The General Practitioners Committee of the BMA trade union pulled back its support for patient and public engagement last month. Now both the Kings Fund and the Local Government Group are at it too. Their formal responses to Liberating the NHS ignore patient and public engagement, despite Mr Lansley’s proposals saying this will be a duty (ie a legal obligation). This is yet more evidence of powerful interests jockeying for position over the heads of those to whom the NHS rightly belongs – its users and the public.
If we have misrepresented their positions on PPI, we invite the Kings Fund and Local Government Group to set us right. But this is what it looks like to us based on their published responses.
Kings Fund could do better
Sadly the KF has ignored patient and public involvement in its response to the White Paper “The Right Prescription in a Cold Climate?” (Liberating the NHS: the right prescription in a cold climate? ) We had hoped for more. But “involvement” is entirely absent from their document and “engagement” occurs only once in the employee-ownership context.
This is odd because the document also says “The King’s Fund strongly supports the aims of the White Paper: putting patients and the public first, and improving health care outcomes.” Nice words, but no follow through. How can patients and the public be put first if they are not involved from the outset in decision making at every level? It’s as though active citizens and service users and carers have no part to play in what is universally acknowledged as the most profound reorganisation of the NHS (in England) since its inception. Really, the Kings Fund must do better on this point.
Low opinion of NHS consumers?
Later in the document there are clues to why the Kings Fund may have a low opinion of NHS consumers. They describe patient choice as a good idea but wasted on most consumers who are generally too unmotivated to exercise it and can’t understand the sources of comparative information that Mr Lansley wants to provide in his “information revolution” to drive choice. Switching between competitive providers does nothing to drive up quality, they assert.
Reading the Kings Fund response, it sounds like we are stuck from the consumer engagement standpoint while the debate rages above our heads. This would not be acceptable even if all providers were excellent, which patently is not the case. Even in the separate discussion on democratic legitimacy there is no mention of HealthWatch England or Local Health Watch. The focus is entirely on local authorities and Health and Well Being Boards.
Local government better but still a long way to go
The Local Government Group’s white paper response is a bit better, but still not up to the mark about engagement.
There are some things to applaud like their vision for Health and Well Being Boards
We envisage HWBs being the senior strategic partnership body comprising chief and senior officers, elected members, GP commissioners and community/patient representatives, driving forward needs assessment, agreeing local priorities and developing commissioning plans to address health inequalities and improve the health and wellbeing of local people. In dialogue with the public, key stakeholders and service users, HWBs will identify gaps in service provision and help GP commissioning consortia take decisions about investment/ disinvestment.
This is fine as far as it goes, but we question the lack of commitment to engagement that is bigger than simply patient and community representatives. Elected councillors are not enough. They are whipped local politicians and often cannot or will not give sufficient challenge. What the Health and Well Being Boards must have are independent, well informed and well supported lay members – a concept that is lacking in the LGG vision which assumes that elected councils know best.
Health Watch black hole
In a criticism of the proposals to turn Local Improvement Networks (LINks) into Local Health Watch, the LGG identified a black hole in the policy. It said
“Currently, LINks are funded until the end of March 2011 and Health Watch will be operational from April 2012. We seek urgent clarification on funding arrangements for patient and public involvement in health and social care during the transition period. This is especially important since local authorities with social care duties will continue to have a statutory duty to ensure that there is support for patient and public involvement in their area.”
If this is right, it is a very big “Oops” in the plan to put patients first and deliver on the “Nothing about me without me” commitment. Mr Lansley should plug the funding gap without delay. Otherwise we are in for a re-run of the discontinuity, demoralisation and loss of organisational memory that has so plagued successive involvement initiatives in the past decade from CHCs, to PPIFs, to LINks and soon to Local Health Watch.
Moving away from user engagement territory
We have to ask why the big players are folding their tents and moving away from user engagement territory? Any other business would strive to keep close to customers in times of major change (brand loyalty, word of mouth etc). But the NHS is not consumer responsive and that is one of its major failings as a near-monopoly organisation and the reason why we must strive for more user choice and provider competition on quality, safety and customer satisfaction grounds. All of this can happen without privatisation.
Surely no would say that patient and public involvement is too difficult a concept, or would they? After all, what’s not to get in Nothing about me without me?
The Moore Adamson Craig Partnership supports user and public participation, trains lay representatives and develops responsive health, care and education organisations. Keep updated by signing up for our newsletter (summary of our blog, opinion and experiences, approximately every month).