Patient voices in the new NHS

Community Health Councils were set up in 1974 when  community  health services were moved from local authorities into the NHS.  During the 28 years of their existence they developed confidence in challenging the NHS locally and nationally.  In 2002 CHCs were abolished as part of the NHS Plan. No explanation was forthcoming, but those involved assumed they had become a nuisance.

In 2003 CHCs were replaced by patient and public involvement forums – one for every NHS Trust. Instead of having their own permanent staff the forums were supported by local host organisations – mostly voluntary organisations – on short term contracts.  The forums were pretty well strangled at birth, as it was announced in July 2004 that they would be abolished by 2008. The Patient Forum in Mid-Staffordshire was worse than ineffective. In January 2006 one of its members produced  a report on the shocking state of the casualty department, but the Patient Forum refused to pass it on to the hospital. When he gave his report to the local paper they expelled him. Many of the Forum members went on to take non-executive positions in the NHS.

In 2008 the Forums were abolished and replaced by Local Involvement Networks – run on similar lines with a host organisation with a 3 year contract providing the staff. Unlike the Forums, the LINKs related to a local authority area, not an institution and were expected to cover social care.

From 2003 NHS Trusts were being turned into Foundation Trusts. They have members, (self-selected) who elect the Governors of the Trusts. As far as many Trusts are concerned Governors are an ornamental part of the constitution to be kept away from the operational parts of the organisation.

In Mid-Staffordshire, as far as Cure the NHS were concerned, none of the involvement structures – Patient Forums, Local Involvement Networks,  Foundation Trust Governors  or even the Trust Board – seem to have had any credibility.  Julie Bailey and her associates treated  them with contempt.

On April 1st LINKs were replaced by Local Healthwatch, quite similar in that they relate to a local area. Each of 152 local authorities has to commission ,fund, and performance manage its Healthwatch. Generally this means a 3 year contract with a voluntary organisation to set it up, though 7 are run by social enterprises set up by commercial organisations. The remit is a bit wider than LINKs, as Healthwatch has a role in advising patients about services and complaining. They will still be allowed to “Enter and View” premises where NHS or social care services are provided. Funding is tighter and not ring fenced. And local Healthwatches will be organisations in their own right with the power to employ staff, where LINKs were just run by their “host” organisation. Healthwatch gets a seat at the new Health and Wellbeing Board to be set up by each local authority, and that may create its own problems as the Boards grapple with unpopular reconfigurations. They will also be represented at the NHS Commissioning Board’s Local Area Team’s Quality Surveillance Groups. But there will be no common pattern of organisation. Just as with LINKs, each area will be different.

There is a national organisation – National Healthwatch “hosted” by the Care Quality Commission, and among other things it will do some national advertising, as CIPPIH did, to promote the “brand”

The Healthwatch regulations provide that they are not allowed to promote or oppose changes in “the policy adopted by any governmental or public authority in relation to any matter”.   Norman Lamb, the Minister,  says that “to be effective, Local Health Watch should speak out for their local communities, ensure their campaigning work is evidence based and that they are not captured by political parties or other organisations.” He said that as a lawyer he agreed that the wording of regulations could be improved but felt that they allowed for campaigning and confirmed that the government wants LHW to campaign. He added that most community organisations would look to guidance rather than statutory regulations and suggested that LHW could use Judicial Review against local authorities which try to stop campaigning.

It seems very clear that the organisations which get the Healthwatch contracts will feel very vulnerable to accusations that they are “campaigning”.  Each successive iteration of the PPI structure ends up more timid than the one before it, and this appears to be the going down the same road.

It’s well established that reorganizations set back progress.  That is even more true of voluntary organisations. It will be difficult to persuade  people that Healthwatch is worth the investment of their time and energy.

For people who want to get involved in the NHS there are other opportunities. Clinical Commissioning Groups are required to establish public and patient involvement structures, and at present the signs are that they are much more interested in listening to the public than PCTs were in their later years.  There are financial incentives for individual GP practices to set up patient participation groups, and some of them are quite active, though many GPs are very wary of them.  In the new more chaotic NHS structures and informal arrangements are springing up that have been variably. They may do more than the statutory arrangements. It will deeply ironic if the new competitive ethos in the NHS leads to a market in active patients with many organisations bidding for their time