As I filled in my petition to keep the Gipsy Hill Post Office open, I fell to wondering what post offices are for anymore? Are they amongst the things that we do not use or indeed value until they are threatened with closure? We spend a lot of time agonising over how we can get the citizenry to join in and take an interest in consultation. The cynic would say that the infallible way to do it is to threaten to close something that few use but everyone values.

Add to this an improved facility somewhere else and you have the makings of a monster row. Post offices, hospitals it is the same – the actual function of the shop or healthcare unit is forgotten and it becomes an abstract symbol of the collapse of life as we know it. The challenge to those of us who believe in consulting people is to guard against it being an exercise that institutionalises nostalgia and turns its back on the future.

I did some consumer representative training some time ago with the newly established Postwatch and have some sympathy with the bind that closures put consumer ‘watchdogs’ in. They want to maintain some flexibility and not get frozen in a posture of nay-saying. While it would be easy enough to declare that further post office closure (or indeed railway services withdrawn) will only take place over our dead bodies, the results sadly are usually more closures and yes, a consumer body dead in the water because nobody takes it seriously any more. Always saying NO and always being igNOred.

Hospitals attract a similar set of emotional responses – nothing gets the elders on the streets faster than a whiff of service withdrawal. They are often disappointed because in a sense, the emotion and the outrage come too late in the process. Consultation is a conversation that has to be continuous and take in both the genesis of a project as well as its outcome. There must be an element of leadership in explaining why the future can in some cases actually be better than the past we know and are comfortable with.

The – rather undervalued – resource that is there and can perhaps monitor a developing situation in a way that a single person or group cannot is the local councillor. Our guess is that local government is going to become if not fashionable then better regarded in future. This will be one of the factors that will make LINks a success. If these new networks are heard by local politicians as well as health and social care commissioners and service deliverers, then they have a chance to drive change and create improvement.

We invite you to enjoy the alliterative feast of plosives – past postings on parks and parents (£38,000 down the slide) as well as our announcement about getting involved in a tender to work with a LINks host and a briefing from Andrew Craig about Section 242.

STOP PRESS: Just after writing this, I heard that in Essex, the local government is trying to buy post offices and re-open them promising lots of innovative service ideas – will they become consultation waystations where citizens make their views known?

From his perspective as a PEC member in London’s PCT-land, Andrew Craig offers a personal view about how to start complying with the new legal duty in Section 242 and make it work to the advantage of good governance in the NHS.

What is “Section 242″?

The NHS loves shorthand and “Section 242″ will soon be part of it: shorthand in fact for the general legal duty on the NHS to consult and involve service users in everything to do with planning, provision and delivery of services. The duty specifically applies where there are changes proposed in the manner in which services are delivered or in the range of services made available. A briefing about Section 242 is available from the Department of Health (December 2007: Gateway Ref 9138) Statutory guidance – i.e. compulsory – about the 242 duty and the related sections of the Local Government and Public Involvement in Health Act 2007 will appear later this spring. DH is clear that all this is being positioned so LINks (Local Involvement Networks) can take advantage of it.

The consolidated NHS Act 2006 re-enacted and enhanced the 2001 “Section 11″ duty to consult and involve users of health services. The new Section 242 duty comes into force 1/4/08 and applies to all NHS bodies in England. It defines “user” of health services as someone to whom health services are being or may be provided. This is meant to encompass the public and carers. There is pressure to extend this to social care services as well, but at the moment Local Government operates under slightly different duties about involving service users. I think convergence in the future is very likely.

The Section 242 duty is an integral part of commissioning and one of the “world class commissioning” competencies. It is significant that Patient-Public-Involvement (PPI) is now part of commissioning and systems management within DH. It is intended that commissioning bodies take the lead in meeting Section 242 duties.

The duty also applies to all NHS providers including Foundation Trusts and any independent providers – profit-making or social enterprises – which are commissioned by the NHS. This includes primary care contractors because they provide “health services for which [the PCT] is responsible.”

How could PCTs in particular start responding to this duty?

• Make it part of Board governance
  Complying with Section 242 is integral to good governance. The suite of compliance and assurance policies that the PCT maintains and which are reported regularly to the Board should reflect this. But compliance shouldn’t be onerous or else people will back off or find ways to fudge. To be effective it has to get into the bloodstream of the NHS so that people do it naturally rather than as an add-on or an afterthought.
• Do proactive PPI and Equality Impact Assessments
  Some PCTs already have a system which is supposed to ensure that their PEC and Board papers provide information on how the patient and public involvement implications of the topic under consideration have been assessed and what intelligence has been generated by engaging with people likely to be affected by proposed developments. That is excellent, but in practice and due to pressure of time and the impossible deadlines managers often work to, the objective is often more aspirational than real. But it must become real. We all need a system to measure proactive compliance with the 242 duty rather than trying to backfill with engagement evidence after policy decisions are taken.

  The same is true of equality impact assessments (EIAs) – if these were done proactively and thoroughly they would generate a lot of evidence around engagement with current and prospective users which could be put to satisfying the requirement to engage and consult. It is hard work, but ignoring it will create real risks and will keep the PCT from being a world class commissioner.

• Understand and work collaboratively with LINks
  When the Local Involvement Networks (LINks) are up and running, they will be an important – but certainly not the only – means of meeting this duty. The Act says the 242 duty can be discharged “directly or through representatives” and a LINk is meant to be “a network of networks” involving organisations as well as individuals. The issue of the capacity of the LINk to work in this way will need to be addressed early on and there is a considerable opportunity for the PCT in particular to form mutually beneficial relationships with these new bodies. LINks should become strong and well-informed so that they can function as independently-minded “critical friends” across health and social care.
• Use existing consultation work as Section 242 learning opportunities
  Section 242 is an opportunity not a threat. PCTs should be creative and positive about this. I was struck when reading the resource pack produced by the London Local Medical Committees on the Darzi Healthcare for London review at the strength of their views that health organisations which don’t have patients on side are vulnerable. How very true in this age of alternative providers! That is a strong incentive to make a Section 242 learning opportunity out of every bit of consultation and engagement work going on now, before the legal duty starts to bite. Can we all prove that our consultation efforts have real “legs” in the community? I doubt it. So what better reason to start collecting the evidence now that would be needed to satisfy a scrutiny from the LINk or the Health Overview and Scrutiny Committee to see if we have complied with the 242 duty? Doing this would be a good “dry run” for all concerned. It could identify any shortcomings in our engagement processes that after 1st April could turn into real risks when the Section 242 duty is fully in force.
• Here’s one we made earlier
  If you want to see an example of how Wandsworth PCT has used “pre-consultation engagement” as en effective process to develop options which inform its formal consultation work on the future of health services in Battersea and North Wandsworth, I commend the PCT’s website to you where it is all explained: how they did it, what they learned and how this has been all carried forward into formal consultation which is now ongoing with the local community into May. I think this will turn out to be the best local engagement process we have ever undertaken and a learning exercise for us about getting ready for Section 242 compliance.

Thoughts and examples from readers about Section 242 learning and compliance would be greatly welcomed.

Press Release: Tuesday, 29 January 2008

“We want to help the new user and public voices involvement networks known as LINks get off to the best possible start,” Andrew Craig of the Moore Adamson Craig Partnership said today. The Partnership is launching a new suite of LINks-related products called LINKSWORKS® for the new world of local authority-based Local Involvement Networks designed to bring the voices of service users and the public into the decision making of commissioners and providers of health and social care.

“The history of patient and public involvement in the health service has been a chequered one recently with Community Health Councils being closed and their ill-fated successor the Commission for Public and Patient Involvement in Health lasting less than five years,” Andrew points out. “It is therefore vital to make sure the new arrangements get off to the best possible start by recruiting good people and reassuring local organisations that this time the new arrangements will work and will last.”

The Moore Adamson Craig Partnership offers a unique blend of advice based on practical experience and on that basis is already associated with the Wandsworth Care Alliance tender to be the host organisation for the LINk to be set up in the London Borough of Wandsworth. The products listed below focus on the set-up phase of getting the best people, giving them the support and training that they need with good communications using modern Web 2.0 techniques. The LINKSDATA tool is a research and evaluation tool to make sure that the LINks can demonstrate their impact and measure their effectiveness.

Recruitment and Capacity Building – LINKSWORLD®
The identification of network builders and participants and the creation of processes to bring organisations and individuals into the ambit of the LINks. Our aim in this process would be to identify and bring forward individuals and organisations that will form the LINks and this process we are calling LINKSHANDS®.

Learning, Development of Social Capital and Training – LINKSLEARNING® with LINKSCOURSES®
to bring together those who form the network and work with them to create a network that makes a difference. Many of the participants will have a considerable experience of the job of representing others to the powers that be. We will take this a stage further and develop a means of targeting health and social care organisations – in particular commissioners: the new focus for money and care delivery – to get action.

The training will be strongly interactive and supported by individual coaching and mentoring as requested.

E-communications and use of Web 2.0 techniques – LINKSWEB®
The effectiveness of the LINks will depend to a great degree on communication across many organisations and people. While the human element remains vital with face to face meetings an essential part of the work, new technology will bring together individuals and their contributions in a cost-effective and easy to use way. We will be working with suppliers and e-businesses to offer advice on how best to do this.

Policy and Research – LINKSDATA®
will help establish both the field of action and assess impact and effectiveness amongst those with whom the LINks will work to put over the user and patient point of view. A range of methodologies – including focus groups and web-based surveys – will be available to the LINks to make use of and to provide a clear picture both of what they have to do and how well they have done it.

Related articles about LINks
Below are links to recent documents/blog entries posted by Moore Adamson Craig:

• Regulations for Links (M-A-C’s response) – December, 2007
  http://www.publicinvolvement.org.uk/2007-12-Dec/LINksResponse.php
• LINks Let Loose at Last – November, 2007
  http://www.publicinvolvement.org.uk/2007-11-Nov/LINksLetLooseatLast.php
• What next for LINks – Local Involvement Networks? – September, 2007
  http://www.publicinvolvement.org.uk/2007-09-Sep/WhatnextforLINks-LocalInv.php

NOTE FOR EDITORS

The Moore Adamson Craig Partnership was set up in 2003 to provide management consultancy services for consumer representatives primarily in the health service. Since then the Partners have worked with patients and their representatives as well as healthcare providers in making effective patient representation a reality.

More details of their work can be seen on the websites www.mooreadamsoncraig.co.uk and www.publicinvolvement.co.uk

LINks are local networks set up to gather and represent the views of users of health and social care services. LINks will look at all health and social care services in an area that are funded by taxpayers. It will not matter whether they are provided by the NHS, a local authority, a private company, a social enterprise or a charity.

LINks will feedback this information to the people responsible for commissioning, providing, managing and checking up on health and social care services so that things can change for the better.

The Department of Health website has more details:
http://www.dh.gov.uk/en/Policyandguidance/Organisationpolicy/PatientAndPublicinvolvement/index.htm