Professor Jonathan Tritter
Chief Executive
NHS Centre for Involvement
Public Involvement in the NHS: Is LINks the way Forward
Friend’s Meeting House, Coventry 25 June 2007
The evolution of Involvement in UK Health Policy
Thinking about Involvement
Introducing the NHS Centre for Involvement
How are we organised and what do we do
The Future of Patient and Public in England
PPI in Commissioning
Local Involvement Networks
Long history:
1974 - Establishment of Community Health Councils
1992 - Citizen’ Charter Initiative
1999 - Patient and Public Involvement in the New NHS
2001 - The Health and Social Care Act 2001
2002 - NHS Reform and Health Care Professionals Act 2002
2006 - The Local Government and Public Involvement in Health Bill
Does User = Patient, Carer, Consumer, Customer or Citizen?
For the UK Government
User Involvement = Patient and Public Involvement
“This is a package of radical reform. It will enhance and encourage the involvement of citizens in redesigning the health service from the patient’s point of view.” (Department of Health, 2000: 95)
Relevance
Different kinds of questions
Focus on process and experience not just outcomes
Participation
Support, Co-production and Compliance
Impact
Efficiency and effectiveness of care
More acceptable patient pathway
User participation in decisions about treatment and care
User involvement in service development
Planning and design of services
Commissioning
User evaluation of service provision
Public Accountability rather than Patient Satisfaction
Regulation
User involvement in teaching
User involvement in research
At all stages of the research cycle
Marketisation
Individualisation rather than collectivisation
Customer surveys not involvement
Private sector
Cream skimming
Undermining risk pooling
Tokenism
Capture by medical elite
Capture by managerial elite
Capture by local political elite
Apathy or unwillingness to be ‘involved’
Tensions between ‘choice’ and ‘involvement’
PPI accepted practice
Lack of clarity about how to do it
about who to involve
Direct and Indirect involvement
Direct: people playing a part in making decisions
Indirect: people as source of experience, ideas and information
Need to focus on Impact
Making a difference
Evidence that PPI has had an influence on practice
Response to an European-wide Tender
Successful Consortium
University of Warwick
LMTA - an alliance for health
Centre for Public Scrutiny
The Centre announced on 24 May 2006
The Health Minister Rosie Winterton
Start of set-up phase from 1 June 2006
Formal launch 28 November 2006
Funded for three years in the first instance
What the Centre does:
Supporting NHS staff and organisations across England to engage with patients and the public more effectively and implement change based on their information
Working with NHS organisations and staff to integrate user involvement systems
into everyday working
Fulfilling obligations under Section 11 Health and Social Care Act 2001
(and its successor)
Working with the Healthcare Commission
The Regulator on how to inspect compliance
Organising our Work:
Research and Best Practice
Gathering and generating evidence
Methodological development
Organisational Development
Working with NHS Organisations to build PPI Systems
Meeting Core Standard 17
Learning and Support
Identifying and responding to needs
Curriculum development
Identification and accreditation of providers
The People Bank
Patient-Citizen Exchange & PPI Professionals Exchange
Local Involvement Networks (LINks)
Voluntary and Community organisations
Health and Social Care
Patient and public involvement in commissioning
Practice Based Commissioning
Increased commissioning from non-NHS providers
Increased Patient Choice
Local Involvement Networks (LINks)
Promoting and supporting the involvement of people in the commissioning, provision
and scrutiny of local care services
Obtaining the views of people about their needs for, and their experiences of
local care services
Making the views known through reports and recommendations about how local care
services might be improved
(Part 11 Section 153 subsection 2)
2nd Reading in House of Lords
In to committee 21 June
DH response to Parliamentary Health Select Committee Inquiry in to PPI 11 June 2007
Expected Royal Assent October 2007
LINks Operational from 1 April 2008
Host organisations commissioned for three years from 1 April 2008
LINks will assist NHS provider organisations to engage with the local community to improve services
LINks will set their own agenda and focus on issues of concern to local people and seek to influence change
LINks will be integral in commissioning decisions to ensure they reflect the views of local people
National Voices
National LINks
Established in all Local Authority who commission social services
153 across England
LINks will be supported by a Host organisation
Contracted by Local Authority
Commission/deliver tailored programme of learning and support
New money from DH (circa £100k/year)
Formula based
Pooling resources with LA involvement activities on social services
Accounting to the local community
To the regulator(s)
To local providers
To local commissioners
Accounting for the views of local people
Priorities for local services
Evaluation of local services
Responsiveness by local services
PPI at all points in the commissioning cycle
Plan
Contract
Monitor
Revise
Commissioning along Patient Pathways
PPI in Practice Based Commissioning
Opportunities
Problems
9 Pilot and Early Adopter Sites across the country
Capturing the Learning
Ongoing dissemination through NCI website
Initial report of learning early July 2007
Working with:
the Healthcare Commission,
the Commission for Patient and Public Involvement in Health
Department of Health (and others)
Governance arrangements to balance stakeholders
Wariness and mistrust of Local Authorities
Establishing set of ‘ground rules’ for behaviour and the consequences of inappropriate
behaviour
Geography is important
Community profiling and mapping the voluntary sector central to effective set
up
LINks annual reports should be analysed to identify regional and national issues
Feedback to individual LINks
Need for clarity and control of payments to individual LINks members
Little attention to collaboration between LINks
Particular concern for Ambulance Services
Little attention to defining success criteria or measurement of impact
Procurement of a Host
Some work on pooling resources for Host to cover three LINks areas
Limited work on how a LINk identifies an issue and engages with the topic
“One of the key roles of civil society organizations is to hold health care providers as well as governments accountable for what they do and how they do it….yet without mechanisms enabling people to hold officials accountable, stewardship may falter. To enable effective pressure for accountability, accurate information about health and health systems performance is required throughout civil society.” (WHO, 2003: 126)
The NHS Centre for Involvement
Modelling and facilitating transformation
Building capacity
Supporting a sustainable approach to change
Contact us at: nhscentreforinvolvement@warwick.ac.uk
last updated 23/07/08