Update 04-3.03.2012
Government confirms the Health Bill will privatise patient representation. Lord Toby Harris.
HealthWatch; is it being set up to fail? National Voices
On radio 4 this morning the inimitable Simon Burns, Andrew Lansley’s right hand man, said that the coalition’s health bill would “slash bureaucracy, put doctors in charge and give patients more power”.
Just as I have never met a doctor who thinks they will be in charge, nor a manager who thinks there will be less bureaucracy, I am yet to meet a patient who thinks the Bill will give them more power, still less one who can explain how. Part of the problem is that the government has muddled ‘patient choice’ with ‘patient power’. Just because having more power usually gives you more choice it does not follow that more choice is empowering.
I’ve tried to answer this question myself, because I think that patient empowerment is an essential part of good care and I’d like to see if it is possible.
Below is the complex way in which the bill enables this.
At the lowest level patients join their GP practice patient-participation group (PPG) (not all practices have them, but all should)
A representative from the practice PPG joins the Local Involvement Network (LINKs) though you may join LINKs without being on a PPG
LINKS are being abolished by April 2013 and replaced with Local HealthWatch. The problem with LHW is that it is part of the Care Quality Commission (CQC). According to the government’s own Health committee, “the CQC was established without sufficiently clear and realistic definition of its priorities and objectives. The timescales and resource implications of the functions of the CQC were not properly analysed, and the registration process itself was not properly tested and proven before it was rolled out” Health Policy Insight
The Health and Social Care Bill 2011 currently establishes health and wellbeing boards as committees in local authorities. The proposed health and wellbeing board membership includes:
• at least one councillor from the local authority
• the director of adult social services
• the director of children’s services
• the director of public health
• a representative of the local HealthWatch
• a representative of each relevant clinical commissioning group
• other persons or representatives the local authority or health and wellbeing board thinks appropriate.
The director of public health will be the principal advisor on health and well-being to elected members and officials in the local authority.
From April 2013, Local Authorities and CCGs, together with local HealthWatch, will be required to prepare the Joint Strategic Needs Assessment through the Health and Wellbeing Board. This will require groups to undertake a comprehensive analysis of the local needs of their population.
So patients can, if they are lucky/ pushy/ talented/ connected or a combination of all these things, get representation on a local authority Health and Wellbeing Board by April 2013.
This doesn’t sound like empowerment to me. And given the state of the CQC and the Bill it might very well not happen.
In the meantime I would like to encourage you all to join your GP practice patient participation group. If there is not one already, ask them to set one up, or even volunteer to set one up for them. Then whatever happens you’ll have a foot in the door.
And do ask your GP a few of these questions while you’re at it:
1. What is your opinion of the Health Bill? Do you support the BMA, the RCGP, the RCN and the Royal College of midwives in their opposition? If not why not?
2. How do you think the Health bill will affect your practice and your patients?
3. The government say that you are going to be in charge of the NHS budget instead of bureaucrats. This sounds good, but what does it really mean?
4. The government say that the health bill will give patients more power. How will it do that?
5. Do you have a patient participation group that I could join?
6. How do patients contribute to the local GP commissioning group?
See also: Big Society Volunteering NHS Vault
Patient & Public Involvement Response by Brian Fisher, GP
The initial design offered absolutely nothing to communities and individuals. Through argument and lobbying, these are now the additional responsibilities and expectations on CCGs. It does not add up to any kind of democratic arrangement, but it does offer opportunities for participatory democracy.
In addition, through a range of mechanisms, the LA has far more say.
CCGs have duties to promote patient involvement in all their functions. This is stronger than the previous obligation which was to “have regard to the need to” promote patient involvement. Clinical commissioning groups will have to involve the public in
- planning all commissioning arrangements,
- developing and considering all proposals for changes in commissioning arrangements
- all decisions affecting the operation of commissioning arrangements.
The previous plans had the same provisions, but they applied only to “significant changes”. They now apply to all changes and arrangements.
CCGs’ commissioning plans will need to be the result of ongoing joint work with Health and Wellbeing Boards. Clinical commissioning groups must involve Health and Wellbeing Boards in preparing or revising their plans and, in particular, to share drafts with the Board and consult it on whether the drafts take proper account of the Joint Health and Wellbeing Strategy.
HWBs can make any objection to the NHS Commissioning Board if they feel that commissioning plans do not match the agreed strategy.
CCGs have duties to promote shared decision-making: patient involvement in decisions about their own individual health and social care.
The governing body must meet in public (except where it would not be in the public interest to do so). Membership of the governing body must include at least two lay members, together with one registered nurse and one doctor with secondary care experience. One lay member must have a responsibility for promoting PPI.
Transparency. There will be increasing expectation to publish health data in the public domain.
Independent scrutiny remains Authorisation requires:
- that CCGs will not only listen but respond to the recommendations of local communities.
- That CCGs do proactive work in their communities, for instance community development
HealthWatch is quite a mess at the moment. It may pull through to become a force for good.
Update 22.2.12
Lansley condemned over Health Watch Guardian
Public involvement blog. Big beast sells out public involvment Involvement sell out gathers pace
DH letter about Local Health Watch Jan 2012
Flagship Health Watch policy to be watered down by amendments HSJ 27.2.12
A Better NHS 
I will email my GP immediately with your suggested questions! Will let you know their response.
How do you get on the PPG? Great arrticle, cut down on bureaucracy !! I even got lost with the acro’s
To join a PPG ask your GP practice if they have one. If not, check the link above to the National Association of Patient Participation groups for advice. Alternatively check LINKs (also above)
I have been contacted by my local PCT a couple of times about the creation of the new CCG – one was looking for “patient champions”, which I volunteered for, the other was for lay members of the authorisation board to oversee the authorisation of the CCG. I recognise that the latter is not board members of the final CCG board, but its reasonable to assume that the CCG board would want someone similar.
I was seriously under-qualified for the authorisation board. And I mean under-qualified. They were looking for people with “evidence of having carried substantial levels of decision making responsibility at senior levels in organisations” and “the successful candidate may have previous corporate links with the public or charitable sector, or personal contribution by their membership of Trusts, social enterprise boards or advisory bodies”.
So “lay” means non-medical. Whether such people could be regarded as being a patient representative is another matter.
Personally, I would make it a requirement of the lay members to show that they were constantly consulting the public, through attending PPGs and local patient support groups. I think the CCG board must have a direct two-way communication channel with patients, and the lay members are best placed to do this. If I become a “patient champion” I may push for this to be as a policy of the CCG.
I am a GP in Tower Hamlets. I am all in favour of patient participation groups. We have a project to set one up. The trouble is that we are so busy with dealing with everyday stuff that there is little time, energy, resources left over for this. But we will keep trying.
Sorry, I only got notified of this post today. Had some personal experience of a pathfinder CCG, who, guided by the PCT have put together a reference group that is becoming increasingly populated by representatives from organisations. You have to be very pushy indeed as an individual patient to get a look in. So much for Domain 2 then.
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Be careful of what you say at your PPG, be very, very careful. Be controversial and out you go on the 8 day rule – from the Practice, not just the PPG.
Our PPG is run by the Practice’s BUSINESS Manager, and GPs have never been – too busy – and that started before CCGs!
We [PPG] tell the Business Mngr, he tells the GPs, but we’re not allowed to see the Minutes of the discussions at that Meeting and don’t get a Report- back either.