Select Committee on Health Written Evidence

88. Evidence submitted by The Royal College of Radiologists (PPI 50)


  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.


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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