I won’t be the only one living with teenagers at at the moment who is sick and tired of tests and exams (not least because it means you cannot predict who is in the house at a given moment). But as they say, if you can’t beat ’em…..So I decided to give myself a little test. In April we issued a Ten Point Plan for what we wanted to see in the Professor Field’s Future Forum Report. So how has MAC done in pushing for better patient and public engagement and clearer governance arrangement in the New NHS?
Ticking the boxes?
It was comforting to hear the Prime Minister in his speech yesterday launching the government’s response to the Field Report tell us that various things were “done” but we will perhaps be a little more cautious and give ourselves a mark for the issues that if not “done” yet could at least be seen as being back on the agenda with a commitment from government to do something about them.
1. Openness – commissioning groups (aka consortia), foundation trust boards to meet in public and publish their minutes.
It wasn’t in the Bill before but it’s all going to be there now. √
2. Evidence of patient focus needed to become a member of the consortia
Well, we have are not quite there yet but there is at least to be a duty to involve patients and the public. New flexibility on the April 2013 deadline presumably means that commissioning groups will theoretically have time to work out what this means and be in a position to deliver decent public engagement BEFORE they are authorised. √
3. No to Health and Wellbeing Boards
We wanted fully integrated health and social care organisations spanning geographical areas and therefore no need for HWB. Well you can’t win ’em all. The new integration rhetoric will present some real challenges to commissioning groups. But at least now there will be some independent scrutiny. Χ
4. Role for lay members on commissioning boards
I thought I was really banging my head on a brick wall with this one when I told the Health Select Committee what MAC thought about this and later read their report which ignored lay people completely. But now we have an apparent commitment to two lay people on each board: one with a special remit for governance and audit, and one for patient engagement. The government even suggests that the lay person should be the chair, or vice chair (though there are plenty of questions to be asked about how these “lay” people will be found, supported, trained and resourced). We wanted local councillors to have a place at the table too and it looks like we’ve got them. √
5. Patient reference groups at all levels of governance
No mention of patient reference groups as such despite the strengthened duty to involve. It’s time for everybody to start thinking hard about what this means in practice. In governance and accountability terms it’s good to have lay people on your board but (have you heard this somewhere before), neither a couple of lay people on a board nor the existence of Healthwatch are a substitute for proper patient and public engagement. Lay people are about governance and accountability. Public and patient engagement and involvement is about shared decision-making and deriving business intelligence through on-going dialogue with your customers, your potential customers and your community. 1/2
6. A seat for Healthwatch on the Board
It’s there. √
7. A duty to involve, engage and consult local populations and demonstrate that they have done so
Well, the duty to involve is there and clearly stated, applying to commissioning groups, Monitor (interestingly) and to Health and Wellbeing Boards (though not individual practices as yet). The challenge will be to develop a structure that enables this to happen – and be seen to have happened – without it either being tokenistic, like much of the lay (NED) involvement in PCTs, or creating (costly) death by involvement amongst the local populace. And a nice new role for Healthwatch England to create a Citizen’s Panel to look at how choice and competition are working. What will that look like I wonder…. √
8. Hands off agreement by local partners for two years to allow for some stability
No mention of this. Χ
9. Feedback on decisions
We want to see commissioners explaining their decisions especially if people have asked for something and been refused. No mention of this either. We have some way to go to get the NHS to understand why feedback matters. Remember the great consultation and involvement formula: Lots of involvement minus feedback = cynical public = no-one left to involve or consult=cold tea and leftover biscuits. Χ
10. More money for patient responsive commissioner
No direct mention of this. There will be a quality premium for effective commissioning. Will meaningful involvement of patients and the public be one of the measures? Χ
A pass, but only just
So it is 5 and a half out of 10. More than we might have hoped for but not exactly A* material. Lots of nice words (too many perhaps). So let’s see how the rhetoric translates into legislation and, perhaps more importantly, how the legislation translates into action. And let’s hope that commissioning groups start to realise why patient and public engagement matters and why they need to start to do things differently. Some progress made this term, but a long way to go.
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.