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12 October 2001
Hazel Blears MP,
Parliamentary Under Secretary of State,
Department of Health,
Richmond House,
Whitehall,
LONDON SW1A 2NS
Dear Hazel Blears,
I am writing on behalf of Social Services North West to reply to your discussion document on Involving Patients and the Public in Healthcare. We have been following with interest the development of the Government’s proposals on patient and public involvement since the publication of the NHS Plan, and have met with our regional counterparts in the North West Regional Association of CHCs. We are as anxious as they are to ensure that the strong voluntary commitment of their lay members (to being a ‘critical friend’ of their local NHS) is carried forward into the new arrangements.
Social Services North West (formerly known as NWASSA – the North West Association of Social Services Authorities) is the member-level body which represents the local authorities in the North West of England which have responsibility for the personal social services. 19 of the 22 eligible authorities are members. We work with our member local authorities and others to promote high quality services in the North West. We have developed a particularly close relationship with the NHS, both at local and regional level, and see Working with the NHS as our top priority issue. We hope you will find that reflected in our comments on your document.
Many of our members have been directly involved in their Community Health Councils over the years, and it is our experience that CHCs at their best have made a very important contribution to expressing the concerns of patient and public about NHS services locally. Their most significant strength has been the involvement of local people, on a purely voluntary basis, in examining local NHS services, commenting on policy proposals and advising patients and public on their individual concerns, within the limits of their resources. They have been a single local organisation with a remit for the whole of the NHS as it affects their population; they have formally harnessed input from local government and other voluntary interests; and although administered from within the NHS, they have sat outside local operational NHS services. We think these last three points are important criteria against which your new proposals should be tested.
We accept the Government’s wish for reform in this area, to ensure that the four key components of patient and public representation each receive the attention they deserve. We welcome the roles envisaged for local government; in overview and scrutiny and in providing an employment base for the sub-regional VOICEs. However the local government involvement should not be inspectorial or adversarial in spirit. It should rather be critical mutual evaluation: another expression of the partnership and joint working which is developing increasingly between the two greatest local public services: local government and the NHS. In particular, it should reflect the commitment of both to get much closer to all the people they serve.
We welcome the principles and aims around public and patient empowerment which you have set out in the document. We have two key concerns about the means of delivering these aims, but there is a simple way to overcome both of these.
1. We are worried that the PALS and Patients Forums will sit inside rather than outside the operational organisations of the NHS. As such they will lack the visible detachment and impartiality of present arrangements, and will mirror the compartmentalisation of NHS organisations. Patients with a concern about their healthcare need a body which will own responsibility for their total NHS experience (which crosses organisational boundaries in all but the simplest cases).
2. We welcome the introduction in this paper of the concept of VOICE organisations across the country, but they cannot truly be described as ‘local’ if they will function only at Strategic Health Authority level. To fulfil adequately the tasks set out in paragraphs 5.11 to 5.24 of the paper, the VOICEs will need substantial staff resources to reach out into each locality in their wide area and to establish links with the many councils in the areas they serve. These staff will be able to operate far more effectively if they are locally based.
We therefore urge 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, overcoming the drawback outlined in paragraph 1 above.
We are keenly interested in ensuring that the NHS and local social services authorities work effectively together to serve local people. It is this spirit that we urge you to revise the proposals set out in your document. Aware of the keen interest in this issue across our region, I am sending a copy of this letter to the 61 MPs whose constituencies lie within the area of our 19 member authorities.
Yours sincerely,
Councillor Cliff Morris (Bolton), Chair, Social Services North West
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