Further supplementary evidence submitted
by the Commission for Patient and Public Involvement in Health
(PPI 109E)
I am writing to you in exceptional circumstances
in connection with your Committee's Inquiry into Patient and Public
Involvement in the NHS.
You will be aware that the Department of Health
submitted to you in confidence a draft Policy Statement in respect
of both the proposed LINks' visiting rights and the eligible locations
for visits. The Commission has only recently been supplied with
this document, also on a confidential basis.
Frankly we are dismayed at the proposals contained
in the document, and would like to be sure that your enquiry has
given due consideration to its contents—we are of course
aware of the huge volume of evidence which you have had before
you in this enquiry.
In effect the proposals make a mockery of the
visiting rights of the new LINks. It appears that before any visit
can take place, they will have to write to, and obtain a reply
from, the regulator, ie the Healthcare Commission! This gives
the lie to any notion that LINks will be able to be free and independent
in they way that they work, and other proposals will severely
curtail the locations which they will be permitted to enter and
observe services in delivery.
Under Clause 156 the Secretary of State will
make regulations requiring service providers (National Health
Service trust; an NHS foundation trust; Primary Care Trust; a
local authority; or a person prescribed by regulations made by
the Secretary of State) to allow authorised representatives of
local involvement networks to enter, view and observe the carrying-on
of activities on premises owned or controlled by the services-provider.
This would replace PPI Forum inspection powers.
Significantly, Clause 156 (2) (a) and (b) would
allow these regulations to include conditions to be satisfied
before a duty arises in a particular case and provision limiting
the extent of a duty, whether generally or in particular cases.
During Committee Stage of the Bill, Robert Neill
MP referred to the Draft Policy Statement on LINks powers. Amongst
the limitations, or conditions to be satisfied, would be the requirement
for the LINk to give written notice of an intention to enter,
view and observe and write to the relevant regulator, indicating
their intention to visit a facility, and have received a reply.
It is intended that the regulator should have the ability to request
the Link to postpone its visit.
This would have the effect of preventing LINks
carrying out informal visits and unannounced formal visits, because
of the requirement to give written notice of a visit. It also
enables the regulator to place barriers in the way of LINks making
use of any right to visit premises, creating unnecessary bureaucracy
and potentially preventing the LINK from following up concerns
raised with them by service users or concerns raised in the media
in a timely manner.
Moreover, the LINk will effectively become an
arm of the regulator if it has to seek the permission of the Healthcare
Commission or Commission for Social Care Inspection before entering,
viewing and observing premises. It would appear that the Government
considers the LINk's primary role in this area to be to collect
intelligence from a lay, or service user perspective, on an occasional
basis in order to assist the regulator to carry out its work.
This is in contrast with the role of PPI Forums
as independent organisations acting on behalf of the public and
service users to enter and inspect premises for a wide range of
purposes appropriate to their remit, subject only to conditions
that they do not compromise the effective delivery of healthcare
or contravene the rights of patients and service users.
There will also be limits on the types of premises
where the duty to allow entry will apply.
It is right that LINks should not have a right
of entry to people's homes without their permission, but the Bill
would not convey that right anyway because it refers clearly to
premises owned or controlled by the services-provider not to all
places where services are provided. It is entirely possible that
a service user might wish to invite representatives of the LINk
into his or her home to view and observe activities in some circumstances.
Other premises that will be excluded are: group
homes and hostels for those with disability, mental health problems
and learning disabilities and extra care housing for older people.
Clearly the LINk should not be able to enter the home within a
care facility of a service user without his or her permission,
but it should be the service user who is able to refuse entry
not the provider or owner of the facility. There may be cases
where service users wish the LINK to visit.
Social care services and institutions for children
would also be completely excluded. There is a clear need to ensure
special protection for vulnerable children and young people, but
consideration should be given to ensuring there are circumstances
in which specially trained representatives of LINks should be
allowed to enter to investigate significant concerns.
The Commission is strongly of the view that
such limitations on the rights of LINks represents a serious attack
on the patient and public involvement agenda, and will serve to
undermine the credibility of the new arrangements from the outset.
We do hope that the Select Committee will take note of our concerns.
Sharon Grant
Chair, CPPIH
20 March 2007
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