Patient and Public Involvment in Transition

Patient and Public Involvement in Transition

Summary

Barely 18 months after establishing the Commission for Patient and Public Involvement in Health to develop and oversee systems for improving public accountability of NHS bodies, the Department of Health decided to abolish it. Pressure from s and MPs together with a desire to review all of the systems for involving patients and the public delayed the abolition of the CPPIH. The Government has now put forward proposals to replace s with Local Involvement Networks. This will require primary legislation.

In The Beginning

The Commission for Patient and Public Involvement in Health (CPPIH) was set up in January 2003 and by December 2003 had established 572 Patient and Public Involvement Forums from scratch and recruited more than 4,000 Forum members across England, providing assistance, guidance and training to the newly constituted Forums.

Arms Length Bodies Review

In the meantime, the Department of Health had embarked on a Review of Arms Length Bodies (ALBs) sponsored by the Department. The former Secretary of State for Health, Dr John Reid made the announcement on before the Health Select Committee, saying he was looking at substantial reductions in staff within the Arms Length Bodies. The ALB Review is related to the Gershon Review of public sector efficiency.

Dr Reid announced the parameters of the ALB Review on [Hansard 20^th May 2004 col 62WS]:

• a 50 percent reduction in the number of arm's length bodies
• savings in expenditure of £0.5 billion
• a 25 percent reduction in posts.

The Commission for Patient and Public Involvement in Health was included in the review, despite having been set up by statute less than two years before at a cost of £3.25 million. [Hansard 12^th September 2005, Col 2660W]

Proposed Abolition of the Commission

On the Secretary of State announced the abolition of CPPIH, [Hansard 22^nd July col. 74WS] subject to primary legislation, and that its responsibility for appointing forum members would transfer to the NHS Appointments Commission.

Nevertheless, the Minister, Melanie Johnson MP said:

?I emphasise that our decision to abolish the commission was not borne out of concerns about its performance?..The commission's performance, particularly its achievement in setting up the forums and recruiting about 5,000 members within a tight time scale, is highly commendable.? [Hansard 22^nd July col 583]

The Department initiated a consultation on future arrangements for supporting PPI forums and in March 2005 announced that:

• The date set for CPPIH?s abolition was August 2006
• PPI Forums would be reconfigured around Primary Care Trusts, with NHS Trust, Mental Health Trust, Ambulance Trust and Specialist Trust Forums effectively abolished.
• Forum appointments, including Forum chairs, would be made by the NHS Appointments Commission.
• A Patient and Public Involvement Resource Centre is to be set up in January 2006.
• Staff support to Forums was to be provided under a limited number of regional contracts and forums will be combined within PCT regions.
• The Government expected Forums roles to be narrower, primarily monitoring and reviewing NHS delivery, seeking the views of the public about those services and making recommendations accordingly.

Following the General Election of 5^th May 2005, it was expected that legislation on CPIH and reconfiguration of PPI Forums would form part of the Health Improvement and Protection Bill.

Forum National Convention

However, at the National Convention of PPI Forums on 6^th June 206 Forum members expressed their concerns in person to Minister of State Rosie Winterton MP.

Their key concerns were:

• the role of the NHS Appointments Commission in appointing Forum members and and the direct appointment of forum chairs,
• the potential loss of specialist trusts Forums
• the timetable and speed of change limited the degree to which Forum members were able to be engaged in decision making.

These views, coupled with representations from Members of Parliament, including Early Day Motion 637, persuaded the Department of Health to postpone abolition and undertake a review of patient and public involvement and accountability in the NHS.

Your Health Your Care Your Say

In a letter to PPI Forum members dated 31^st August, Rosie Winterton announced that the ?Your Health, Your Care. Your Say? consultation on healthcare outside hospitals provided an opportunity to:

?take a strategic look at patient and public involvement to build on the best of the work of patients? forums and help us ensure that future patient, user and carer involvement, as well as public engagement is as fit for purpose as possible?

She announced that abolition of CPPIH would be deferred until 2007, plans to give responsibility for appointments of forum members and chairs to the NHS Appointments Commission would not go ahead, and the reconfiguration and reduction of PPI forums was also postponed. The PPI Resource Centre will go ahead.

The Strategic Review

The terms of reference of the Review were:

"?to carry out a strategic review of PPI to understand fully the need for PPI and accountability. The review being an umbrella title for a range of activities that will take place between now and the launch of the health and care outside hospitals (HCOH) White Paper, to draw together evidence on good practice in PPI and consideration of how it can be strengthened further. The review will draw evidence from desk research mapping the current configuration and interaction of various parts of the PPI structure, the HCOH deliberative consultation, and a targeted engagement exercise that will run alongside the consultation to check out and explore ideas and their implications for PPI as they emerge. " [Hansard 30 Nov 2005 : Column 493W]

The Strategic Review of PPI consisted of a series of discussions with forum members, stakeholders in the public and voluntary sectors and an on-line survey organised by the Opinion Research Company MORI.

Our Health, Our Care, Our Say White Paper

The White Paper published on 30^th January 2006 contained no explicit commitment to maintaining independent local structures representing the opinions of patients, service users, and the public.

Instead the White Paper pointed towards greater use of local government as a vehicle for public engagement in health and social care services. In particular:

• Community calls for action, with ward councillors playing a key role
• A stronger PPI role for Overview and Scrutiny Committees
• Consideration of the use of Local Area Agreements as a vehicle for public engagement

The White Paper stated that the Strategic Review of PPI would continue and on 14^th February 2006 it was announced that an Expert Panel chaired by Harry Cayton, the Department of Health?s Director of Patient Experience would consider the evidence collected by the Strategic Review and make recommendations to ministers by end of April 2006. The Expert Panel also held a small number of session and invited written and oral evidence.

On 13th July 2006, by Written Ministerial Statement, the Secretary of State for Health announced her publication of ?Health Reform in England: Update and Commissioning Framework? and ?A Stronger Local Voice?, which sets out the Government's plans for the future arrangements to support public involvement in health and social care.

The Statement announced the Government?s plans ?to build on patient and public involvement forums through the creation of local involvement networks (LINks). The networks will provide a flexible vehicle for communities and groups to engage with health and social care organisations, and will promote public accountability in health and social care through open and transparent communication with commissioners and providers.?

A Stronger Local Voice ? CPPIH?s view

The Board of Commissioners of CPPIH will issue a detailed comment on the proposals for LINks shortly. However, there are a number of initial concerns, including:

The need to ensure LINks are capable of acting independently of commissioners and providers of services, of local government and local special interest groups in the communities they serve

Have available to them similar statutory powers as are currently available to Patient and Public Involvement Forums, such as the right to demand information

Are properly resourced to carry out all the functions required of them and promote involvement from disadvantaged and seldom heard groups

Effectively PPI Forums will be abolished and replaced by LINks. There need to be proper arrangements for transition between the two systems sufficient to ensure that the voices of patients and the public can continue to be heard.

The Next Steps

Legislation to put the new system into effect is expected in the 2006/2007 session of Parliament.

Laura Bruni, Commission for Patient and Public Involvement in Health

24^th July 2006

• Copyright 2008 Dod's Parliamentary Communications Ltd
• About ePolitix.com
• Stakeholders
• Contacts
• Terms & Conditions
• Blog guidelines