1.   What is the purpose of patient and public involvement?

—  To give a patient perspective

—  To improve services

—  To represent the interests of patients and the public in the NHS decision making processes

—  To champion equity and choice

  2.   What form of patient and public involvement is desirable, practical and offers good value for money?

  The existing structure is now well established and working effectively in many, many areas. Rather than change it yet again it would be more appropriate to give Forums a period of stability and continuity so that they can focus on their role rather than fighting for their future.

  3.   Why are existing systems for patient and public involvement being reformed after only three years?

  Why indeed? To start again would be a waste of time, money, resources and the goodwill and experience of forum members and staff.

  4.   How should LINks be designed, including:

—  Remit and level of independence—Independence from the local NHS is a vital requirement.

—  Membership and appointments—Existing mechanisms are adequate.

—  Funding and support—Existing levels of funding and support could be adequate if they are used more effectively and concentrated on supporting grass roots forums rather than an unnecessary and costly central agency.

—  Areas of focus—It is vital that LINks continue the non-political tradition of PPI Forums and CHCs. For individual forums the focus should be overwhelmingly local.

—  Statutory powers—Continuation of the existing powers and rights (rights to information, visits and inspections etc) is essential if the LINks are to have teeth.

—  Relations with local health Trusts—One of the successes of PPI Forums has been the development of specialist forums (mental health, ambulance, oncology and acute trusts) with a dedicated focus. LINks based on geographical areas might loose this expertise and experience.

—  National coordination—For national and regional issues there needs to be some means to co-ordinate a wider voice. ACHCEW is a good model.

  5.   How should LINks relate to and avoid overlap with:

—  Local Authority structures including Overview and Scrutiny Committees—Existing structures work well and ensure a non-political element to the scrutiny process. LINks should be patient-centred and OSCs should have a more strategic element so there should be no conflict or overlap in roles.

—  Foundation Trust boards and Members Councils—FT boards can specify who they appoint. LINks members should follow the lead of PPI Forums and be drawn from diverse sources. LINks can be more independent as they do not have the burden of corporate responsibility.

—  Inspectorates including the Healthcare Commission—Existing rights to report and "call in" are adequate.

—  Formal and informal complaints procedures—Help and assistance with NHS Complaints procedures should be provided by a dedicated service of paid professionals—preferably to a higher standard than current ICAS arrangements. LINks will, however, need access to data on complaints. This has never been provided to PPI Forums in any meaningful format.

  6.   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?

  Existing Section 11 requirements on NHS bodies must remain in place for any substantial variation in the pattern of services provided by the NHS locally. Additionally, this should be extended to cover the redrawing of access criteria—this has been used by many PCTs as a "stealth" method of rationing.

Countess of Chester Hospital PPI Forum

January 2007