By all means add your voice to the almost 600,000 who have signed the 38 degrees petition against the NHS Bill. But don’t stop there. What concerned citizens should then do is consider some “engagement entryism” at local level. That is where the real issues will be fought out and that is where you and other patients, carers and active citizens can make a difference. It is not a numbers game. Influence stems from intelligence and good networking and knowing when and where to focus your efforts in the decision making process.
There’s nothing covert or sinister about entryism. It just means not hanging around for someone to ask if you want to exercise your rights and opportunities to be engaged with what the NHS is doing. We’ve created a practical “6 Point Action Plan” of what “engagement entryism” means in terms of opportunities for local patient representatives and active citizens to get inside the local organisations that matter in health and social care and make their voices heard.
A flawed system can still be exploited
Yes, we know that it is a system that has not delivered for consumers and that the Bill’s changes are going to make that worse (vide changes to Local Health Watch’s status). The alternative is to just say “woe is us”, smear on the ashes and rend a few garments. Or, hold your nose and get stuck in anyway. There’s nothing to lose.
Here’s a menu of “entryism” choices. We’ve prioritised it in terms of what has – in our opinion – the greatest potential. Foundation Trusts come out tops, followed closely by bottom-up patient participation in GP practices.
1. Join your local Foundation Trust. Once you are a Member, get yourself elected as a FT Governor. The Governors role is to hold the Board to account in public and you can attend Board meetings and ask questions. Each FT is required to have a patient and public involvement strategy. Find out what your FT is doing and see what opportunities it offers. In the post-Bill NHS, Foundation Trusts are going to have more power and Members and Governors should have a greater share of it.
2. Join your practice’s patient participation group (PPG). If you practice doesn’t have one, make a written suggestion to the senior partner that it creates one. Look to the National Association for Patient Participation (NAPP) for how to do this. The local Clinical Commissioning Group (CCG) will probably be setting up an “overarching PPG” drawn from all of its constituent practices. It will have an input into strategy. Become your local PPG’s representative on this larger CCG-wide group.
3. Put yourself forward to be one of the lay members on the CCG board. They have to have at least two lay members – one of which has oversight of patient and public involvement.
4. Go to the meetings held in public by the CCG “board” (it may have another name, but it is the main decision making body for the CCG). Submit written questions in advance that have to be answered formally and included in the minutes.
5. Exploit your local authority’s scrutiny duty over health and social care by demanding the Overview and Scrutiny Committee (OSC) investigate any shortcomings and shady dealings in what the CCG is doing.
6. Each Council will be creating a Local Health Watch (LHW) by April 2013. Find out what is happening in your area and how you can become involved in it. The existing Local Involvement Network (LINk) will know what is happening and may be a “pathfinder” for LHW. Healthwatch locally will have influence with the Council’s Health and Wellbeing Board and can enter and view premises where health and social is being delivered and make reports and complaints if standards are not acceptable.
Battle at the grass roots
This list shows that there is real patient and public influence to be had at local grass roots level. That is where implementation of the NHS Bill will have the biggest impact on patients, carers, the public and local communities. There are lots of local allies, clinical and lay people who can come together to take advantage of the engagement and influencing opportunities. Remember the power of social media and networking as a way to contact people and spread the word.
The way to get into “Fortress NHS” is not to charge the main gates. Tunnelling under and around them and coming up inside is a better strategy. Twitter and Facebook may work better than a battering ram.
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.