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SOCIAL SERVICES NORTH WEST
MEETING ON 14 SEPTEMBER 2001 AT BLACKBURN
SUPPLEMENTARY REPORT OF THE CO-ORDINATOR
WORKING WITH THE NATIONAL HEALTH SERVICE
1. Matter for Consideration:
To report on the responses to the survey undertaken jointly with the North West Regional Association of Community Health Councils, and on two further key Government policy initiatives.
3. Information:
3.1 At the meeting between the Chair and officers of Social Services North West and representatives of the North West Regional Association of Community Health Councils in July, it was thought useful to find out from member authorities what liaison links already exist with CHCs, and in particular whether CHC representatives are already involved in scrutiny arrangements. Comments should be invited as to how such input could still be accessed if CHCs were abolished.
3.2 Replies have been received from only four member authorities, all of them metropolitan districts with coterminous boundaries with CHCs. Two authorities have CHC representatives involved in a number of joint bodies, whilst such involvement is not so formalised in the other two. The need to draw on the expertise of CHC members is recognised by all authorities, with the CHC in one district given the lead role in a group looking at consultation, involvement and scrutiny. In another district, the emphasis was on building links with the new emerging structures such as PALS and Patient Forums. Asked for general comments on the issues raised, respondents highlighted their independent and transparent approach to scrutiny; their commitment to the inclusion and participation of service user and patient representatives; the need to maintain and build on the expertise of CHC representatives and the need for a performance framework for patient and public involvement.
3.3 The North West Regional Association of Community Health Councils received a better response, some 10 CHC’s returning their questionnaires. A summary of those responses is included in the Appendix, revealing only limited involvement by CHC representatives in local authority overview and scrutiny arrangements, although CHC representatives undertake some lay visiting of social services establishments. They aspire to greater roles in new structures, but highlight the need for resources, knowledge, expertise and a non-adversarial approach if local authority overview and scrutiny of health issues is to be effective.
3.4 The Department of Health has published two further key papers since the last eport, the first being a discussion document specifically addressing the question of Involving Patients and the Public in Healthcare. The vision set out in the document is to move away from an outdated system of patients being on the outside, towards a new model where the voices of patients, their carers and the public are heard through every level of the service, acting as a powerful lever for change and improvement. To give effect to this, the patient must be at the centre of everything the NHS does. Some principles underpinning public and patient empowerment were set out in the recent Kennedy Report:
- patients and the public are entitled to be involved wherever decisions are taken about care in the NHS;
- the involvement of patients and the public must be embedded in the structures of the NHS and permeate all aspects of healthcare;
- the public and patients should have access to relevant information;
- healthcare professionals must be partners in the process of involving the public and patients;
- there must be honesty about the scope of the public’s and patients’ involvement, since some decisions cannot be made by the public;
- there must be transparency and openness in the procedures for involving the public and patients;
- the mechanisms for involvement should be evaluated for their effectiveness;
- the public and patients should have access to training and funding to allow them to participate fully;
- the public should be represented by a wide range of individuals and groups and not by particular ‘patient groups’
3.5 The immediate focus of this document is the Government’s intention to legislate at the earliest opportunity to replace Community Health Councils with a set of arrangements that will:
- align the structures for patient and public involvement with the devolution of resources and power to the NHS frontline as outlined in Shifting the Balance of Power within the NHS;
- integrate the views of patients and citizens into every level of the NHS, and ensure that involvement and support is consistent throughout;
- make it easier to listen to patients’ voices across the NHS so that services reflect their needs;
- make it easier for citizens to contribute to strategic decisions so that services reflect and meet the needs of communities.
3.6 The Government say they will not only ensure that everything CHCs currently do will be picked up in the new arrangements, but that patient and citizen involvement will be strengthened and, as a result, will become part of day to day NHS activity. The introduction to the document concludes:
‘We are clear that changes must be made – and we are committed to making them. Your views on how we make our proposals as strong as possible, will help us ensure that patients, carers and citizens really are properly involved so they can influence their healthcare and health services in their community.’
In addition to PALS and Patients Forums, the paper introduces the concept of VOICE organisations at national and sub-regional level. Their tasks will be to help all parts of the NHS improve public involvement; help communities have an effective say in their local NHS, and ensure that the new system works in the best interests of patients and the public. However, it is a matter for concern that they will operate at the same tier as Strategic Health Authorities, ie only three in the whole North West region.
3.7 When members of SSNW and NWRACHCS met in July, they agreed that a further meeting in the Autumn may well be appropriate to review the up-to-date situation. The publication of the above document certainly demands a response from SSNW before the close of consultation on 12 October. Members are asked to consider whether a further joint meeting should be sought either before or after the close of consultation.
3.8 The other key paper from the Department of Health is entitled: Shifting the Balance of Power within the NHS: Creating Strategic Health Authorities. It explains that the Department is working towards shifting the balance of power away from central government to frontline staff, who have a day-to-day understanding of patients' needs and concerns. As part of this process, they propose to change the structure of the NHS and Social Care to help empower patients and to help staff and patients have their say on the future. One of the options for reforming the structure of the NHS and Social Care involves replacing England's 95 existing Health Authorities by around 30 new larger and more strategic health authorities. Local Primary Care Trusts (PCTs) will become the lead NHS organisations in assessing need, planning and securing all health services and improving health in their localities. They will also provide most community services and develop primary care services, including GPs and dentists. NHS trusts will continue to provide most secondary care and specialist services in hospitals.
3.9 It is proposed that 28 Strategic Health Authorities (StHAs) will be created in due course, subject to legislation. They will strategically develop the local health services within their areas. They will also manage the performance of PCTs and NHS Trusts in their areas. The aim of the public consultation exercise is to give everyone the chance to read about the proposed new Health Authorities that will be established in April 2002 and, subject to legislation, will become Strategic Health Authorities later in that year. The Department is inviting comments on the proposed boundaries for the new Health Authorities, and guarantee that any comments received before the close of the consultation on November 30, 2001 will be taken into account when drawing up the boundaries. As widely anticipated, it is proposed that three Strategic Health Authorities be formed in the North West, for Cheshire and Merseyside, Cumbria and Lancashire and Greater Manchester. Members are asked whether a collective response should be sent from Social Services North West, or whether individual authorities should be left to comment from their local perspective.
4. Recommendations:
4.1 That the responses to the joint survey with NWRACHCS be noted
4.2 That a decision be taken on whether to propose a further joint meeting with NWRACHCS
4.3 That a response be formulated on the Department of Health discussion document on Involving Patients and the Public in Healthcare.
4.4 That a decision be taken on whether a collective response should be made on behalf of Social Services North West to the Department of Health paper on Shifting the Balance of Power within the NHS: Creating Strategic Health Authorities.
APPENDIX
RESPONSES OF CHCs TO QUESTIONNAIRE ON OVERVIEW & SCRUTINY
Ten Community Health Councils completed questionnaires. This is a rather low response rate, due largely to the holiday period and the turnover of staff.
Q2
3 CHCs have co-terminus boundaries with MBCs (or almost co-terminus in 1 case)
2 CHCs share a co-terminus boundary with an MBC
1 CHC is co-terminus with a unitary authority
1 CHC is partly covered by an MBC and partly by Derbyshire County Council
3 CHCs lie within County Council areas
Q3
No information forthcoming (2 CHCs)
Little development as yet as far as aware (2 CHCs)
Proposal to establish OSC covering health, social care, public health
Existing health review group meets 6 monthly; expected to build on this
Social Services panel incorporates health
Education & health scrutiny panel established – 2 meetings to date; provisional work programme; CHC involvement
Workshop to be held in autumn including county councils, Boroughs, 3 CHCs
Currently lay visiting of social services establishments; County Council scrutiny cttee expected to take an interest in health scrutiny
Q4
None – (7 CHCs) - one CHC has offered to be involved but no response; another CHC has prompted discussion
Two CHCs in discussion
Protocol drafted on co-operation between panel and CHC; discussions taken place on issues panel ought to investigate, etc; CHC Chief Officer invited to attend and contribute to briefing and panel meetings
CHC Chief Officer and several members are lay visitors of social services establishments
Q5
None (5 CHCs)
Health Policy Group
Joint Commissioning Forum/Social Inclusion Task Group
Observer on Selected Living Committee
National Service Framework Local Implementation Teams/Drugs Rehabilitation Group/Inspection Unit Advisory panel
Q6
Essential to work alongside CHC for as long as possible
Post CHCs – links with Patients Forums, access to complaints/advocacy information
Carry out surveys
Involve/second ‘expert patients’, members of public or CHC members to inform OSC
Listen and respond to ‘local voices’
Something more meaningful than postal questionnaires to ‘citizen’s jury’
Form citizens panels or citizen’s participation development agency – but need administrative and financial support (travel/carer expenses)
One CVS has health development worker to raise interest of local groups
Perhaps extend lay visiting to NHS premises
Q7
Need to avoid parochial view an also overburdening those local authorities with specialist services within their boundaries
Need to consider joint OSCs, and also role of associations such as Association of Greater Manchester Authorities
A desire for co-terminosity is not necessarily in the best interests of patients and public
Which OSC should scrutinise the Health Improvement Programme?
Real issue - local PCT and acute Trust relate to County & 3 District Councils
Abolition of Health Authorities will make this more difficult
Q8
Need a clear definition of scrutiny
Will social care, public health and/or joint services be covered?
Possibility of conflicts of interest needs to be addressed
Capacity of local authorities to scrutinise the volume of health issues which need addressing is a concern
Need well-informed and adequately resourced officer support
Need mechanism to seek and take account of views of citizens, patients and other agencies
So far as county councils are concerned, scrutiny will be very remote unless local arrangements are made (2 CHCs)
Need for constructive, non-adversarial approach
CHCs need to start working with local authorities now
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