An Overview of National Health Service structures for lay participation and NPSA's experience

1

• An Overview of National Health Service structures
  for lay participation and NPSA's experience

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The regulatory framework

• Legislation
• Regulation
• Stakeholders
• Patient Forums
• Overview and Scrutiny Committees

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Section 11 of the Health and Social Care Act 2001

• places a duty on NHS organisations to involve
  patients the public in
• service planning and operation
• in the development of proposals for changes
• not just when a major change is proposed, but in
  ongoing service planning
• not just in the consideration of a proposal, but
  in the development of that proposal and
• in decisions about general service delivery, not
  just major changes.

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Local Government Act 2000 and Health and Social
Care Act 2001.

• Introduced local authority overview and scrutiny
  committees
• Social Care Act formally enabled authorities with
  responsibility for social services to
• review and scrutinise health service matters
• to make reports and recommendations to NHS bodies
• NHS bodies are under a duty to respond to
  committee reports and recommendations, but are
  not bound to accept recommendations.
• OSCs can refer contested NHS proposals to the
  Secretary of State on the grounds of either
  process or merit.

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health scrutiny committees have powers to

• Summon officers of health trusts to committee
  meetings
• To require information from NHS bodies on the
  planning and provision of health services
• They must be consulted by health trusts about
  significant changes to service provision
• They can initiate their own reviews of any topic
  that affects the health and well-being of local
  residents

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NHS Reform and Health Care Professions Act 2002

• The Commission for Patient and Public Involvement
  in Health (CPPIH) was set up in January 2003
  under the Act
• The Commission establishes, funds, monitors and
  supports the patient and public involvement
  forums,
• Patient and Public Involvement Forums (PPIFs)
  themselves promote patient and community
  involvement in the planning and delivery of
  healthcare.
• There are currently 572 PPIFs in England one for
  every NHS Trust, Primary Care Trust (PCT),
  Ambulance Trust and Mental Health Trust.
• In March 2005 the Department of Health announced
  plans to reorganise this structure to create a
  single PPIF for each Primary Care Trust area,
  whilst retaining the existing number of forum
  members.

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Patient Forums roles

• PPIF members are lay volunteers, whose specific
  duties include
• monitoring and reviewing services provided by
  their Trust
• inspecting premises
• obtaining the views of local communities
• representing those views to Trust Boards as an
  influence over the design of services
• monitoring how Trusts are carrying out their duty
  under Section 11 of the Health and Social Care
  Act to involve patients and the public
• referring matters of concern to local authority
  health scrutiny committees, or any other
  authority they consider relevant
• providing advice to patients about services and
  monitoring the effectiveness of local Patient
  Advice and Liaison Services (PALS)

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The future

• July 2004 - the DH announced its decision to
  abolish the CPPIH. 
• After August 2006, Forum members will be
  appointed by the NHS Appointments Commission.
• In place of CPPIHs forum support function, DH
  Department announced plans to establish a Centre
  of Excellence for Patient and Public Involvement

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The role of patients and those close to them
within NPSA
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Often the people most difficult to deal with can
be the most valuable

• They see things staff dont
• They sometimes place different value sets of
  things to staff
• So without them staff
• See a partial picture
• Can reinforce organisational myths or prejudices

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Why involve patients

• NPSAs experience shows it
• increases the confidence, understanding and
  skills of those who participate
• benefits all those who become involved
• influences the policies, plans, products and
  services of providers

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Using patient participation as a catalyst for
change - example

• Anticoagulants
• Who we involved
• How we involved them
• The outputs
• Reality check
• Influencing the definition of the problem
• Induction maintenance supply and usage
  process design

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Who are players?

• Patients and those close to them via
• 187,000 Charities and at least 200 with a
  particular interest in health
• People reporting issues to NPSA
• PPIFand CHCs in Wales
• Expert Patients
• Professional working in the PPI field
• PALS
• PPI Strategic health authority leads
• 150 LA Scrutiny Committees
• Non Executive Board members of NHS services
• People Like Us operational and procedural
  development
• Czar for PPI policy development
• DH Branch for PPI policy development

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How? Develop a principled approach

• Reasonable adjustments
• Go beyond a simple consumer model
• Working with a diversity of sources
• Recognising and acting upon patient and public
  perceptions and experience as well as
  professionals
• Proactive facilitation
• Listening to, but avoiding being dominated by any
  single interest
• Retaining a degree of independence

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How? Developing and Applying concepts

• Inform consult involve collaborate
• Pre design
• Implementation
• Product development
• Recognising diversity
• Making reasonable adjustments
• Active Facilitation
• Mainstreaming embedding
• Support materials for staff as well as patients

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What this means for NPSA staff

• They must consider how and why to involve
  patients and the public in their work
• What aspects? How? At what cost? To what end?
• The Director and staff already involving people
  can provide advice
• Purpose Methods Desired outcomes Who to
  approach Links to external resources
• Support materials are available.
• Induction handbooks Payments policy Check lists
  for meetings Permission forms

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What this means for patients

• Safer health care
• More informed views
• Better understanding of risks
• Growth in skills and knowledge