The Hammersmith and Fulham Service User Network aims to support people who use mental health services to get involved in influencing and improving the services they use. The project is funded by the Hammersmith & Fulham Primary Care Trust, and is based in Hammersmith and Fulham Mind.

  The responses in this memorandum correspond directly to the points raised in the request.

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

  1.1  The purpose of PPI is for service providers and commissioners to improve health services for patient and publics, based on the experiences of those who have used them. Public and Patient Involvement should enable service users, service providers and commissioners to communicate "first-hand" in order to achieve this aim.

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

  2.1  Independently facilitated local involvement networks, linked to local NHS services would provide effective local involvement. These networks should be funded and coordinated through a national centre capable of supporting the networks to work together in developing, promoting and sharing effective local policies and practices at a national level.

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

  3.1  The experience of involvement for patients, public and providers is an inconsistent one; dependent on not just which Trust is concerned, but also which particular directorate or service. This is partly due to the very recent development and evolution of involvement where Trusts, directorates and services are learning as they go along. However this inconsistency is also heavily influenced by the attitudes, practices and policies of those Trusts, directorates and services. How patients and public are involved, how they are supported to be involved, and how their input is acted on varies greatly from service to service, even within a single Trust, leaving those involved often feeling unsupported and undervalued. This results in many potential contributors becoming disillusioned and unwilling to engage with the process. This results in the Trusts not receiving the quality of involvement, and therefore the improvement of services that they could achieve. This is not helped by the reliance of existing projects on local Trusts for funding and support; as the involvement can become partisan, or can get caught up in political and financial debate rather than concentrating on working as a critical friend for the benefit of the services. Greater independence at a local level and greater communication between projects at a national level would strengthen the projects' abilities to engage and involve patients and public, as would more consistent policies and practices around support for involvement.

4.  How should LINks be designed?, including:

4.1  Membership and appointments

  4.1.1  Membership should be open to anyone who uses, or would potentially use NHS services in a local area.

  4.1.2  There should be annual elections of members to committee roles, with at least two co-chairs for mutual support and continuity of service.

4.2  Funding and Support

  4.2.1  LINks should be funded by the NHS through a national coordination centre. (See 4.5).

  4.2.2  Local LINks facilitators should be employed to support patient and publics to get involved, and to support services to involve patient and publics. This includes advising local trusts of best practice based on examples shared nationally as well as ensuring more consistent support for patients and public (training, disability support, expenses and remuneration for their involvement).

4.3  Areas of focus

  4.3.1  These should include existing points such as environment, cleanliness and food, as well as staff attitudes and capacity.

4.4  Relations with local health Trusts

  4.4.1  LINks should be independent to Trusts at a local level to enable service users to act as a critical friend. This could take place through commissioning facilitation services to voluntary sector organisations or local Trusts. However, funding should not be set through local Trusts (see 4.5.). LINks should also work with local groups and forums, as well as regional and national organisations to share good policies and practices.

4.5  National Coordination

  4.5.1  Although operating at local level and funded by the NHS, commissioning should take place through a national coordination centre such as the new PPI Resource Centre. This will ensure that networks will truly be able to work independently with their local services without fear of financial reprisal, or the work of the network being disrupted due to local funding arrangements. The Centre should also facilitate communication and joint working, wherever appropriate between LINks at local, regional and national levels in the interests of sharing good policies and practices.

5.   How should LINks relate to and avoid overlap with

5.1  Foundation Trust boards and Members Councils?

  5.1.1  Members Councils and Trust boards should include LINks representatives, and should be accountable to LINks.

5.2  Inspectorates including the Healthcare Commission

  5.2.1  Relations should be facilitated through a national coordination centre.

5.3  Formal and Informal complaints procedures

  5.3.1  LINks should work with local PALS and ICAS, as well as Trust boards and Members Councils to ensure that complaints are investigated and appropriate actions taken.

6.   In what circumstances should wider public consultation be carried out and what form should this take?

  6.1  The wider public should be consulted about major changes to services and annual evaluations of services. This could be facilitated through LINks, providing that local networks are given advance notice of the work schedule.

Hammersmith and Fulham Service Users Network

January 2007