The Big Beast in the NHS jungle Sir David Nicholson has decreed that the new PCT “clusters” will take responsibility for public involvement in the “shared operating model” the Department of Health released on 28th July. “Shared” in this sense means everyone doing things the same way. The operating model dictates that engagement work merge with “communications”. That’s bad news. Our work with PCTs that put PPI and comms together meant real involvement usually took second place to those controlling the party line and pulling the strings. This is going to happen across England quickly and with a vengeance. The Big Beast’s iron grip – he has to squeeze £20bn+ recurring “savings” out of the system by 2014 remember – means real commitment to patient and public involvement has been sold down the river. And all for the sake of opening up the provider market to “any qualified provider”
AQP coming to a place near you
By September this year the “shared model” says, “Clusters to have undertaken patient engagement and have determined services of choice for Any Qualified Provider”. That’s what this tightening grip from the centre on engagement and comms is all about. Each commissioning group will have to have three AQPs delivering community and mental health services by April 2012.
Make no mistake. This isn’t about grass roots involvement to find out what local people think should happen and what would be acceptable to them. It is about giving some legitimacy to the “any qualified provider” initiative. Did you notice there was a consultation about that? If not, read the government response to it here. It is moving at juggernaut pace. So much for things slowing down during the dog days of summer.
Opening up choice and competition
Here’s how it is going to work. By April 2013 all of these services will have been opened up to “choice and competition” – and local clinical commissioning groups can add to this list if they have more important local priorities.
• Musculo-skeletal services for back and neck pain
• Adult hearing services in the community
• Continence services (adults and children)
• Diagnostic tests closer to home such as some types of imaging, cardiac and respiratory investigations to support primary assessment of presenting symptoms
• Wheelchair services (children)
• Podiatry services
• Venous leg ulcer and wound healing
• Primary Care Psychological Therapies (adults)
The iron grip tightens
It gets worse. By October this year, we are commanded to “Establish regional communication and engagement hubs in line with SHA Clusters in October.” For London this means, it will all be done by NHS London.
This goes hand in hand with establishing interim management of the locally delivered, nationwide shared service in the Autumn. “ So that by April 2012 we will have a nationwide shared engagement and communications service, locally delivered.
What this really means is faceless people in a communications department at the “cluster” – or even more removed at the SHA – telling us what those even higher up at the National Commissioning Board – of which the Big Beast is to be the CEO – want us to hear. If you think that’s engagement, much less involvement, you need your head examined.
No involvement means no legitimacy
The “single operating model” means clinical commissioning groups (no longer called “consortia” remember) will not have their own involvement and engagement staff. We suspect GPs who are leading these CCGs and local councillors keen on Health and Well Being Boards aren’t aware of that yet. Many will not be happy when they wake up to it.
So where will the local knowledge and sensitivities about interacting with diverse local communities come from? Co-production? Community development? Shared decision making? You may well ask.
Sold a pup?
“Nothing about me without me” sounds more like being sold a pup as each day passes and we find out more about what the “reformed reforms” really mean.
If there is no meaningful local involvement in decision making, there can be no legitimacy for the commissioning decisions that are taken. That is not a negotiable point.
It would be a terrible irony if patient and public involvement became a casualty of the unseemly rush to expand “choice”, but that is the way it looks like going.
The Big Beast and his political master may end up paying a high price if the wheels come off his “shared operating model” because it has no local support.
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.