Examination of Witnesses (Questions 100-105)
MR HARRY
CAYTON AND
MR MEREDITH
VIVIAN
1 FEBRUARY 2007
Q100 Mr Campbell: LINks are to be
encouraged to sign up special interest groups, campaign groups,
providers themselves and social care services. What about the
silent majority like young healthy men like me?
Mr Cayton: I would be encouraging
the Men's Health Forum to join the LINk. It is true that there
are certain groups, for example young men and particularly groups
of Asian women, who do not engage with the health service very
effectively. I go back to my example of Communities of Health.
There are ways of achieving that by going into the community instead
of expecting the community to come to you. I hope that we shall
see LINks developing those kinds of models. Communities of Health
does not have any money, nor does it need it. It has one PCT member
of staff who co-ordinates it part-time, but the resource comes
from the community.
Q101 Mr Campbell: Would you expect
LINks to go out to these small groups and encourage them to come
in?
Mr Cayton: Let us take the example
of young men which is an interesting area. Bodies like the Men's
Health Forum do terrific work producing health information for
men and engaging with young men in the places where they go. They
go into pubs and talk to young men about sexual health, smoking
and drinking. Although we are not asking LINks to become public
health bodies there are ways in which they can elicit those kinds
of views and interests.
Mr Vivian: We are always tempted
to talk about LINks as if they are the only way by which news,
views, ideas and experiences are fed into health and social care.
They are one route and device. It may very well be that a LINk
thinks it is really important to focus on the needs and experiences
of young men in its area. It will certainly collect the views
of young men because it will not rely on a small group of members
to hear what it is like in the wider area. There are ways of contributing
those views. The other important aspect is that local authorities,
PCTs and service provides themselves are required to talk to people
and will need to be able to make decisions about how best to improve
their services. I would not want us to think that LINks is the
optimum solution for everything.
Q102 Jim Dowd: You said in your submission
that you would simplify, clarify and strengthen section 11 of
the 2001 Act which deals with consultation. Can you explain what
you mean by that? We have also received submissions that people
fear it will become narrower. Both may be true and perhaps you
are using different terminology.
Mr Vivian: Section 11 of the Health
and Social Care Act 2001 places a general duty on NHS organisations
to do three things: involve and consult people in the planning
of the provision of health services; to involve and consult people
on the development of proposals for changes to services; and to
involve and consult people in decisions that affect the operation
of services. But at no point in the legislation does it say to
what level that applies, so it literally can be from the biggest
reconfiguration to the smallest issue; indeed, it could even relate
to something that has no impact on service delivery from the point
of view of the patient. The change might be made and people would
not be aware of the difference. What we have done to simplify
it is introduce the notion of significance. The three limbs to
which I have referred need to apply to a degree of significance.
The duty kicks in when it is above a certain level. That is not
to say that it must be a huge reconfiguration; it just needs to
be significant in terms of the range of services or the manner
in which they are provided. We are simplifying it to enable the
NHS to say of a particular matter that it is clearly something
on which it needs to consult and involve people and now it knows
where it is. In part, it also picks up an issue mentioned earlier.
People become very cynical if they are being consulted on something
that does not have any real impact on them. They just wonder why
they have been asked about it and do not understand it. As to
clarification, the Act is also to be revised by the department
by inserting a requirement on NHS organisations to have regard
to statutory guidance. Currently, section 11 does not have that
requirement. We believe that statutory guidance is absolutely
fundamental to enable the NHS to be better at what it is supposed
to do. We have strengthened it by imposing a new duty, which I
mentioned earlier, for PCTs to report back on what they have done.
They will now be required to say how they will engage people,
say what they have heard and say what they are going to do about
it.
Q103 Jim Dowd: With characteristic
prescience you have answered a large part of my next question
but not all of it. Under the current section 11 there have been
a number of legal challenges against various trusts. Do you think
the changes, amendments or improvementscall them what you
likethat you envisage will reduce those opportunities,
or will it be easier for people to make challenges?
Mr Vivian: The intention of these
specific changes is to make it clearer. The North East Derbyshire
case is a perfect example. Section 11 just was not clear enough
as to what the PCT had to do and the PCT felt that it had put
in place arrangements necessary to comply with the provision.
The judge who considered it decided that that was not the case.
What we have attempted to do is carry out a clarification process
and the statutory guidance is specifically intended to make clear
what is expected so that NHS organisations can be much better
and more effective at fulfilling the duty that is upon them.
Q104 Chairman: I have not seen the
two judgments relating effectively to reconfiguration. I assume
that if a doctor's surgery closed for whatever reason, or had
been closed for a number of years, the offer of a contract to
reopen it would be a significant matter as far as the local community
was concerned?
Mr Vivian: Yes.
Q105 Chairman: Would that be so if
it was the closure of a hospital ward?
Mr Vivian: That is absolutely
right. That is the kind of thing which would certainly be above
the threshold. It would have a significant impact on the range
of service delivery and the manner in which it was provided.
Chairman: I just wanted to put those
two matters in perspective in terms of what the department believes
the Bill should mean. I thank both of you very much for coming
along and giving evidence. I am sorry that we have gone on until
three minutes past one, but as this is the first evidence session
of the inquiry it is very important as far as the Committee is
concerned. We hope that before the Bill finishes its stages in
the House of Commonswhich may be a bit difficultbut
certainly before it receives Royal Assent, this inquiry will have
some influence on its content.
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