Evidence submitted by Mary Adams, Head
of Public Involvement in North Somerset PCT (PPI 154)
What is the purpose of public and patient involvement?
— To include a relevant lay perspective
in all aspects of health service planning, service redesign and
delivery to influence design and delivery of NHS services.
— In the past within a "patriarchal
medical model" where health professionals were perceived
as experts who knew what was best for patients, the clinical and
management perspectives held the power to shape service design
and delivery. The inclusion of a relevant lay perspective will
help to ensure that services are designed and delivered in a way
that users want. This is of key importance as the NHS is funded
by the tax paying public who at various life stages become its
users. They are therefore the key stakeholders/(shareholders)
and should have the opportunity to influence design and delivery
of their NHS.
— Public and user views offer
a valuable perspective that in the past has been the missing piece
of the jigsaw. For example, people who are disabled or from a
different culture can offer a particular perspective that can
add real value when improving services. It is important however,
to make a distinction about which level of involvement is needed.
For example, citizen through to patient involvement. The danger
is that PPI tends to perceived as an homogenous activity, where
in practice tailoring approaches to specific project requirements
is of paramount importance.
— Relevant lay engagement and
involvement is critical to success. People need to see that their
view is valuable and will really help to shape the way NHS services
are designed or delivered. Some issues will need a broad inclusion
of public views, for example designing the future health services
for a whole county for the next 20 years, where some will need
specific views for example redesigning a care pathway for people
with diabetes or coronary heart disease. People also need to know
that their comments and concerns will be fed into improving services
through mechanisms like PALS and complaints services. These support
services need to be responsive and fair to re-establish trust
when things have gone wrong.
What form of public and patient involvement is
desirable, practical and offers good value for money
— To ensure that the PPI work
undertaken is appropriate for any specific project, it is very
important to continually ask a series of questions when approaching
the task.
For example:
— Why are we asking for public/patient/lay
views for this particular project?
— Who are the relevant people
that we need to include?
— What is the best way to engage
and involve people for this project?
— What methods have worked in
the past?
— Are there new ways of working
that might be more effective?
— Are these methods cost effective?
— Do we think this will add value?
— How will these methods affect
timescales?
— How are we going to use people's
views—what weight will they be afforded in decision making
processes?
— How will we inform people about
how their views have helped us?
This questioning approach to PPI should include
a lay perspective at the early stage, and could also build in
staged "PPI review points" as the project progresses.
Why are existing systems for patient and public
involvement being reformed after only three years?
— Some aspects of PPI are not
working as well as anticipated. Some of the structures have not
led to anticipated outcomes and some processes are overly clumsy
and bureaucratic. For example, recruitment and support of PPIF
has proven problematic in some areas, there is very little capacity
to take on a huge amount of work as volunteers, and PPIFs are
still not visible enough to the general population. Also PALS
services not linked in well enough to other structures and feedback
is under utilised in supporting NHS service improvement. Some
areas of PPI have however offered great improvement for patients
as for example the Expert Patients Programme, which has been shown
to reduce GP and hospital visits.
How should LINks be designed, including
— Remit and level of independence.
— Membership and appointments.
— Relations with local health
Trusts.
Links should be independent of the NHS and have
a range of roles including:
— Focusing on issues of concern
that the population served are raising about their local health/social
services.
— Gathering information about
local health/social services from the population served.
— Working across social service/health
boundaries to look holistically at the public/patient/carer experience.
— Role in inspection—perhaps
by working closely with Healthcare Commission. This way local
knowledge can be added into the any assessment/inspection process.
Membership/appointments:
— Should be open to whole population
served. This should be to individuals as well as members representing
voluntary and community groups. Special effort needs to be made
to include people seldom heard from to ensure this perspective
is present. Care will need to be taken that influential individual/group
agendas do not divert the LINKs to become a single issue pressure
group, and that they maintain a balanced approach to serving whole
local population needs.
— Time limited membership for
a maximum of three years, with a buddy system so that people can
have support to help them contribute their potential in the first
year, a year of working/ leading projects and a final year to
support newcomers. A three year membership should ensure that
the LINKs does not become `professionalised' and retains a fresh
outlook on health and social care matters.
Funding and support:
— Funding from central government
from health/social care funding stream as the work undertaken
by LINKs will benefit NHS/Social Care. Could also benefit from
donations from commercial and voluntary/charitable sources as
working for the benefit of local communities, as long as independence
maintained. Social Enterprise model.
— Volunteer members should be
rewarded and recognised for their contributions at a nationally
consistent tariff and in a way that does not exclude people in
receipt of benefits.
— As mentioned previously a "buddy
system" to support individual LINKs members needs to be established
as part of the set up.
Area of focus:
— Issues of local concern—working
with PALS/complaints Depts. Health and Social care.
— Service redesign and planning.
— Service delivery and improvement.
— Working across boundaries—along
patient journeys.
— Locally agreed projects based
on local hot topics.
— Partnership working especially
with Healthcare commission.
Statutory powers:
— Access to information from health
and social care with full regard for data protection/ confidentiality.
— Formal link with Overview Scrutiny
Committee.
— Formal link with PALS/Complaints
Depts health/social care—(eg receive their reports).
— Inspection of local health and
social care services in partnership with Healthcare commission.
Relations with local Trusts:
— Presence on Trust Boards/key
committees and meetings.
— Willingness to work with Trusts
on projects.
— Support Trusts with PPI agenda
especially Section 11 requirements.
National Co-ordination:
National Body to co-ordinate LINKs, support
members and provide consistent support/platform for a national
voice.
How should LINks relate to and avoid overlap with
— Local Authority structures including
Overview and Scrutiny Committees.
— Foundation Trust boards and
Members Councils.
— Inspectorates including the
Healthcare Commission.
— Formal and informal complaints
procedures
LINKs and OSCs
— Formal relationship with LINKs
reporting activity to OSC and receiving information about local
concerns that may generate project work.
— Shared information and database
of interested stakeholders.
— Agreed communication channels
with Trusts/Social Care.
— Sharing work programmes to avoid
duplication.
Foundation Trust Boards/Members Councils
— Links could offer a very varied
level of public involvement from a registering of an individuals
interest to be involved with a specific area of work to full scale
regular membership across all LINKs activities.
— Links will work across a whole
population rather than with a single organisation.
Inspectorates including the Healthcare commission
Formal and Informal Complaints Procedures
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?
— For service redesign and new
plans/initiatives in health and social care that affect a whole
cross section of a population or that will have a significant
impact on the way that services are delivered to people, especially
where this could be perceived as a negative impact.
— The form needs to be tailored
to project need as already indicated. There is not a "one
size fits all" solution.
Mary Adams
Head of Public Involvement, North Somerset PCT
February 2007
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