Changes to patient and public involvement in the NHS

Report of CVS Voluntary Sector Forum meeting held on 2^nd July 2003

From the autumn of 2003 there will be a new way for the public to become involved in the running of the health services and for patients to get help to pursue complaints. Since 1974 this role has been done by Community Health Councils. These are soon to be abolished, despite a national campaign last year to retain them. They are to be replaced by several new bodies:

* Patient and Public Involvement Forums (PPIF) – one for each of the 571 Health Trusts in the NHS. Locally we have trusts for primary care, local hospitals, ambulance services and mental health services. 

* An Independent Complaints Advocacy Service for individual complaints which ultimately will be run through the Patient Forums.

* A new Overview and Scrutiny Committee of  the local authority, locally Hertsmere Borough Council.

* A Patient Advice and Liaison Service in every trust to provide information and advice.

* An Expert Patient programme to involve patients to improve care programmes.

Hertsmere Community Voluntary Support (our local CVS) recently held one of their regular Voluntary Sector Forum meetings on this subject. The speaker was Malcolm Alexander, Chief Executive of the Association of Community Health Councils.

He said that it has always been difficult for communities to have an effective influence on the NHS. The role of Community Health Councils will now be split between other bodies: monitoring will be done by the new Patient Forums, a new role of scrutiny will be undertaken by local authorities and individual complaints by the new ICAS. However who will undertake the campaigning role which many CHCs did is uncertain.

He said it is important to look at the changes positively – they will create an opportunity for communities to express their views, a specific organisation to support patients with complaints and to organise debates on NHS issues. The present right of access to monitor and report on NHS facilities, the right to information and the right of community advocacy of the CHCs will pass to Patient Forums.

Initially the ICAS for individual complaints will be set up by the Department of Health but it is envisaged that this is only for one year after which the Patient Forums will take over. This should make it easier to set up complaints systems more accountable to local needs. In addition each trust in the country will have a PALS service (Patient Advisory Liaison Service) and if the Patient Forum believes these are not running properly, they can take this service over as well.

The right to be consulted will pass to the local authority overview and scrutiny committees. Not much is known about how this will work because the Department of Health have not yet published their O and S manual. This is very important because local authorities have not previously had a role in health. However because of restrictions of time and resources they will inevitably not be able to do too much, perhaps 4 or 5 exercises a year. And at present local councillors are not geared into health and may not be aware of changes or needs of services or of the information gained by those active on health issues.

Mr Alexander said that one of the weaknesses of the NHS system is that there is little room for change or manoeuvre because the government have set their 20 priorities for the NHS which are non-negotiable. Local health services have to act on the things coming down but it is very difficult to influence things going up eg by adding extra priorities. One way is by using the Strategic Partnership route. Government priorities are influenced by people with a loud voice or able to use the media but those with other needs are ignored. For example new techniques of heart surgery compared with chronic arthritis. If money is concentrated on waiting times in Accident and Emergency do cancer patients suffer because money is not then going to chemotherapy? The real need is for more resources for the health service, to raise spending consistently to other European levels.

He suggested that the NHS works on the process of nobody knows everything except for 2 or 3 people, but a lot of people know a bit of the picture. This is a new role for the voluntary sector with a lot of new organisations to get involved in: Patient Forums, Overview and Scrutiny Committees, Commission for Patient and Public Involvement, PALS, ICAS and expert patients. Locally the all CVS organisations across Hertfordshire County have joined together to bid for running the new Patient Forums and it is quite likely that in Hertsmere this may be successful. We will know more in September.

In the discussion the role of Primary Care Trusts was raised: they can be more flexible as they have 3 year plans but a lot of their resources are swallowed by the national priorities. They are more accessible than the previous large health authorities, but there has been a failure by the local community to engage in health issues. Perhaps local PCTs will welcome local involvement until they are challenged on something or  are forced to change their priorities. Mr Alexander suggested that the voluntary sector should have the confidence to do this bearing in mind that health authorities have the duty under S 11 of the Health Service Act to involve their local communities in planning and provision and in decision making. For the first time there is a right of access for Patient Forums into the Primary Care Trust through providing a non-executive director.                  

The discussion also looked at what the voluntary sector need to do: develop new services, act as advocates to improve conditions eg for mental health patients, to identify gaps in provisions, to form effective alliances in the community. One way to achieve change is to involve the  local MP to have an adjournment debate. There are also the Expert Patient Programmes which involve patients in the way their care is delivered and focus on chronic illnesses. Locally this is called a Skills for Health programme in Hertsmere.

 If you are interested in being active on health issues locally or want to volunteer your help or expertise to the voluntary sector please contact Hertsmere Community Voluntary Support (HCVS) based at Allum Lane Community Centre, Borehamwood, WD6 3PJ, telephone 020 8207 4504 or email cvs@hertsmerecvs.fsnet.co.uk