The new Patient and Public
Following the passage of the NHS Reform and Health
Care Professions Bill, this briefing asks:
- How have the Government’s proposals
- What will the new system look like?
HOW HAVE THE GOVERNMENT’S
According to the NHS Plan (July 2000),
which was said to be ‘non-negotiable’:
- There was to be no national body for patients and the
public on health issues following the abolition of ACHCEW. Now, the Commission
for Patient and Public Involvement in Health is an essential element of
- There was to be no Independent Complaints Advocacy
Service (ICAS). If complainants were not helped by the Trusts’ own internal
Patient Advocacy and Liaison (PALS) staff, they were to be left to fend
for themselves or seek help from voluntary agencies. Now, ICAS is to be
provided by Patients’ Forums covering PCTs, and the limitations of PALS
are recognised (now Patient Advice and Liaison Service).
- Patients’ Forums for each NHS Trust were to be almost
completely lacking in independence and powers. They were to have no staff
of their own but rely on support from the Trusts’ own PALS staff and their
funding would have come from the Trusts themselves. They would have been
severely restricted in what they could work on and whom they could report
to. The powers and independence of Patients’ Forums have been significantly
improved during the NHS Reform Bill – see below.
- There was to be no replacement for the role CHCs have
played in taking an overview of the local health economy from the public’s
perspective; tracking the patient experience/journey across institutions;
and looking at health inequality and public health issues from the community
perspective. The new role created for Patients’ Forums for PCTs allows for
this wider overview and integration.
Specific improvements achieved during
the passage of the NHS Reform and Health Care Professions Bill include:
- A special role has been created for the Patients’ Forums
covering PCTs to provide an integrated overview of local health issues.
Their membership is to include members of each Patients’ Forum in the area
and other relevant community groups.
- PCT Patients’ Forums are now to have staff deployed
to them by the Commission for Patient and Public Involvement in Health (CPPIH)
to support the work of all the local Patients’ Forums; promote the involvement
of the wider community, especially hard to reach groups.
- An unnecessary tier of bureaucracy – the ‘local networks’
of the CPPIH (previously referred to as ‘Voice’) has been dropped. Instead
of this staff-only tier with no lines of local accountability, staff will
be accountable to local people via the PCT Patients’ Forums.
- The Independent Complaints Advocacy Service is now
to be provided by staff deployed to the PCT Patients’ Forums, with additional
ability to commission specialist advocacy (for example bi-lingual advocacy)
where needed to support complainants.
- The remit of Patients’ Forums has been extended to
take account of the range (or absence) of services, and for the PCT Patients’
Forums to consider issues affecting health rather than just services.
- The independence of Patients’ Forums has been safeguarded
by amendments which ensure that:
- funding will come from the CPPIH
rather than the Trust that they are monitoring.
- the lifting on restrictions on
who forums can report to (they are now able to report to the media and
politicians, for example).
- the allocation of staff employed
by the CPPIH to PCT Forums to support the work of all Forums.
- The powers of Patients’ Forums have been extended.
Rather than being restricted to reporting to the Trust that they are monitoring,
they can now make formal referral of issues of concern to the local Overview
and Scrutiny Committee of the local authority, or the national CPPIH.
- The independence of the Commission for Patient and
Public Involvement in Health (CPPIH) has been improved by amendments which
- the appointment of the Chair
by the NHS Appointments Commission rather than the Secretary of State.
- the appointment of future Chief
Executives to be made by CPPIH itself rather than the Secretary of State.
- the ability to make reports to
people or bodies it sees fit rather than being restricted to those specified
by the Secretary of State.
- The CPPIH, which was to have been largely restricted
to developing and monitoring the patient and public involvement mechanisms
and processes themselves, has had its remit widened. It can now draw on
issues referred to it by Patients’ Forums or identified through their annual
reports to do work at the national level on policy and service issues affecting
patients. It has been guaranteed that this can, if necessary, include taking
WHAT WILL THE NEW PATIENT AND PUBLIC INVOLVEMENT SYSTEM
The following is based on a description provided by the Department of Health:
In every Primary Care Trust and NHS trust there will be a Patients’ Forum
- monitor and review the services arranged and or provided by the trust
from the perspective of the patient – not just the operation of services,
but the range too;
- seek the views of patients receiving services provided or arranged by
- inspect premises where NHS services are delivered;
- make reports and recommendations to the management of the trusts;
- refer matters of concern to OSCs, StHAs, CHI and National Patient Safety
Agency etc – and any other person or body the forums deem appropriate including
- be represented on the Board at Non Executive Director level.
In addition the PCT Patients’ Forum will:
- have a wider membership, including representatives of other patients’
forums in the area and other relevant groups
- promote the involvement of the public in decisions and consultations on
matters affecting their health;
- provide or commission independent complaints advocacy;
- collect information about patients’ experiences, identify trends and make
reports to decision-makers;
- put forward the views of the public to key local decision-makers;
- help Forums work together across boundaries;
- have to take account of Forums’ views when setting priorities for their
- provide a one stop shop service by providing advice and information to
the public about public involvement;
- monitor how well the NHS is meeting its duty to involve and consult the
And in every NHS trust and PCT there will be a Patient Advice and Liaison
- resolve problems on the spot;
- provide information to patients, carers and their families about local
health services and put people in contact with local support groups;
- tell people about the complaints procedure and direct people to independent
complaints advocacy support;
- act as an early warning system for trusts and Patients’ Forums by monitoring
trends and highlighting gaps in service and making reports for action to
trust management. These recommendations and the trust/PCT response will
be included in the annual patients’ prospectus for the trust/PCT in question.
In all local authorities with social services responsibilities there will
be an Overview and Scrutiny Committee. They will
- take on the role of scrutiny of health services including the NHS;
- be able to refer contested service changes to the SofS;
- be able to call NHS managers to give information about services and decisions;
- report their recommendations locally;
- have to be consulted by the NHS where there are to be major changes to
Nationally there will be a Commission for Patient and Public Involvement
- monitor and make recommendations about the performance of Patients’ Forums
and providers of independent complaints advocacy support;
- set standards for Patients’ Forums and providers of independent complaints
- submit reports to the Secretary of State on how the whole system of patient
and public involvement is working and advise him about it
- make reports as it sees fit to other national bodies such as CHI , the
National Care Standards Commission and the National Patient Safety Agency
on patient and public involvement issues and issues that in its opinion
give rise to concern about the safety or welfare of patients that have not
or are not being dealt with properly
- carry out national reviews of services from the patients’ perspective
– collating data from forums and making recommendations to the Secretary
of State, and to other bodies and persons it considers appropriate.
Community Health Councils (CHCs) and the Association
of CHCs for England and Wales (ACHCEW) will be abolished (a date has not been
set for this).
CONCLUSION – WHAT IS NEEDED NOW?
ACHCEW, together with most commentators,
believes that the changes set out above represent a very welcome and significant
shift on the part of the Government. There is now a legislative framework
that can provide the basis for a good system of patient and public involvement
following the abolition of CHCs, provided there is the goodwill to plan a
smooth transition and sufficient resources to make the new system work. The
Transition Advisory Board will have a crucial role to play in advising the
Department of Health on the detail and the transition to the new system. See
Some key issues are:
- Much work still needs to be done
on the detail of how the new system will work in practice.
- CHCs and ACHCEW must be able
to continue representing patients and the public’s interests until the
new system is up and running. There needs to be a realistic timetable
- Ways must be found to retain
the skills and experience of staff and members of CHCs and ACHCEW, which
will be vital to the new system. This needs to happen urgently to avoid
more loss of CHC staff and members.
The Department of Health has provided no indications or
even estimates as to the resources that are to be made available for the new
system. It is clear that very substantially more resources will be needed
than have been available to CHCs if the system is to be made to work. Planning
the new system and structures is almost impossible without any idea of the
ACHCEW, June 2002