A legal duty of patient and public involvement on GP-led commissioning consortia was confirmed by a bullish Secretary of State Andrew Lansley before the Health Select Committee on the 15th at the same time as Ministers published their response to the white paper Liberating the NHS consultation (MAC’s response was one of over 6,000 received), sketching out the legislative framework and next steps to create the Health Bill due in January 2011.
Lansley’s ministerial statement spoke of “a broad mix of support, suggestions for improvement and critical challenge”. The results include abandoning the daft idea of the national Commissioning Board taking over maternity services. That is welcome, but MAC still has concerns about the more difficult end of commissioning, whether specialised or not, particularly neurological long term conditions, which are not popular with GPs. The shiny new commissioning tools we’ve had a hand in shaping may not to be used much and that would be a tragedy for all concerned.
Aspects of PPI duties
While we await the Bill, the legislative framework gives very strong clues to its content. On duties of patient and public involvement, there are two dimensions.
1. First, the National Commissioning Board under will be under “a duty, in exercising its functions, to have regard to the need to promote the involvement of patients and their carers in decisions about the provision of health services to them. The NHS Commissioning Board will also be under a duty to issue guidance on commissioning to GP consortia, which could include guidance about how to fulfil their duties in relation to public and patient involvement.”
2.To make this more explicit, the Bill will also place a duty on GP consortia and the NHS Commissioning Board to ensure that people who may receive a service are involved in its planning and development, and to promote and extend public and patient involvement and choice .
Of course, this is in effect brings existing Section 242 obligations about engagement up to date and is to be welcomed.
And as a welcome bonus, the Bill will also strengthen the power of Foundation Trust Governors to hold the FT Board of Directors to account through the Chair and Non Executives on the Board. This is something MAC strongly supports because the Governors are the elected representatives of the Members of the FT, who are the legal owners.
No prescription about lay participation in consortium “boards” and governance
Our friends at National Voices in their submission said it was “vital that there is equal lay participation in the governance of the consortia, and that their meetings are held in public”. A point we and many others strongly support, but the Government has taken a non-prescriptive view. It argues thus:
The Coalition Government has considered very carefully the issue of lay and patient representation within consortia. We are clear that requiring there to be a statutory management board for each consortium would be over-prescriptive; and that placing legislative requirements for there to be lay or patient participation in the governance of consortia is unlikely to work. At its heart a GP consortium is about a nexus of professional inter-relationships, the exercise of peer influence, and professionals taking on direct responsibility and public accountability for the decisions they collectively make. The Government does not see how this can be mediated through imposing upon consortia a small number of lay or patient appointees. The Government certainly does not wish to discourage consortia from developing arrangements for lay or patient involvement, which can often work well, but it must be for consortia to make their own decisions on this.
Lansley was clear before the Health Committee that he would not prescribe the internal mechanisms of consortia, provided that they had an acceptable constitution (but there would be no model) and achieved transparency. Otherwise, prescription would simply re-create PCTs, he said.
“Glass half full”
Many will be disappointed by this, but prescription is not the way this government works. In effect we have a “glass half full” position on patient and pubic involvement in consortium governance. That means it is up to local user groups to understand the leverage, particularly through the powers of the Local Authority, which the new legislation will give and, if their local consortium is deficient on meaningful patient and public involvement. They should create and then use their influence with the Town Hall and Local Health Watch to improve the commissioners’ performance.
MAC published our advice to commissioners and providers about how to meet their duty of patient and public involvement in the White Paper back in October. We will now revise that to include these additional government legislative commitments.
Stand by for a heavyweight
Back in the summer people were speculating that the Health and Social Care Bill would be light, mainly enabling, and with all the details done in subsequent secondary legislation (SIs, Directions etc). There will still be a flurry of those, no doubt, but on this outing – a 174 page legislative framework response from government – it seems clear that the primary Bill will be a heavyweight. Block out your calendar for January now.
The Moore Adamson Craig Partnership supports user and public participation, trains lay representatives and develops responsive health, care and education organisations. We are ready to work with and support all those who want to make sense and a success of the new structures of patient and public engagement within the new arrangements for health and social care commissioning and providing. Feel free to contact us to discuss the opportunities.