Evidence submitted by Councillor Barrie
Taylor, Westminster City Council (PPI 158)
Executive Summary
1. There are three questions that must be
answered in respect of Patient and Public Involvement in Health:
What are the key elements of successful public
and patient participation?
What are the strengths and weaknesses of the current
system? and
Will LINks add value to that which currently exists?
My responses to these questions would be as
follows:
2. Put relationships first, over issues
and policies, since good relationships are the most effective
building blocks to mutual confidence and understanding, ensuring
that there is some equity between organisations by guaranteeing
their independent status.
3. There is a role for both statutory and
voluntary frameworks of public engagement As our experience demonstrates,
PPIFs can and will work within the new world of health and social
care commissioning—they already deal with the joint commissioning
process, and there are a number of examples of good practice,
including working with hard-to-reach groups.
4. Above all, what is needed now is a period
of stability—building on what exists. There is little in
the current proposals to indicate that LINks would add value—only
that further upheaval would undermine an already fragile process.
Health Scrutiny in Westminster
5. The Health Overview and Scrutiny process
in Westminster uses the four principles developed by the Centre
for Public Scrutiny in the approach to its task:
— Acting as a "critical friend".
— Reflecting the voice and concerns
of the public.
— Leading and owning the process.
— Impacting on delivery of public
services.
6. Our understanding of the role and duty
for health scrutiny has led us to conclude that the process requires
three key elements in any work programme:
— scrutiny of health policy and
planning—strategic overview of local health status;
— scrutiny of NHS performance-
local accountability; and
— scrutinising issues of local
and community concern—responding to public opinion.
7. Some scrutiny activity is undertaken
in reaction to formal proposals for change and other scrutinees
are designed to contribute towards the development of policy for
the public good (eg introduction of smoking restrictions in public
places).
8. Regardless of structures, public and
patient involvement work in Westminster is centred on the primary
need to build confidence in relationships so that effective dialogues
can be established. It is from the starting point of strong relationship
ties that Health Overview & Scrutiny performs well—representing
best practice.
9. With this in mind, strong links have
been fostered between the local PPI forums, voluntary sector networks
and the O&S committee. As part of the work of O&S I believe
it is vitally important to be in direct contact with local groups—fostering
the relationship and dialogue that is critical to success.
10. Of equal importance are health scrutiny
relationships with local health and social care providers and
their executive teams. Confidence in relationships reduces confusion
and improves joint working at early stages in decision-making.
Confidence also reduces the sense of mistrust—which can
easily occur if decisions are merely "placed" in the
public domain.
The Importance of Independence
11. For dialogue to work well, the bodies
that are being reviewed need to remain independent of those offering
views and opinions. Dialogue is of course, by its very nature,
a two-way process. This is especially important when trying to
involve "hard to reach" groups.
12. The status of a "critical friend"
is of vital significance. Public bodies (NHS Trusts/Local Authorities)
are given public duties to perform—against which they can
be held accountable. The same goes for Overview and Scrutiny Committees
and publicly funded PPI Forums.
13. Public confidence in decision-making
is enhanced by the process being more transparent and by the disclosure
of pecuniary and non-pecuniary interests.
14. Voluntary sector and citizens' interests
are not subjected to the same levels of governance or public scrutiny.
Views/opinions in such cases could be seen by the outside world
to be distorted by a variety of vested interests—eg single
issue pressure group interests/commercial interests of third party
providers of service.
15. Westminster has experience of public
involvement from each perspective—publicly accountable PPI
Forums, a local BME Forum funded by two PCTs and networks of Voluntary
Forums.
Patient and Public Involvement Forums in Westminster
16. An example of the work of the St Mary's
Hospital Trust and the Westminster PCT PPI Forums shows how public
bodies, with rights and responsibilities towards their local community,
can jointly exert influence in decision making.
17. Following consideration of the work
plans for each PPI Forum, their respective NHS Trusts and the
Overview and Scrutiny Committee, it was clear that a common priority
was outpatient-waiting times.
18. On the initiative of the Overview &
Scrutiny Committee, a round table discussion was convened to establish
the level of overlap and need for joint action. Each of the partners
used their independent statutory status to contribute towards
the value of the project.
19. The PPI Forums were able to contribute
£2,000/Forum of development project money, with the two NHS
Trusts and Overview and Scrutiny contributing similar amounts.
PPIF members undertook the survey work.
20. The result of this study is summarised
in a report When will I be seen? 3[3]
Each contributing agency gained from the joint nature of the project
(A copy of the report is enclosed with this submission)
21. This example shows how statutory bodies
can use their powers and responsibilities to undertake common
reviews of service provision. In this case, a project with resources
of £2,000 was raised to a budget of up to £10,000—due
to formal agreement. Equity in this relationship ensured that
the project did not become skewed towards any particular agencies
interests.
Kensington, Chelsea and Westminster BME Forum
22. The work of the KC&W Black &
Minority Ethnic (BME) Forum is also especially relevant. Kensington,
Chelsea and Westminster PCTs fund their activities and employ
a co-ordinator. The BME Forum has a Health Forum sub group. The
group has trained 20 volunteer interviewers to undertake local
research with BME groups on health issues.
23. In one research project, volunteer interviewers
spoke with over 200 local BME groups in Kensington and Westminster.
The basic question asked was "what does the term consultation
mean to BME communities?" The result of this study is summarised
in a report called Minding the gaps4[4]
and a copy of the report is enclosed with this submission.
24. A resume of the key findings in respect
of "consultation" is as follows:
— The term "consultation"
is easily misinterpreted.
— Mixing information giving and
promotional events in the context of a consultation can easily
mislead.
— The NHS needs to be more explicit
about its intentions when seeking public views.
— The NHS needs to demonstrate
that it has listened to people's views.
— Feedback is required on actual
participation and influences on policy and decision-making.
— Consultations need to be timely
and framed in an appropriate format.
— Communications need to be improved
on outcomes of consultations/effect on local services.
— A strategy is required to achieve
wider participation by BME organisations.
— The NHS should monitor levels
of BME participation in consultations.
25. This example indicates how volunteers
can contribute towards public policy, how volunteers can take
part in consultative processes, maintaining a distance from commissioning
and provider agencies, whilst knowing that their work will be
set against mainstream NHS priorities and reliance upon local
funding decisions. In the words of a local PCT Chair, "The
Forum cannot be seen to be independent of the Executive".
Westminster "Involving People Network"
26. Regardless of what framework the NHS
uses to engage citizens in processes of decision-making and consultation,
the voluntary sector already has in place many other forums and
networks which relate directly to health and social care interests.
Voluntary Action Westminster even co-ordinates a network dedicated
to consultation.
27. "Westminster Involving People Network"
was launched in December 2003 as a partnership between Westminster
City Council, Westminster PCT and Voluntary Action Westminster
with sponsorship from all the partners.
28. The aims of the "Westminster Involving
People Network" are as follows:
— To work together to improve
engagement and consultation activity with Westminster residents
and stakeholders.
— To provide training for members
on engagement and consultation.
— To share information about involving
people activity.
29. In addition, Voluntary Action Westminster
also co-ordinates the Black and Minority Ethnic Network; Children
and Young Peoples Community Forum; Disability Forum; Homelessness
Forum; Lesbian, Gay and Transgender Networking Forum; North Westminster
Voluntary and Community Sector Forum; Westminster Older Peoples
Network; Women's Forum; South Westminster Community Network; The
Refugee Consortium and the Soho Caring Agencies Forum.
A Period of Stability
30. Much is said about the changes that
are taking place in mainstream NHS—particularly the emphasis
of the new commissioning roles of PCTs. However, the NHS is not
an island and should not be seen to ride roughshod over already
established arrangements when it comes to engaging more citizens
in decision-making and consultation.
31. There are many special interest health
groups, although some of the more highly specialist interests
struggle to be involved in decision making—as much of the
commissioning and provision takes place at strategic or national
levels. Virtual communication networks are now addressing some
of these interests.
32. Health policy makers appear to be convinced
that the model of patient and public involvement is best focused
on "patient treatment" care pathways, which omits to
acknowledge the priority of preventative and general public health
concerns. In addition, it ignores a swathe of wider changes surrounding
citizenship.
33. Citizenship and citizen empowerment
is now a key priority in the reform of public service. The Civic
Renewal Unit has developed a range of active learning networks—covering
involvement across a range of communities, both in terms of place
and interest.
34. The Annual Review of the Together
We Can[5]
2005-06 programme, published by the Department for Communities
and Local Government provides excellent examples of best practice
of citizenship in all government departments.
35. The Department of Health and The Home
Office have sponsored a project on the question of citizen governors—to
support citizen involvement in decision-making.
Background Note on Personal Expertise (for information)
— My working life has been devoted
to citizen involvement in decision-making.
— I was a Community Health Council
Chief Officer until their abolition in 2003.
— I have been an elected member
of Westminster City Council since 1986.
— I chaired Westminster's Health
Overview and Scrutiny Committee between 2003-06.
— I am currently a member of the
Westminster Scrutiny Commission.
— I chair the Westminster Health
Scrutiny Task Group.
— I am an adviser with the CfPS
Expert Advisory Team on Health Scrutiny.
— I have advised WHO (Europe)
on the formation of Patients Rights Networks and I am also a Commissioner
with CPPIH.
Cllr Barrie Taylor
Westminster City Council
January 2007
3 When will I be seen Westminster and St Mary's
PPI Forums; St Mary's Hospital NHS Trust; Westminster PCT and
Westminster Health Overview and Scrutiny Committee (June 2005). Back
4
Minding the gaps KC&W BME Health Forum (June 2006). Back
5
Together We Can-Annual Review 2005-06 Department for Communities
and Local Government (June 2006). Back
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