Issue 88
A free publication for Doctors and Patients
Learning to listen, listening to learn:
Public and patient involvement in health Report by Dr. Tom Fitzgerald In April, 150 Local Involvement Networks (LINks) will go “live”. The LINKs are a new opportunity for local people to engage with local health services. Public and Patient Involvement (PPI) has been a major theme in contemporary UK health policy. Mechanisms for PPI include: the Commission for PPI in Health (CHIPPIH), PPI Forums (PPIFs) for each NHS trust, Local Authority Oversight and Scrutiny Committees (OSCs) PPIFs were introduced to replace Community Health Councils (CHCs). The CHCs scrutinised all health services provided in local communities; in their later years, CHCs became politicised and unfit for purpose. PPIFs were established to act as “a critical friend” to their partner NHS trusts.
that best serves their needs. Time and effort was required to overcome mutual suspicion and cynicism between trusts and PPIFs. More progressive trusts recognise their forum as a useful resource. PPIFs have their limitations. NHS trusts must work with their PPIF to fulfil their statutory responsibility to listen to the views of local people. However, trusts are not obliged to make changes to their services or strategy on the basis of that dialogue. The Local Government and Public Involvement in Health Bill 2006-07 proposes radical changes in existing PPI mechanisms, including abolition of the CHPPIH and PPIFs, replacing them with new Local Involvement Networks (LINks), for every local authority area with social services responsibilities The proposals describe strengthening
PPIFs monitor standards in trusts, seek the views of local people and consider the wider impact of changes to the provision of services. Increasingly, NHS trusts adopt a marketing perspective, seeking to put patients at the heart of everything they do. PPIFs provide NHS organisations with robust feedback on service provision and plans for reconfiguration.
local accountability, whilst streamlining participation. Many patient and community groups are concerned they will be marginalised when LINKs are introduced. Local authority OSCs and LINKs will have relationships with large numbers of acute and mental health trusts, as well as a range of alternative providers. In London, co-terminosity between PCTs and local authorities ensures integrated co-ordination between primary health and social care. Elsewhere, NHS trust catchment areas may overlap the boundaries of several local authorities. LINKs are likely to focus on community-based services. To provide truly patient-centred services, acute trusts need a strong independent body representing the views of patients and local people. LINKs will ensure that NHS organisations meet the needs of local people. On occasions, trusts corporate interests may conflict with those of local communities. In competitive local health economies, trusts have to compete for market share. This will make acute trusts more customerfocused. LINks represent an exciting opportunity for local people to get involved in shaping the sort of health services that they need and want.
This constructive criticism may help trusts improve and provide services local people want, delivered in a way
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