What is the purpose of patient and public involvement

  1.  We consider that the purpose of effective Patient and Public Involvement is to provide a route through which those making decisions about services are required to test and shape proposals in a way that takes account of the views of those actually using and funding services. There are a wide variety of institutional, professional and bureaucratic interests that are able to influence this decision making- this can lead to a situation where decisions about service delivery can be taken without account of its impact on those using services. Patient and Public Involvement, if effectively delivered can balance this influence and enhance accountability to patients and the public.

What form of P&PI is desirable, practical and offers value for money

  2.  Patient and Public Involvement must be understood and influential in the context of the system in which it operates. Public services such as health and social care are immensely complex and this is likely to increase given the programme of policy reforms that are now starting to emerge. It is essential that there is flexibility to tailor Patient and Public Involvement activity around local circumstances and the issue to be addressed. A prescriptive, "one size fits all" approach is will not work. Equally effective Patient and Public Involvement needs to work alongside, and not duplicate existing systems. It therefore needs to be distinctive in the work that it does. We have not yet been able to ascertain how LINks will meet these requirements.

  3.  Current proposals for LINks do not recognise the infrastructure already in place to allow for engagement with communities and support the accountability of public services, including representation by democratically elected members, LSPs and LAAs. The LINks need to complement the infrastructure in place to support these arrangements and not duplicate functions that are already embedded in, and working on behalf of, local communities. In this sense it is difficult to see how LINks will be different from other existing forms of engagement, particularly taking account of the changes set out in "Strong and Prosperous Communities", which will strengthen the existing overview and scrutiny function of Local Government and provide a route for challenging issues of concern to communities through the "community call for action".

Why are existing patient and systems being reformed after only three years

  4.  Despite the initial efforts to bring the new system to life there has been little or no practical support with the delivery of the Patient and Public Involvement remit at front line level. Problems with FSOs have seen some go into liquidation and others simply not cope with the level of input required. Other FSOs have worked well. Funding for the FSO contracts limited what could be offered and failed to take account of the skills it takes to secure meaningful feedback from different communities and process this to provide objective information or evidence for action. Patient and Public Involvement Forums have been continually frustrated by not having the resource to undertake this type of work.

How LINks should be designed to relate to and avoid overlap with existing local structures including:

Remit and level of Independence

  5.  Developing the point above we would ask that there is absolute clarity about the distinctive role that the LINk could bring to building effective community engagement and involvement across health and social care. They also need to be able to work across patient pathways that do not map easily with their geographic area. Hampshire for example is a large and diverse county. Some services, such as ambulances, now run across both Hampshire and Thames Valley whilst others are focused on practice based commissioning areas or district boundaries. LINks have to be able to respond to these very different models of care provision.

  6.  If different groups with competing interests are part of a LINk, how can they give an independent view of an issue. How can the LINk be held to account if it fails to fairly reflect the perspective of the community that it is supposed to serve because of conflicts of interest in its membership.

Membership and Appointments

  7.  Recruitment to these new bodies will inevitably be based on the perceived influence that the LINk can exert in the planning and delivery of local services. The way in which some Patient Forum members have been treated over the past 18 moths has devalued and marginalised their role. CPPIH has generated a bureaucracy that militates against Forums active and timely engagement to shape services that are important to local people. It will take time to address these perceptions.

  8.  Equally there needs to be clarity about how LINks draw their views together and what perspective will shape these views. The old CHCs were required to take account of the "public interest" in coming to a view, HOSCs have to consider the impact of any proposals on the population affected, locally elected members can represent the views of their individual constituencies (and are directly answerable through the democratic process), the NHS has to take account of the views of current and future service users. Voluntary sector, independent and professional organisations are able to reflect other interests and views. LINks must be able to add value by drawing together views that otherwise it would not be possible to access.

Funding and Support

  9.  There has been significant variability in the hosting arrangements for the Patients Forums and a number of concerns that funding has not been available to support the activities of individual Forums in discharging their statutory duties. If public funding is to be properly monitored and controlled we would suggest that there is greater clarity about what it is that LINks are expected to deliver and flexibility in the options open to Local Authorities in ensuring that this is supported appropriately. Local circumstances vary widely, and it should be open to local discretion to determine the best way to support the delivery of this function. Rather than talking about model contracts that replicate previous arrangements it may be more helpful to set out a range of quality requirements that will be expected of any support provided to deliver the role of the LINk.

Areas of Focus

  10.  HOSCs already provide a mechanism through which local services can be held to account and are increasingly influential in the areas in which they operate. They are separate from the executive/service provision arm of local government and the NHS. Our view is that this function has considerably strengthened both decision making processes and the way in which democratically elected representatives can influence the way in which services are delivered to our populations. LINks need to complement and not duplicate this function and we have expressed considerable disquiet at proposals that seem to confuse our respective roles.

  11.  If their role is to be one of gathering additional information and experiences it needs to be equally clear what added value this brings given the fact they will not be the only route through which the service commissioners, HOSCs and others access the views of people affected by a particularly proposals. It would not be helpful if the introduction of the LINks undermined local arrangements around community engagement that are currently working well.

  12.  As currently proposed we believe that LINk will confuse, rather than compliment existing engagement mechanisms and those proposed through "Strong and Prosperous Communities".

Cllr Dr Raymond J Ellis

Chairman, Hampshire CC Health Overview and Scrutiny Committee

9 January 2007