Last week as Lay Member of NHS Wandsworth PEC I got to spend two hours with a group of patients and a couple of the non-clinical surgery team members at the Balham Park Surgery Patients Liaison Group, where I am also a patient, talking about the Liberating the NHS consultation. It turned out to be a real learning opportunity for all of us.
In getting ready for this, I had gone through the suite of consultation documents again but lost count after 100 questions, many of which were too detailed and repetitive anyway. So I opted to boil the main points from Commissioning for Patients and Increasing Democratic Legitimacy down to to two sides of A4 and focus on what I think are seven questions that address the meat of the consultation from the patient and public perspective. You can read these below together with my precis of what the participants in the group had to say.
Two themes stand out
Two themes during the discussion really stood out for me.
First, the overriding importance of real patient and public involvement in new arrangements – “No decision about me without me” is a hostage to fortune and the Government will be mercilessly pilloried if they abandon it or, worse, let the special interests water this down to mere lip service or box ticking.
Second, the central role of local authorities in leading on the things that matter to local people about health and well-being.
The question came up unprompted several times about why commissioning was to be divided between GP consortia and Councils. Would it not be more effective, people asked, to deal with Wandsworth as a single place with a single population and a common pot of resources and expert people working in a single agency to do the work across health and care?
What people said
Here are the questions we used and a summary of what the participants had to say about each one.
How can GP consortia and the NHS Commissioning Board best involve patients in improving the quality of health services?
Involvement and whatever else is needed to improve the quality of health services through engagement of patients and carers should be contractual and enforceable.
Lay people who are members of decision making bodies – commissioning consortia, health and wellbeing boards etc – must be paid an appropriate attendance allowance in recognition of their time and the shared accountability they are taking on.
How can GP consortia can work closely with secondary care, community partners, local authorities, and other health and care professionals to design joined-up services that are responsive to patients and the public?
Pathways reflecting patient journeys must be commissioned. Third Sector bodies must be helped to be able to deliver a share of public services if they have the right skills.
Local authorities should take the lead for long term conditions and services for older adults, children and learning disabilities. Possibly also for mental health.
How can GP consortia be patients’ advocates and accountable to patients and the community for their decisions in some meaningful way?
Consortia must have boards with lay people (lay members) recruited and paid to be on them. There should also be lots of opportunities for patient representatives to influence what the consortia do. This should be in the consortia’s contract with the National Commissioning Board. Perhaps lay people should be elected to the boards?
Local Authorities should have strong scrutiny powers to see that consortia are involving patients and carers and making themselves accountable to the community.
Consortia should focus on achieving outcomes that improve the patient experience and reduce inequalities as well as making better use of less resources.
Local Healthwatch and the Care Quality Commission should have powers to inspect what consortia are doing. If consortia fail or do not involve their communities, they should be closed down and their responsibilities taken over by a successful consortium.
Are statutory H+WBBs led by Councils a good idea?
Yes, but there must not be struggles for power and resources between Councils and the GP consortia.
Should local HealthWatch take on new functions around health complaints advocacy and patient choices? If so, what needs to happen to achieve that and support people who do not have the means or capacity to make choices about their care?
Local Healthwatch should not get involved with health complaints or advocacy as this is a specialised area which the local authorities should lead on. But Local Healthwatch should be involved with providing information and helping people to make good choices.
There should be a close working relationship between the local authority and Local Healthwatch.
How should patient groups in practices relate to local HealthWatch, to local authority Health and WellBeing Boards and to GP commissioning consortia?
Patient groups in practices should be able to and encouraged to join Local Healthwatch but not required to join it. They should be part of the wider reference and intelligence networks of the HWBBs and commissioning consortia. There should be a duty to involve patients and the public including patient groups.
How can the user, carer and public voice across health and social care be strong and most effective?
Patient participation groups in GP practices are the bedrock for achieving strong and effective user and carer voices across health and social care. If they existed in all practices, it would give the biggest outreach possible into the community.