Select Committee on Health Minutes of Evidence


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 improvements—call them what you like—that 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 Commons—which may be a bit difficult—but certainly before it receives Royal Assent, this inquiry will have some influence on its content.





 
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