1.   Why are PPI Forums being reformed after three years?

  The DoH has offered very little information about what they think has gone wrong with Forums, however it was the DoH which killed off the Community Health Councils and we wonder if the same kind of chop and change policy is being repeated for the sake of being seen to be doing something—anything! The DoH has also given very little information out about why it thinks LINks will be better than either the CHCs or the PPIFs, and how they see the LINks system functioning and achieving MORE than the PPI Forum system is currently achieving. (Will they make the same mistake as with PPIFs, ie lack of training of inexperienced members of the public who became Members of Forums. As a result of the badly-planned set-up period, the Forums have had a sharp learning curve but now appear to us to be working well).When considering the track record of the DoH for forward projections of staff requirements, funding, etc., and knowledge of the complex relationships of NHS services, we have doubts about the preparations made for LINks. If the DoH can so badly miscalculate, for example, the financial effects of the new Consultants and GPs contracts and the costs of the EC Directive on Working Hours (an error factor of perhaps £30 million in total in Oxfordshire alone), who would rely on their forecast of the efficacy of LINks?

2.   Violent change requires time to bed down

  The DoH has a penchant for (a) springing surprise changes on the NHS and its auxiliary bodies without sufficient consultation and (b) not giving any new system time to bed down. If there were fewer radical changes and more consultation, the changes would be more beneficial, less violently revolutionary and have a greater chance of successful implementation. It is therefore difficult for the existing Forums to know what the final structure and operations of LINks will be. How can we comment constructively on what is basically a vague concept?

3.   Adequate funding required

  The lack of funds trickling down to PPI Forums has been a major setback for Forums and this must not happen to LINks. Very little advertising has been done by the CPPIH or DoH to recruit Forum Members or to keep NHS staff informed of the activities (or even existence) of Forums at a local level. Public awareness is still not good after three years of existence. We also need funds for training programmes (we have found the CPPIH training courses inadequate for our needs) and Member/team development. Of even greater importance is funding for patient and public opinion surveys on local NHS services (including printing of information leaflets and news releases/photos). If LINks fares the same way we confidently expect that LINks will also "fail" (if we have failed!). It has been strongly rumoured that the DoH was not enthusiastic about the form PPI took when it was launched, which was probably due to inadequate consultation and parliamentary timetabling, but went ahead with the scheme rather than pull out at the last minute. We have no direct knowledge of whether this is true.

4.   How should LINks be designed?

  We are dubious about the internal stresses likely to be in-built into LINks with the close connections between Overview and Scrutiny Committees, local branches of pro-active national charities with professional staff at local level, and the entirely voluntary/altruistic PPI Forum Members who are essentially men-and-women-in-the-street. Local politicians and professional charity staff will have both hidden and open agendas and an element of self-interest and conflict of interest. This will vary from area to area. It is difficult to see why a high-powered charity would wish to recruit volunteers for a "sedentary" organisation such as LINks when it is already desperately short of volunteers for its own activities. We are particularly concerned about relationships between OSCs and Social Services departments and the potential for conflicts of interest, and between them and charities who act as service providers, all of which may have representatives on the local LINks.

5.   Local and national

  PPI Forums are currently cooperating nationally and regionally on a variety of patient-orientated projects. We feel that it this is probably a unique democratic process in the NHS which is unlikely to be matched, let alone bettered, by LINks. Apart from this, LINks should be purely local in operation and not organised nationally. Overlap between the activities of OSCs and LINks is a

positive factor.

Christopher Ringwood

Chair, Northern Group of Oxfordshire PCT PPI Forum

9 January 2007