Wednesday, 24 January 2007
Patient and Public Involvement and Petitioning
We hear that the evidence sessions for the Patient and Public Involvement in the NHS enquiry by the Commons Health Committee are to open with a line-up of the usual suspects on 1st February: Professor Celia Davies, National Institute for Health Research; Ed Mayo, Chief Executive, National Consumer Council and Dr Jonathan Tritter, NHS Centre for Involvement in the first session with Harry Cayton OBE, National Director for Patients and the Public and Meredith Vivian, Head of Responsiveness and Accountability, Department of Health next. Worthy champions of user involvement all of them and we shall read their transcripts of evidence with interest.
Local voices missing
But shouldn't MPs start their enquiry by hearing from the grass roots? Where are the voices of the members of PPI Forums and other user involvement groups in surgeries, Trusts and PCTs? It is their story of fortitude in the face of institutional frustration and policy contradictions that needs to be heard first and learned from. Without them, there simply wouldn't be any patient and public involvement in health. We hope their enthusiasm is sufficient to tide the current ramshackle system over to the advent of the LINks, which at least have the promise of more coherence across health and social care.
PPI will be the flavour of the month of February it would appear. As well as submitting evidence to the Health Committee's enquiry, we have been doing our homework on two particular aspects of the local government and public involvement in health legislation - namely public petitioning and the question of a lead councillor for adult social services getting involved with commissioning. They have proved to be difficult policy trails to follow in the undergrowth of white papers and parliamentary bill drafting.
Whither public petitioning to trigger community action?
The best clue about this we found was the House of Common Library research paper - House of Commons Research Paper 7/01 on the local Government and Public Involvement in Health Bill (10 January 2007). This confirms our suspicions that "petitioning" in the sense of direct access by the public to an authority which then has a duty to respond about its commissioning decisions has got subsumed into something rather different - a "Community Call for Action" (CCfA) described on page 54 of the research paper. The text of the Bill itself doesn't help much on this one. Looks like watering down to us. What do readers think?
CCfA has come from the Government's "respect" agenda and started life as part of public order thinking. CCfA focuses on local government matters, which would include social care, but it doesn't explicitly mention health commissioning or provision of health services. Of course, the word on the street is that Government may change this by making regulations under existing legislation to involve local authorities much more than in the past 30 years in planning local health services.
If that became the case, then the CCfA would probably cover health as part of all local public services. That would be welcome, but the point remains that all of this is about the role of local councillors as advocates for their constituents. While that is welcome - and the best local councillors have been doing this anyway of course -- it is a far less direct remedy than the "public petitioning to trigger community action" that was trailed in the Our Health, Our Care Our Say White Paper and then outlined in the July 2006 Health Reform in England Commissioning Framework consultation. We think public petitioning is a distinct part of public and user involvement that is worth fighting for. See our blog posting from October 2006 on how this could be useful.
Lead members as advocates?
The proposal for a Lead Member for adult social services in each Local Authority to influence commissioning for health and care came from the Local Government White Paper Strong and Prosperous Communities (October 2006), particularly in the context of the statutory duty of partnership between health and local government bodies. But as far as we can see, this isn't spelled out in the draft of the Bill itself. It could come up in amendments at committee stage (after today's 2nd reading) because it builds on the statutory guidance that already exists about what a lead member for adult social services is supposed to do. Government might not even need legislation for this and could do it by regulations.
The detail of this proposal for policy wonks is below:
In volume II of the White Paper, page 14, it says:
"to ensure there is more visible local leadership on health and wellbeing, particularly on public health issues such as childhood obesity, smoking rates and health inequalities. It is important that the local authority lead member for adult social services is able to influence the commissioning decisions of health and social care bodies, and drive action to reduce health inequalities";
and on page 25 we read:
"We have already set out in statutory guidance our expectation that every local authority will have a lead member for adult social services with responsibility for well-being, preventing social exclusion and protecting vulnerable adults. We will consider ways to encourage the local authority lead member for adult social services to play a leading role on the new statutory health and well-being partnership."
Now you know. Sounds good, but as usual, the Devil will be in the Committee detail.