Notes from the field of public involvement

Thursday, 12 October 2006

Public Petitioning to Trigger Community Action

We freely admit to being a bit obsessive about public participation and if you are reading this, perhaps you are too. So no surprise then that we tracked down the consultation in Appendix E of Health Reform in England: Update and Commissioning Framework from July on "Triggering Community Action". Our main response is on the main Moore Adamson Craig Partnership website. Obsessives can read it all including our excursion to the canton of Geneva to take a look at how they do this sort of thing in one bit of Switzerland.

Here we discuss briefly for the less obsessive some of the main issues arising from that paper. The new mechanism of 'public petitions' is a means of "giving people the power to demand changes".  We responded to all the questions asked but only reproduce here our response to what we think is a key issue – that of the threshold number of signatories to require a formal response from the PCT. The consultation question was

The threshold number of signatories to require a formal response from the PCT. What level of threshold should induce a review, for example a response from 1% of the public served by a PCT or 10% of the users of a service?

We said it was especially important to get this right so that people and carers affected by a relatively rare disorders were not disadvantaged and we used the example of Motor Neurone Disease to illustrate the point:-

The threshold should be "either/or" depending on the scale of the affected group and the significance of a particular aspect of care in terms of risks incurred or resources consumed. For example, many people in a given area will be users of community nursing services, therapies or sexual health services and therefore 1% of the population served by a PCT would be acceptable to trigger action in one of these service areas.  With reconfigured PCTs averaging 300,000 in population size, that would be a petition with 3,000 names.

In contrast, many fewer people will be affected by a relatively rare disorder like Motor Neurone Disease. In a PCT serving 300,000 people, there will be some 21 people with a diagnosis of MND and about 6 new cases diagnosed each year (according to incidence and prevalence figures in the relevant NSF). This is a small number of course, but the implications for a PCT of not  commissioning and managing care well for people with complex deteriorating neurological conditions are serious.  Not following the care pathway identified in the NSF for Long Term Neurological Conditions, for example, impacts not only on the experience of patients and carers but also on service quality and costs where there are inappropriate admissions and weak case management.

It would be logical, therefore, for a petition representing 10% of a much smaller but clearly defined patient group, such as people with MND and their carers, to be enough to trigger a formal response from the commissioning PCT.  This proportionality is justified because of the magnitude and complexity of resources which their care represents.

It will be interesting to see what others say about this issue. Any views you want to share with us, post a comment using our new 'interactive' feature and let us know what you thought of this piece (we still accept old-fashioned email!)

M-A-C's response to the consultation on "Triggering Community Action" in Appendix E of Health Reform in England: Update and Commissioning Framework

Andrew Craig / Colin Adamson | (Problem occured connecting to database: The server requested authentication method unknown to the client