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SOCIAL SERVICES NORTH WEST
MEETING ON 21 DECEMBER 2001 AT WARRINGTON
REPORT OF THE CO-ORDINATOR
WORKING WITH THE NATIONAL HEALTH SERVICE
1. Matter for Consideration:
2. Introduction:To report on developments in relation to Involving Patients and the Public in Healthcare and the formation of three large Health Authorities covering this region.
At the last meeting, it was reported in a tabled supplementary report that the Department of Health had just published two further key papers, the first being a discussion document on Involving Patients and the Public in Healthcare. This represented a considerable advance on the previous proposals for replacing Community Health Council with two kinds of body which each had only limited scope: the PALS and Patients Forums. The second paper was entitled Shifting the Balance of Power within the NHS: Creating Strategic Health Authorities. It was decided that responses should be made by Social Services North West to each of these documents.
3. Information:
3.1 In his reply to Involving Patients and the Public in Healthcare (Appendix 1) SSNW Chair Councillor Cliff Morris welcomed the principles and aims around public and patient empowerment which were set out in the document. We had two key concerns about the means of delivering these aims. The first was that the PALS and Patients Forums would sit inside rather than outside the operational organisations of the NHS. Secondly, whilst we welcomed the concept of VOICE organisations across the country, they could not truly be described as ‘local’ if they functioned only at Strategic Health Authority level. We therefore urged the Government to create many more local VOICE organisations, each serving only a small number of health economies and local authorities. They would be able to co-ordinate all the levels of patient and public involvement to which we are all committed. They would also be the suitable vehicle to employ the staff of the PALS and the Patients Forums. We stressed that we are keenly interested in ensuring that the NHS and local social services authorities work effectively together to serve local people.
3.2 In November, Hazel Blears, Under Secretary for Health and MP for Salford, acknowledged our contribution and many others to the debate (see Appendix 2), and published the Government’s Response to the Listening Exercise. Key proposals now were:
- Give the new Commission for Patient and Public Involvement in Health the power to set up local networks, to provide local as well as national support. The Commission will be able to operate some of its functions at PCT level; and for each local network to use a number of community-based premises from which outreach teams can work for the benefit of local people and build on existing local work.
- Make the Commission an independent statutory body. Local network staff will be directly accountable to the Commission centrally, but will also have local lay reference panels to steer their work programme. To increase lay input, we will also give PCT Patients’ Forums collectively the power to attend Strategic Health Authority Board meetings.
- Ensure co-ordination through the Commission’s local networks. Given the independent status of the Commission’s local networks, with responsibility for commissioning ICAS, supporting Patients Forums and informing Overview and Scrutiny Committees across the area, they are ideally placed to act as the "glue" which binds together all the other elements of the new arrangements
- Simplify the system under the umbrella of the Commission, which, as well as fulfilling national functions, will now employ local teams which will promote and facilitate involving the public in local decisions that affect their health.
- Draw membership for the Commission from Patients’ Forums and Local Strategic Partnership lay members and others, in particular from the voluntary sector. In addition to original responsibilities around standard-setting, training and evaluation, it will be given a strengthened role to report matters of concern on issues of patients’ safety and welfare to bodies in a position to take action, for example CHI and the National Patients Safety Agency.
- The Commission will also produce an annual report highlighting its findings for the benefit of Parliament and the Secretary of State for Health.
- Use the NHS Appointments Commission to set the criteria and process for appointment to Patients’ Forums, to ensure transparency, but to make membership subject to very broad and inclusive criteria. Lay reference panels for local networks of the Commission will be charged with making the appointments to Patients’ Forums. The local network staff will then provide support for Patients’ Forums in their work.
- We will also rename PALS as Patient Advice and Liaison Services, and to make the Commission responsible, through its local networks, for commissioning ICAS.
3.3 These proposals represent a further welcome advance, in that they strengthen the local machinery considerably and provide important independent elements at the local level. It will however be a complex and demanding structure, demanding considerable skills from its staff, not all of which are readily available within the NHS at present. The intention is to introduce the new arrangements fully by April 2003 but clearly much preparatory work will be needed. In view of the close involvement of member authorities, both as partners of the local NHS and as hosts of the Overview and Scrutiny Committees which have a key role, members may feel that Social Services North West should continue to work with regional partners to further shape the development of these structures in the North West.
3.4 The second document Shifting the Balance of Power within the NHS: Creating Strategic Health Authorities was swiftly followed by consultation documents on the formation of new Health Authorities for Cheshire and Merseyside, Cumbria and Lancashire and Greater Manchester. Key points made by Chair Cliff Morris in responding to the consultations (Appendices 3, 4 and 5) included:
- We particularly welcome the commitments to supporting delivery at the front line, and to encouraging partnerships in health and local government to ensure integration between health and social care. These are commitments which we share.
- The rapid and radical change in the management of the NHS was bound to lead to instability, but it remains as essential as ever for us all to remain focussed on the need to maintain adequate delivery in the short term, as well as to improve delivery in the longer term.
- We welcome the development of Primary Care Trusts and support the three key roles identified for them in the document: Improving the Health of the Community, Securing the Provision of Services, and Integrating Health and Social Care. Our member authorities see the emerging PCTs as their primary partners at local level, and are committed to developing ever closer working relationships between health and social care.
- Our member authorities are involved in (and often leading) a rapidly increasing number of joint projects using Health Act flexibilities, and joint managerial appointments for key areas of service. We see such voluntary partnerships as key to the successful integration of health and social care at the point of delivery to service users. In this context, we welcome the document's recognition that Care Trusts will have a role "where local partners agree."
- In relation to Strategic Health Authorities in general, we accept the case for an organisational tier in the NHS at conurbation/sub-regional level. We also accept the three key roles envisaged for them: Creating a coherent strategic framework, Performance Management of local NHS organisations, and Supporting Improvement. As agreed with your colleagues earlier this year, we look forward to developing a working relationship with the Chairs and Chief Executives of the three Strategic Health Authorities to be established in the North West.
- We have reservations about the role of the Regional Directors of Health and Social Care, which as yet is insufficiently defined in relation to the Social Services Inspectorate and autonomous local authorities. We shall watch developments with interest.
- Our member authorities, and Social Services North West as a body, look forward to further developing our joint work with the NHS, both locally through the PCTs and at the level of the Strategic Health Authorities. In this way, we shall all be able to play our part in further improving the health and wellbeing of the people of the North West.
3.5 Clearly the rapid pace of change in the organisation of the NHS is continuing, and Social Services North West will need to make contact at appropriate points in the new structure. Particularly, members may wish contact to be made with the new Regional Director for Health and Social Care, and with the Chairs and Chief Executives of the three new Strategic Health Authorities being set up in the North West.
4. Recommendations:
4.1 That this report be noted and the responses made on behalf of Social Services North West be endorsed
4.2 That further work be undertaken with appropriate partners on Involving Patients and the Public in Healthcare
4.3 That contact be made with the new Regional Director for Health and Social Care, and with the Chairs and Chief Executives of the three new Strategic Health Authorities being set up in the North West, seeking appropriate meetings
4.4 That a further conference on health issues, possibly with NHS partners, be held in the Spring of 2002
4.5 That a further report be presented to the next meeting
Appendix 1: Reply to the Consultation on Involving Patients and the Public in Healthcare
Appendix 2: Reply of Hazel Blears, Under Secretary of State
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