Panel: Dr Paul Walker, Dr Guy Routh, Dr Aneez Esmail.
How to increase democracy accountability in the NHS in the short and the long term?
Sally Brearly: A succinct message should go out to public that CHCs are their mechanism. How about a postcard campaign for the public to send to the government requesting an effective, independent mechanism for public and patient representation?
Mike Turner: The SHA should write to government suggesting that CHCs remain to set up and manage all the new involvement and patient organisations within the Plan.
Helen Groom: Most PCGs will have no idea about these issues. In the headlong rush to PCT status, they will need this information. They want to have a base in the community, to be accountable and to make the necessary changes in culture, so send this information to the PCGs and discuss it with the PCGs, especially around the need to change cultures.
Aneez: There is a need to engage PCGs and not to reinvent the wheel.
Guy: Consultants have even less idea about these issues. CHCs have a lot to offer. It would be a mistake to hang on to their name - but we need to keep their skills and abilities, rather than necessarily the CHCs themselves.
Paul: The point of today is for the SHA to feed into its policy development processes and then to respond to the government through the policy which it will develop arising out of this conference.
Michael Varnam: There are a million health care workers in the country, which means that 1 family in 5 is involved. If they are all democratically accountable then they could change what we do at work.
Ali Syed: It is important to communicate with consultants. We will get more in co-operation than by acting alone. The CHCs should be improved, not abolished.
Joan Penrose: The GLA has set up a London Health Commission chaired by Trevor Philips, which is currently looking into models to replace the CHCs in London. This will help us who live in the London area.
Aneez: We should spread these models around. At the moment the NHS is too hierarchical and secretive, so it is good suggestion to engage more with NHS staff. We need to start democracy inside the NHS.
Fiona Campbell: The DHN has sent out a survey to all local authorities asking them how they will use the health scrutiny function. Some innovative proposals are coming back, including using CHC members in a new way. The DHN is happy to share this information.
Maureen Smith: Social services now have to draw up service needs assessment for each user in conjunction with the user, then produce a care plan with outcomes, identifying who will be involved in delivering it. This is a good collaborative model.
Malcolm Cooper: Re openness in the health service, our local staff have been told not to speak to the media.
Guy: This happens everywhere, as an attempt to put the frighteners on staff, but management has absolutely no authority to impose any penalty.
Martin: There has been a lot on CHCs today. There is still an issue around lay members, NEDs, etc. They are told they are there to represent the Secretary of State. This needs addressing. They should have some notion of accountability to their local community, otherwise they might as well just be paid civil servants.
Julia Knight: As a lay PCG member, she was told by the Health Authority that the role of the PCG is to carry out government policy, not to be a campaigning organisation. She has had training in corporate responsibility and cannot match this with the lay member job description and the statement that she is there to represent the interests of local people.
Angela Young: It is possible to do a course in public involvement at the Public Health Resource Centre at Oxford University, to NVQ standard. There is a need to learn and understand the importance of talking and listening to the people lay members are supposed to speaking up for. This training could be rolled out to all local universities.
TONY JEWELL SUMMARY:
Questions to ask of lay members, NEDs:
* who agreed you?
* who do you represent?
* what do they ask of you?
* how much do they pay you?
* how do we get rid of you?
"Questions for quangocrats" devised by Tony Benn.
Donna: the abolition of CHCs was a sudden idea to meet an immediate need. There is now a struggle to put it into practice. "Dangerous watchdogs" like the farce of the Dangerous Dogs Act. It was policy on the hoof, a bright idea at 2.00 a.m. Why should customers have to shop around for their rights?
Rita: Importance of strategic planning and partnership. Linking performance review to scrutiny.
Linda: Will CHI make a difference this time? We had similar institutions in 1961, in 1963, with investigations into hospitals. CHI is a carrot and stick development, and the jury is currently out.
Reports from the four groups
Local democratic accountability
There are unresolved issues, with no easy answers. There is a need for clear structural processes. Do local authorities have the skills for the scrutiny role? How do you empower local communities?
Participation: patients or citizens? Consultation - active or passive?
If CHCs are to be replaced, the core principles underlying the replacement services must have:
independence, integration, accessibility, transparency, and proper resources.
Delivering an effective NHS
We must recognise the complexities with the different professional groups that we cannot control and direct. There is a need to value staff, to look for success in health outcomes, and to involve all staff, from primary to acute to tertiary care and build a culture of openness
Two sorts of accountability - health authorities, trusts and local authorities
* We need a context of co-operation
* There should not be a HImP and a Community Care plan - they should be integrated into one plan
* We must listen to people
* Communities need to have the ability and processes in which to stress their needs
* We must go out to engage excluded communities
* Should scrutiny committees be televised?
Circulate bullet points within a longer report of today's conference.
The three organisations must consider:
* in the short term, the need to respond to CHC abolition and the need for the gap to be properly filled
* in the longer term, the complexity of defining what democracy is, what health and social care is, and what structures and processes are needed to deliver democracy to health and social care.
Workshop1 Participation
Workshop 2 Local democratic accountability
Workshop 3 Two sorts of accountability
Workshop 4 Delivering an effective service