Tuesday, 18 April 2006
RIP Patients' Forums
It appears that Patients' Forums (readers outside England where different bodies exist may relax) will have time called on them after only two years. Judging by leaks in The Times about the review led by Harry Cayton at the Department of Health and the recent comment of David Colin-Thome, National Primary Care Director, that something "more organic" was needed, it's no surprise. These are independent statutory bodies, so primary legislation will be needed to give the coup de grace. But in the interim they can be starved and neglected into insignificance.
The price of change will be heavy: ill-will, frustration and largely wasted effort, not to mention millions down the tube to create and then kill off the CPPIH and more money wasted on the ill-fated Forum Support Organisations. 572 Forums was always too many. In some places PCT and NHS Trust Forums met together, not only because they shared common interests and needed to share information, but for the practical reason of getting a decent number of people in the room.
The people who will be the most annoyed at the news are the 'keen to contribute' members of the Forums, all volunteers, who took government at its word about the commitment to public involvement and local scrutiny. Probably too few to affect the local elections in May. But you never know - this is just the kind of issue, coupled with well-loved local NHS institutions at risk in many parts of England, that make people use their ownership voice through the ballot box. The effect will go beyond this issue and add to the corrosion of confidence in the politicians managing the NHS. It makes the end of CHCs look well-organised in retrospect.
Engaging lay people in health services will only get harder as a result of the Forums demise whatever replacement is proposed. Once bitten and all that. But if being slapped in the face serves to radicalise health service consumers, then perhaps some good may come of it. We have always been concerned about the way these organisations were set up. We trained some FSOs and heard from members who had joined the Forums - no one seemed to be settled and productive with a clear idea of what they were there to do. Much time and good will was dissipated. Was that what Ministers intended? Perhaps the Health Select Committee would like to address that question once the review's recommendations are in the public domain.
Scrutiny must strengthen across health and social care
So what should succeed the Forums? M-A-C strongly believes that function not structure is the answer. There must be a beefed up form of local scrutiny - by which we mean specific to a locality not specific to institutions - spanning health and care. And the scrutiny function should operate from the perspective of those using these essential public services. We argued for this in our comments at the beginning of the fitness for purpose review in September 2005.
The best next step would be to designate places on Health Overview and Scrutiny Committees for independent (and paid) "lay assessors" who would be publicly recruited to join local councillors in holding the local health and social care economy to account for its commissioning and delivery of services. This would give some realism to scrutiny because users don't see divisions between GPs, nursing, hospitals and social services. They just want them to be there when they need them.
Sounds rather like reinventing CHCs somehow. Well if so, then that's probably what should have happened in the first place.