Local Government and Public Involvement in Health Bill, Second reading brief, House of Commons
Parliamentary Brief
18 January 2007
Introduction
The Department of Health’s document, A stronger local voice: a framework for creating a stronger local voice in the development of health and social care services, was published in July 2006 proposing to provide a framework for individuals and communities to have a stronger voice in their local health and social services. The Government’s stated intention is to ensure that the needs, preferences and involvement of local people are central to the planning, development and delivery of health and social care services, and in particular commissioning decisions.
Clauses in the Local Government and Public Involvement in Health Bill, currently before Parliament, relate to reforming the current arrangements for patient and public involvement (PPI) in the provision of health and social services.
The bill aims to:
• abolish the Commission for Patient and Public Involvement in Health (CPPIH) and patient forums .
• create local involvement networks (LINks). There will be fewer LINks, one per local authority, than there are currently PPI Forums. These LINks will inform local authority overview and scrutiny committees (OSCs) on their local populations’ views on health and social care services.
• give stronger and more wide ranging powers to local authorities’ overview and scrutiny committees.
With an increasing plurality of providers and more focus on commissioning, the Government believes that it is no longer appropriate to have a PPI system which is based around individual providers. The Government aims to create a system of PPI which is capable of following the whole user experience across health and social care.
The term public and patient involvement encapsulates the two streams of lay involvement in healthcare services, and it is important to differentiate between the two. Patient involvement is the contribution of individuals to their own healthcare, and public involvement the participation of individuals or groups in the development, planning and provision of services.
The majority of people want a say in how local healthcare services are run but, more often than not, have never been asked about what they would like from their local services. In addition they feel that they have no power to influence local service development. The BMA supports the Government’s intention to strengthen the involvement of the public and patients in the planning and delivery of their local health and social services.
The BMA’s views on public and patient involvement
The BMA’s view is that effective PPI is a benefit to people and organisations because it allows them the opportunity to engage in decisions about healthcare services, and because it can:
• educate the public and patient body
• allow the public to see what good has been done and recognise what improvements have been made
• allow the public to understand what constraints there are.
Healthcare policy decisions, at whatever level they are made, ultimately affect patients’ lives and people have a moral and ethical right to play a meaningful role in developing healthcare policies. Engaging patients in health policy decision-making helps to ensure that policies reflect patient needs and preferences, and this must ultimately make for more effective healthcare. In a publicly funded health service, this serves to increase accountability.
Public involvement should be necessary for decisions as to what services are provided, how they are provided, quality setting, and monitoring and the maintenance of standards. A service can only be responsive to users if users are involved. Public involvement offers service providers and commissioners the opportunity to better understand the needs of the public.
The BMA supports the following general principles for effective public and patient involvement:
• PPI should be a collaborative process with all voices in discussion helping to develop partnerships between patients, the public, health professionals and policy makers
• the process should be ongoing and not just a periodical or one-off exercise
• feedback mechanisms must be built into all PPI activities
• the processes must be transparent
• PPI activities must be accessible to all relevant groups
• efforts must be made to specifically target hard-to-reach and marginalised groups in order to accommodate equality and equity within the PPI structures and the relevant health services.
The BMA’s concerns regarding the new structures
There are a number of possible strengths and weaknesses of the proposed system over the current system:
Strengths
• the smaller number of organisations may mean more capable people for recruitment to LINks, rather than those spread between the current numerous PPI Forums
• LINks with populations that are well educated and able to dedicate time may work well
• LINks will have the power to refer matters to Overview and Scrutiny Committees
• LINks will have the power to inspect providers’ premises.
Weaknesses
• LINks with populations that are less well educated or less able to dedicate time may not work well
• there may be conflicting views within LINks because of the size of areas covered and the priorities of particular localities
• LINks may be too closely allied to local authorities to be independent of local politics and any conflicts of interest that may arise
• there is a danger of LINks being patronised, out-thought and manipulated by managers
• the lack of national coordination for LINks does not formally enable sharing of information, ideas and good practice.
There must be adequate resources to ensure effective PPI involvement and to enable the revised organisational structure proposed in this legislation to have the capacity to consult with the community it serves . This means engaging with service users, taxpayers and groups who traditionally do not, or cannot, get involved. The criticism of patient forums has been that, as well as their variability in quality, the cost of supporting them through CPPIH has been high. However, the funding must not be at the expense of patient care which will make this difficult in the current financial climate.
There is a danger of inequity of public involvement between local authorities. The legislation charges local authorities to enter contractual arrangements with host organisations to run their LINks, but the governance of LINks will be left to local arrangements. In addition, the LINks membership will be set at local level with no national guidelines for the type or number of members, or the training for members.
While LINks have the power to refer matters for consideration to overview and scrutiny committees, OSCs in turn must use LINks to inform their work in reviewing local health and social care services so that they can hold NHS organisations to account locally. There are potentially a number of failings in the OSC system which could undermine its effectiveness, namely:
• seats are filled only by local councillors
• seats do not have to reflect the political make-up of the council (ie the majority party may choose to fill all seats)
• councillors may have no interest in local health issues
• being charged with overseeing both health and social care may result in conflicts of interest and culture between health and social care concerns.
Parliamentary Unit contact details:
BMA House, Tavistock Square
London, WC1H 9JP
E-mail: parliamentaryunit@bma.org.uk
Fax: 020 7383 6830