I remained after my evidence session to listen to the evidence from the Foundation Trust Chair, PALs officer and the Healthcare Commission which followed it. There were a couple of salient points that I feel would add value to the deliberations of the Committee and take this opportunity of setting these out below.

  Reduction in inspection visits by the Healthcare Commission: I was struck by an omission in the discussion on the inspection rights issue. I would like to point out to the committee that, as of the introduction of the Annual Health Check by the Commission replacing the previous Star Ratings system, the annual inspection visits by the Commission to NHS Trusts have been reduced to three yearly, except in cases where there is a discrepancy between the evidence provided to the Commission by local stakeholders such as Patients Forums and Overview and Scrutiny Committees. In addition, the Commission visits a random sample of Trusts.  I believe this random sample is 10%. The relevance of this change to the question of whether LINks should do monitoring visits to NHS premises is twofold:

  1.  There has been a dramatic reduction in visiting by the Healthcare Commission as part of their change to self assessment as the basis for the Annual Health Check. Whatever the rights and wrongs of that change, which was subject to public consultation, it is as yet unproven as a sound way of judging the performance of the NHS. To remove the visiting arrangements by Forums or LINks at the same time as this change has happened to the national regulatory regime, seems to me to be a high risk approach.

  2.  The ability of Patients Forums to contest the self assessment by NHS Trusts which forms the basis of the Annual Health Check is dependent on them knowing how the Trust is actually delivering services. If they have not monitored those services, it is hard to know how they will be able to contest such assessments. For example, if a Trust claims to have complied with privacy and dignity standards on inpatient wards, the only way a Patients Forum will know whether this is the case or not will be if they have monitored those wards to observe standards and spoken to patients to get their views. This is particularly important in the case of patients who may not fill in the Commission's Patient Surveys, such as frail older people, those whose first language is not English or other socially excluded groups.         

  Disenfranchisement of non LINks members: In addition, I feel it is important to consider what relevance will be given to the views of groups or organisations by commissioners of local services, if they are not members of LINks. It seems to me that individuals and groups who do not participate in LINKs are disenfranchised. If there is no greater say to participants in LINks, what is the point of being a member of a LINk? If there is a greater say for such participants, then how can this be equitable?

Elizabeth Manero

HealthLink

26 February 2007