Examination of Witnesses (Questions 215-219)
MRS JENNIFER
BEESLEY, MS
PENNY ROBINSON
AND MR
BARRY SILVERMAN
22 FEBRUARY 2007
Q215 Chairman: Good morning. Could I
welcome you to the third evidence session we are taking in relation
to Patient and Public Involvement. Could I ask you to introduce
yourselves and your organisation?
Mr Silverman: I am chair of the
Southwark Patients Forum for Primary Care.
Ms Robinson: I am chair of the
United Bristol Hospitals Trust Forum.
Mrs Beesley: I am the former chairman
of Great Yarmouth PPI Forum.
Q216 Chairman: Could I ask a general
question to all of you? What have been the best and the worst
things about the existing public and patient involvement arrangements,
do you think?
Mr Silverman: We have a job to
do but there have never been the financial resources to allow
it to be done and that has an impact on recruitment because you
need to go out and make people aware that you exist, understand
what you do, and that leads to a healthy recruitment. Without
those kinds of financial resources and without the support, which
there has never been, those things have faltered.
Ms Robinson: I would absolutely
agree with that; recruitment has been a real problem. We are a
small forum. On the other hand, I think being a small group makes
us more effective in many ways in that we can work together effectively,
and one of the most effective things we have done is we did a
stroke report for our local hospital, and they took on board all
our recommendations and have started to implement improvements
in the service. We feel that we have a very good relationship
with them and that from the hospital's point of view we work well
together, but we are very constrained by the finance as to what
we can do.
Mrs Beesley: I think the best
thing that our forum has done was our GP survey. That was the
most wonderful experience, meeting the public. We did 687 individual
questionnaires and we evaluated 1,477 comments, which was the
patients' perception, and we learnt such a lot. That was the best
thing in the forum of working together as a team. I agree with
my colleagues that the amount of work that we should be doing
and could be doing is sad because we have not got enough members
and it is very difficult to recruit. The public does tend to have
this apathy and they think the Government should do everything
concerning health, and that is very sad.
Q217 Chairman: Maybe that is the
answer to my next question but what has been really the biggest
problem that you have faced and how could you fix it, as it were?
Presumably it has been recruitment as far as you are concerned.
Mrs Beesley: Yes.
Q218 Chairman: How could you fix
it?
Mrs Beesley: By getting the public
aware of us more. You can talk to people and they have never heard
of the PPIF. They all still know the CHC but they have not heard
about the PPIF. When you ask your support organisation: "Can
we advertise to try to get it in the paper?", it is always
"There is not enough money", so apart from knocking
on doors I really do not know the answer. I would like to see
more put into recruitment.
Ms Robinson: I think one of the
things we have found difficult is not knowing what our future
is going to be. We had only just got up and running and got ourselves
organised and we were promised that whatever happened to the CPPIH
we would still exist as forums, and we had got our heads round
the idea we were going to be combined in Bristol and work from
the PCT, and then all of a sudden we were told that we are no
longer going to exist and it is going to be a LINk instead. Every
week somebody threatens to resign and we only stay because we
are friends, you know, and people say "Oh, don't go".
It has been very disheartening for people looking towards the
future. We do not know what we are going to be doing next year
or the answers to any questions we address. We just do not know
what form really LINks is going to take.
Mr Silverman: I think the uncertainty
cannot be underestimated. If you take organisations out in the
country, like we are, with three years ago the Commission going
to be abolished, from the moment the Commission was going to be
abolished, for whatever reason, it put a question mark over forums
and whether there was going to be change. The Commission was going
so that meant there was going to be change. Now, as far as the
trust is concerned that you relate with, you can hardly be surprised
if a Primary Care Trust or a hospital trust is uncertain what
its relationship should be or whether the organisation it is interfacing
with is going to be changed, and I am absolutely certain that
although we did not experience direct problems, what you say to
people and the seriousness with which they treat you must have
some bearing on what they think you can do or cannot do. There
has been this uncertainty now for years, not just in the last
few months, and where there has been criticism of some forums
I instinctively believe that maybe their ineffectiveness is due
to the uncertainty. You have to drive very hard in the present
situation to get the recognition knowing that, in fact, all the
time there is really this problem of legitimacy. For example,
the Southwark Trust has never disengaged with us but it began
to set up a shadow network of consultation and was never tired
of saying: "Well, of course, you are not the only PPI."
Q219 Mike Penning: Good morning.
Thank you for joining us. Can I ask all of you how you feel the
NHS has integrated or worked with you as a public forum, and whether
there have been problems within the NHS? We have discussed the
public side but how has rapport with the NHS been?
Mr Silverman: Well, speaking from
direct personal experience, when I joined the forum I think it
is fair to say that it was fairly inactive. We were not in any
sense rejected by the Primary Care Trust but, if you like, they
set up a patient experience group and they often put consultations
to their own experience group and not to the forum, and the forum
did not react. When I became chair I set up rattling the bars;
it was necessary to create change so we found an issue and rattled
the bars with it by saying to the Primary Care Trust: "Look,
consultation does not begin when you have decided what to do,
it begins right at the very beginning", and we chose as our
example when trusts were asked to make plans to become commissioners
and not providers, and this was going to be if it was in the public
interest. So we asked for a meeting and we said: "Before
we go any further, could you please put in front of us for consultation
the criteria for what public interest is", and that was the
beginning of our dialogue that brought about change. Now, all
this time—and I want to be absolutely fair to the Southwark
Trust because, as I said, they have never rejected us—at
board meetings we were treated pari passu with non executive
directors; we questioned from the boardroom table, we got answers
and we could join in the debate. It was not just a question of
question and answer. If we did not like the answer we were given
we could ask supplementary questions, so always we had this recognition.
Now, as I said in my evidence, which you may want to question
me on, we have a protocol that embeds us in the trust, and my
point to the Committee today is that you have to have two things:
one a trust that is prepared to recognise public and patient involvement
in a formal sort of way, and, secondly, it cannot exist without
what I call embedment—that is the ability of public and
patient forum members or its equivalent to be part of the trust;
to sit, as one of my members does, on the Practice-based Commissioning
Committee, or the Nursing Improvement Committee or whatever, and
to be there at the table, so that as the ideas are discussed before
decisions are taken there is a public and patient involvement.
Ms Robinson: I would like to speak
in praise of United Bristol Hospital Trust because they have always
had a good attitude to PPI and they came halfway to meet us from
the very beginning. Almost every month we get a representative
from the hospital at each one of our forum meetings, but most
frequently it is the head of nursing, the chair, the chief executive
who really goes out of their way to keep in touch with us and
we find this sorts out a lot of problems at the initial stage.
I would also like to say that not only has the Trust been very
welcoming and responsive to what we do, and they have asked us
to continue, whatever happens with LINks they say they want us
to have the same powers we had before and they want us to help
them still with the hospital, but one of the things that forums
can do is support hospital staff when they visit. It is not just
a question of patients. Often staff take us on one side and say:
"We have been pressing and pressing for this, we would really
appreciate it if you could put a good word in", and we do
find sometimes that tips the balance.
Mrs Beesley: When I became chairman
of Great Yarmouth Forum there had been no contact previously with
the PCT, they did not have any regular meetings at all, so I set
about setting up meetings with the chairman and the chief executive.
We did have a place on the board but it was not as good as it
could be. I am very proud to say we have had some wonderful work
done with the PCT and the Chairman has listened to everything
we have said and asked even down to when the GUM clinic had a
17-week wait in Great Yarmouth. We mentioned it to the chairman
and the chief executive and they worked very hard and we brought
that down to 48 hours. I am sad to say it has reverted back now
to just an occasional meeting with the new PCT and PPIF but the
work is there to do and we should be working with the PCT. Since
leaving I have been asked to join their new PCT/PPI group within
the PCT which I will do and I hope I will get them to work again.
We were very lucky, we were on practice-based commissioning and
I was very honoured to be asked to be on their transition board,
so we did work very closely with them and I think it is imperative.
Barry is extremely lucky but you have to work with these people
and work together in partnership but as the critical friend. It
can be done and it should be done, and I would encourage anybody
to go and do this work with their chairmen and chief executives.
It is very rewarding and I was very pleased.
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