The aims of the project were:
· to respond positively to the new agendas for citizens' empowerment
· to improve the involvement of, engagement with and accountability to,
local citizens, especially those who are the most disadvantaged or marginalised
· to set a course for transition to new citizens' empowerment mechanisms.
The project involved a wide-ranging process with a broad variety of citizens and agencies across Manchester, Salford and Trafford. The work included:
· 48 interviews with leaders in statutory and voluntary agencies
· five different community involvement processes
· an 'open space' event attended by 159 people
· a survey of 32 statutory and voluntary bodies.
People do not see themselves as consumers or 'care groups'. Citizens do not fit into health and social care boxes, but have much wider and complex concerns.
If health and social care services are focused on individual prevention and cure, and community improvement and well-being, participation mechanisms must reflect these aims.
While geographical community is of most importance to many citizens, capacity is needed to reflect the diversity within the population. Some groups are articulate, while others need help and learning to amplify their concerns.
There are fundamental barriers to engaging marginalised and vulnerable groups. These include communication, cultural, generational and mobility issues.
The mechanisms in the Health and Social Care Act and the N.H.S. Plan have an N.H.S.-bounded scope. Citizens will only see most impact if they cover both health and social care.
Citizens do not and should not have to recognise boundaries between services. They want clearer, 'joined-up' ways to engage and have a say not only in health and social care services, but also in economic regeneration, education, health, housing, etc.
Agencies are increasingly seeking to listen, but citizens' views often have little significant effect, while perceptions of professional arrogance remain. Trust and openness need to be built by taking citizens' participation much more seriously.
The Health and Social Care Act 2001 provides for:
· local authority overview and scrutiny of the N.H.S.
· a duty on all N.H.S. agencies to involve and consult service users
· independent advocacy services to help people with N.H.S. complaints.
Patient Advocacy and Liaison Services (P.A.L.S.) are being developed inside each trust. Proposals remain for patients' forums and patients' councils, and the abolition of C.H.C.s.
Complaints and advocacy work are distinct. Complaints deal with the past and mainly come from more articulate and assertive people. Vulnerable people often need independent advocacy to articulate their needs and wishes for the future.
While welcome, such mechanisms have N.H.S. limits and few clear links. They will not meet broader Government policy, or often address cross-agency issues.
The development of primary care trusts, care trusts and local strategic partnerships (L.S.P.s) suggest something more ambitious is needed to fulfil local desires and national aspirations.
The Government seeks greater social inclusion and reduced inequalities. Both will improve health and well-being, but will only be achieved by 'joining up' health and social care services with neighbourhood renewal, community regeneration and improving well-being.
Real potential lies in joining up the key modernisation agendas, not least for citizens' participation. A vehicle is needed to support and promote this.
Our vision, based on local views, is of a broad citizens' participation agenda of relevance to the real lives of local citizens. Using clear principles, we propose an emerging framework with four main platforms in order to meet local desires and broader Government policy. This reflects but goes beyond the N.H.S. Plan and the Health & Social Care Act.
The outcome must be a single framework for citizens' participation, and not separate ones for health/social care or acute/community care. It should be assessed not only on the quality of its processes, but also on its success in effecting changes desired by citizens and communities.
Whatever structures are developed, they must see people as citizens, and be flexible enough to recognise and respond to the complex diversity among them.
Processes for involvement and participation must seek and be able to engage with all sections of communities, especially those who are the most disadvantaged, excluded, marginalised or vulnerable.
There should be distinct complaints and advocacy services spanning across - but independent of - local health and social care systems. Informed by existing effective practice, both will complement P.A.L.S. within trusts and link with the Community Legal Service.
· The complaints support service will help people with complaints about health and social care unresolved by internal processes. This should build on the independent advocacy service described in the Health & Social Care Act.
· The independent advocacy service will focus on the most disadvantaged and vulnerable groups, identified in advance with the local health and social care system (but must include people detained under the Mental Health Act).
Jointly resourced by the N.H.S. and local authority, both will be required to interpret and report trends to them and the overview and scrutiny committee.
Each local authority overview and scrutiny committee should:
· listen to 'local voices', as a forum for groups to respond to and
be heard by
· receive information from feedback from survey and involvement processes,
service user and carer forums, and advocacy and complaints services
· inform policy development for health care, social care and public health
· review the local authority's own plans and priorities in the light
of emerging health plans, issues and trends.
Each local strategic partnership has a key role in overcoming artificial boundaries. It should:
· be the overarching body informed by the overview and scrutiny committee
· link together the wider agendas drawn from community planning, community
forums, issues and trends from complaints and advocacy, and developments in
health care, social care and public health
· facilitate turning overview and scrutiny into strategy for health and
social care services and public health, and relate this to wider issues (like
neighbourhood renewal).
The Citizens' Participation Agency will be the vehicle to maximise the impact of work from individual to strategic levels. Built upon the experience of the H.A.Z. and local agencies, it will be an integrated development agency for each local health and social care system, resourced by both the N.H.S. and local authority, perhaps through the L.S.P. Its purpose is to:
· develop a strategic overview of the involvement and participation
of citizens within and beyond the health and social care system
· coordinate, develop and sponsor citizens' involvement and participation,
making sure the public's voice is truly heard and has a meaningful impact
· promote effective practice in involvement and participation, and to
provide opportunities for access to training and development on this
· ensure that all activities effectively engage the most disadvantaged,
excluded marginalised and vulnerable citizens and communities
· collect and amplify the views of particular groups on care services
and public health
· empower citizens and communities to develop and implement their own
solutions to health and social needs
· support both the complaints support service and the independent advocacy
service
· support and advise the local authority overview and scrutiny committee
to get evidence, drawing attention to strategic linkages, liasing with the local
modernisation boards
· work with the local strategic partnership, contributing to the strategic
overview, putting trends into context and setting individuals' issues inside
broader parameters.
This proposal:
The outline action plan is to:
1. establish a Participation Implementation Group at H.A.Z. level to share
learning and coordinate developments
2. seek support in principle for the proposal from N.H.S. agencies, councils
and L.S.P.s
3. inform relevant regional and national agencies of the proposal, and seek
support where appropriate, including endorsement and development funding from
central Government
4. establish implementation groups in each borough (involving agencies from
all sectors) to develop detailed plans for this framework that draw on existing
effective practice
5. offer support to N.H.S. agencies and local authorities in developing their
own involvement mechanisms and processes
6. identify at what level each part of the framework and supporting infrastructure
should be
7. identify resources to develop and implement the proposals
8. promote the proposed development to local, regional and national audiences
9. report regularly to local citizens and communities on progress made.
Briefing / NB / CD / 18.6.01