and publics is
not straightforward. People as individuals and within groups can
have diametrically opposed views. Commonly excluded groups such
as those with language difficulties, learning difficulties, disabilities
and those without the time available to commit through traditional
means of involvement need to be reached. Once involved, it is
important that people do not become distrustful of the process.
This can happen if their participation is not acknowledged, or
what they contribute does not appear to make a difference or at
least be considered. Involvement must not be tokenistic.
10. PPI structures should exist at all levels
throughout the healthcare system and should be used to feed both
up and down into decisions relating to the design and development
of services and to the commissioning of services. Decision-makers
should also be required to demonstrate how they have incorporated
and responded to the views of those with whom they consulted.
It is important to ensure appropriate training, resource and support
structures are in place to ensure effectiveness.
11. Professionalising of PPI may lead governments
and providers to regard only the views of a national organisation
or their locally trained patient advocates because they "represent
the patient view". This would be detrimental to PPI. People
who do not belong to a patient organisation would not have a voice.
The terms of reference for the inquiry do not appear to give consideration
to the many already existing Public and Patient Fora, which do
valuable work, and have direct influence, albeit in more restricted
fields.
How should LINks (Local Involvement Networks)
be designed?
12. Representation, capacity and resources
are key elements in enabling LINks to work. The task of collecting
real public opinion can be complex and time-consuming, particularly
if it is to be done properly. Therefore, LINks must have the capacity
and resources to be able to undertake their duties. Representation
would ideally reflect the population, but more important will
be the ability of LINks to reach all the constituent parts of
its population served, including those traditionally excluded.
13. There is a danger that LINks may be
too closely allied to local authorities to be independent of local
politics and any conflicts of interest that may arise. There may
also be conflicting views within LINks because of the size of
areas covered and the priorities of particular localities.
14. However, a smaller number of organisations
may mean more capable people are available for recruitment to
LINks. It is important that LINks have the power to refer matters
to Overview and Scrutiny Committees and to inspect providers'
premises. It is also vital that LINks have the appropriate funding
to carry out their role.
How should LINks relate to and avoid overlap with
Local Authority structures including Overview and Scrutiny Committees
etc?
15. As stated above, it is important that
LINks have the power to refer matters for consideration to Overview
and Scrutiny Committees (OSCs) and that OSCs use LINks to inform
their work in reviewing local health and social care services.
16. It is also important to consider how
LINks relate to other bodies such as non-Foundation Trust boards,
private sectors of the Health service, patient and public representation
on many medical/clinical bodies such as BMA, medical Royal Colleges,
Cancer networks etc.
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?
17. Any attempt to use consultation as a
tool for gaining public views should provide open and transparent
information. It is also important that appropriate timeframes
are given to consultation as, for individuals or unsupported groups,
tight deadlines can give little scope for deep consideration or
understanding.
The Royal College of Radiologists
4 January 2007
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