Patient and Public Engagement

MAC share their views on Andrew Lansley’s Health White Paper…

Liberating the NHS the new Health White Paper on “equity and excellence” could turn out to be, in Chris Ham’s prophetic words today, the “biggest organisational upheaval in the health service, probably, since its inception”.  This is about England only of course: the contrast with the other three countries in these islands will now be even starker.

Shaping the new order

Speaking in the Commons this afternoon as the document was published, Secretary of State for Health Andrew Lansley said his objectives were putting patients right at the heart of their care, putting clinicians at the heart of decisions about services and achieving health outcomes comparable of our neighbours.

We are to have an outcomes framework identifying what the health service should achieve and it will be up to the professionals (in collaboration with the public and patients if Lansley is serious about “no decision about me without me”) to say how it should be achieved in each part of the country.

Some of the other highlights of the new order include:

• A payments system that acts as a driver for quality, safety and integrated care not just a reward for activity (very welcome)
• Decision making as close to patients a possible, including patients with long term conditions having budgets (we hope for health AND social care combined) to make real choices about their care.
• Real, local accountability: Local Authorities will agree local strategies to integrate NHS, public health and social care together.  (fine, assuming councillors rise to the challenge and there isn’t likely to be extra money for cash-strapped authorities)
• Consortia will commission NHS services in line with the local health plan agreed with the local Council; this is how GPs will lead bottom up redesign of services:“GPs are senior professionals in public service and paid well for that.” No opting out.
• Patient choice over treatment options, including the consultant-led team that treats them, based on a torrent of information to guide informed choices
• Choice of GP practice and  power to control our own patient records. (no practice boundaries)
• Patient voices will be heard and acted upon by Healthwatch as a national body working through local healthwatch incorporating the current LINks (across health and social care which is essential)
• An English NHS “liberated from command and control”, including all NHS Trusts to be Foundation Trusts with power in the hands of their employees and users: “Our ambition is to create the largest and most vibrant social enterprise sector in the world.” (could help with getting assets off the government’s balance sheet and sort the pensions issue too)
• Any willing provider in the health care marketplace, provided they deliver to NHS standards and prices
• A more powerful Monitor as economic regulator and CQC as the guardian of safety and quality standards
• The NHS Commissioning Board holding the national GP contract, managing performance, allocating resources to commissioning consortia and leading specialised commissioning (big job all of that, any applicants on the horizon?)

Liberation is a double edged sword

MAC’s initial reaction to all of this – our deeper thoughts are for later –  is that what Mr Lansley is proposing  - and the devil will be in the detail of the coming consultations and the autumn Health Bill – could certainly be “liberating” both in an innovative but also in a chaotic sense (think Pandora’s box)  - and probably at the same time.  The phrase “constructive discomfort” comes to mind.

But there’s a catch. The NHS in England must save recurrently some £20bn by 2014 - “every penny saved will be a penny reinvested for the benefit of patient care” Mr Lansley said. That takes many steady eyes and hands on the job and some well placed voices are wondering if now is the right time to pursue wholesale root and branch change which will be very distracting in our largest and most expensive public service? Managers fashioning lifeboats for themselves may have concerns other than achieving efficiency savings.

Cromwellian thoroughness and speed

The reforms to commissioning and accountability aim to be Cromwellian in thoroughness and speed.  Andrew Lansley seems to be taking Tony Blair’s approach further and faster than anyone thought possible, but the difference is there seems to be a map this time.  Our modern day “major generals” (aka Strategic Health Authorities)  are being marched off to the Tower awaiting termination  - or as Mr Lansley termed it “disempowerment of bureaucracies” – by 2012, to be followed by PCTs by April 2013.

As we move towards then, will the crowd be shouting “behold the heads of tyrants” as we breath the free and pure air of GP commissioning, or will we just be too distracted to care?  And will there be anyone left in PCT land by then to turn off the lights, cancel the milk and put the cat out?

2 Comments

Filed under Foundation Trusts, Local Involvement Network, Management & Innovation, NHS, News posts, Public Involvement, Social Care, commissioning, social enterprise
Tags:

Comments

2 Responses to “Liberation root and branch style”

Caroline Millar says: July 13, 2010 at 10:19 amI have real concerns about GP commissioning not relieved in any way by watching the debate on Newsnight yesterday where the panel of around ten people contained no-one who represented the patient voice – although of course several GPs who were utterly convinced that they knew better than anyone what patients needed and wanted. We have to stop this persistent conflation of what GPs think is good for their patients with what patients themselves want. They are not necessarily the same thing. How do GPs know what patients want/think/experience? How many GP practices have patient groups – and where they exist do they make a difference? Every time you ask patients what they want they come back with the same issues. Two of the biggest issues are evening opening and rude receptionists yet somehow nothing ever seems to get done about these particular wants. So with the GPs in charge will patients necessarily be better off than they are now? It certainly is by no means a foregone conclusion!Peter Westland says: July 13, 2010 at 2:25 pmwell it is early days but it would be nice to know whether they mean “commissioning” or “procurement” and at what level in this “new” two tier arrangement the “commissioning” will be done….ie the analysis, horizon scanning, planning services for the future3. This will no doubt be placed with the “top” brainbox end of a consortium…with people imported from PCT’s and SHA’s OR that lot will be abandoned in favour of intellectuals from the USA or even Price Waterhouse. Whatever…it will look a bit like a PCT except it will not have the usual governance by retired captains of industry, accountants and estate agents….or will it. Also I can’t make out how the accountability will work. And Finally …Public Health to Local Authorities….some of us have argued for this for 20 years…but how will this now relate to the new NHS. Plenty of work for you Andrew and colleagues….

As the election looms, uncertainty prevails. What lies in store for LINks after the election?  

The conservatives have put together their 5 priorities for Patient and Public Involvement which outlines their aim to keep LINks and give them more power and autonomy.

• Tougher inspection to root out failure
• A strong voice for patients
• Power for patients to hold failing hospitals accountable
• An end to box-ticking and targets
• Exposing hospitals to public scrutiny

Click here to read the ConservativesPatient_safety_plan[1] and their  Health Watch Proposal

Secretary of State Andy Burnham has this week announced the start of a nationwide consultation about abolishing GP practice boundaries/catchment areas.

GP SURGERIES CONSULTATION

Here is an excerpt from the press release, which also quotes local GP Dr Seth Rankin:

Patients will have the chance to choose the best GP practice for them under new plans in a consultation published today by Health Secretary Andy Burnham.

At present, GPs operate within fixed geographical boundaries that can be restrictive and severely reduce patients’ choice of the practice they register with, especially for those patients living in poorer areas. 

The majority of patients are happy with their current GP practice but a significant minority would like to change their GP.

For many patients it is important to be registered with a local GP so their GP can visit them at home and help co-ordinate care with local health professionals. Others want to register with a practice closer to where they work, or one closer to home, open longer or offers more services. Other patients have said they’d like to be able to stay registered with their current practice when they move house.

The consultation is seeking views on a wide range of proposals, in particular around the issues involved in arranging home visits, co-ordination of community based services, safeguarding access for local residents, and access to hospital and specialist treatment.

This is a very important development with a number of issues attached to it about patient choice, continuity of care and how primary care practices are funded.  

You can read the full story here www.dh.gov.uk/en/News/Recentstories/DH_113502 and also access the consultation at the foot of the page.  

The assumption is that the changes will be implemented from October 2010.

What do you think about these proposals? LINk is trying to gather the thoughts and opinions of local Wandsworth Residents which they will then feed into the consultation. Please get in touch with us or write your comments at the bottom of this page.

Wandsworth Borough Council & DisabledGo invite you to join them at the Steering Group Meeting

on Tuesday 9th March,   2.30- 3.30 p.m at Wandsworth Town Hall, Wandsworth High Street

Wandsworth, SW18 2PU.

About DisabledGo

DisabledGo has been working in partnership with the Wandsworth Borough Council since 2004 to produce an online access guide to Wandsworth

So that the DisabledGo-Wandsworth guide develops in the way that local people want it to, we invite you to the steering group to give us feedback on the following:

- New venues that you would like to see added

- The new DisabledGo website

- Online steering groups

RSVP INFORMATION

Please RSVP using the attached reply slip as soon as possible with any specific requirements you may have to:

Tom Felton, DisabledGo, Ardent House, Gates Way, Stevenage, SG1 3HG.

    E: tom.felton@disabledgo.com 

    Tel: 01438 842710 

     Fax: 01438 842717

If you know of anyone who may be interested in hearing more about the service we provide, or would like to attend the meeting please do not hesitate in forwarding this information on

LINks Exchange Newsletter Issue 17

There are three main topics in the latest issue

Campaign

The Department of Health has launched a campaign to ‘promote the meaning and merits of LINks – among the whole community and among health and social care care professionals. with the ultimate aim of encouraging engagement and participation in your LINk’ The Department is using a social PR company – Forster – who will be coming out to LINks to work with them on this.

Last change to have your say on Quality Accounts

In High Quality Care for All, Lord Darzi said publishing quality performance would help patients and their carers make better informed choices about health care and allow clinical teams to benchmark, compare and improve their performance.

High Quality Care for All proposed that all providers of NHS care should produce Quality Accounts to provide the public with information on the quality of care they provide. The Department of Health has introduced legislation to require the publication of Quality Accounts from April 2010. Designing the format and content of Quality Accounts, is being facilitated by the DH, and steered by stakeholders, including the regulators, NHS management, clinicians, professional organisations, patient groups and the public.

The lessons learnt in a pilot from producing Quality Reports , alongside those from the Quality Accounts engagement process, are being used to develop the detailed guidance that the Department of Health aims to publish in early 2010, following a consultation on the proposed content of Quality Accounts over the autumn 2009. This process will also inform the Care Quality Commission and Monitor in their approach to developing the regulatory system for healthcare.

In September the Department of Health launched a consultation which you can find here.

The consultation closes on Thursday 10th December.

Indemnity Update

A number of LINks have asked about this topic and whether LINks are covered by a indemnity policy set up by the Secretary of State. Some LINks have concerns that an authorised representative making a report following a visit might be reluctant to make a candid and honest report in case the business owner makes a claim for defamation against them personally.

The answer is no – it is up to the local authority – Wandsworth in our case. If you feel that you might need such a policy, you can see the advice on the LINks Exchange website and take it up with the LINks office.

NHS Wandsworth is currently reviewing Adult Community Nursing Services, including District Nursing, Community Matrons and Specialist Nursing Services (Diabetes Nurses, Heart Failure Nurses, Leg Ulcer Nurses, and Respiratory Nurses)

If you have received any of these services or are a carer of someone who has received these services, NHS Wandsworth would like to hear from you!

Please take the time to complete this short questionnaire and return it to NHS Wandsworth (not the LINk office).

• View the Service User Survey, July 2009 (opens in Microsoft Word, 127Kb)
  (Either click the link above, or right click and select ‘Save As’ to save it on your computer)
• or view the survey in PDF format

Please return completed surveys by Friday 28th August to:

Suzanne Lawler
Long Term Conditions Commissioning Manager

By email: suzanne.lawler@wpct.nhs.uk
By post:

Wandsworth PCT HQ
3rd Floor, Wimbledon Bridge House
Hartfield Road
London
SW19 3RU

Queen Mary’s Hospital in Roehampton are looking for a volunteer to take part in their regular inspections.

Join PEAG and do PEATs

These inspections are called Patient Environment Action Team (PEAT) inspections and assess a range of factors including standards of maintenance, décor, furnishings and cleanliness to help bring about improvements to the patient environment.

Queen Mary’s carries out 3 “mini-PEAT” inspections and one PEAT inspection every year through a group called the Patient Environment Action Group (PEAG). The PEAG meets every 3 months, and volunteers will be expected to take part in each meeting and inspection (i.e. 8 sessions per year).

The hospital is looking for volunteers who have a keen interest in the patient environment and experience, and are able to report back to the LINk (verbally and in writing). They will cover all expenses that you incur when taking part in this role and can provide additional support in the form of basic training (giving background on PEAT inspections).

The deadline for submission is the 4th August, applicants to supply a short personal statement (no more than 200 words).

Please note if there is an insufficient response, they will defer an appointment until October so there will be another chance to get involved.

If you are interested in this opportunity please contact Tom Magill on 0208 812 7642 or Tom.Magill@wpct.nhs.uk.

Some totally timely topics in the latest issue of the report from the PEC/ NHS Wandsworth Management Team meeting (link opens in PDF). This is personal feedback from Andrew Craig in his role as the Lay Member  on the PEC.

Cancer Prevention and Early Detection Plan

Local data shows a clear link between deprivation and cancer mortality with the more deprived Wandsworth wards (Latchmere, Queenstown, Northcote) having higher rates than the rest of London. The action plan covers

• Smoking cessation
• Obesity control
• Increasing physical activity
• Alcohol reduction
• Cancer screening
• Raising awareness
• Sun protection and early detection of skin cancer
• HPV vaccination

More work is needed with users of cancer services and those who were identified as being at risk. To be successful, these programmes, Andrew argues, must be engaged with users – for example finding out what young people in particular know and understand about skin cancer risks.

Swine Flu and the provision of antiviral drugs in Wandsworth

Swine flu seems to have well and truly arrived in Wandsworth and the PEC queried why drugs like Tamiflu could not be obtained from ordinary chemists rather than two designated health centres and one chemist in Tooting? If things get worse, the PEC wants to see these drugs available in all pharmacies in normal hours as well as a convenient out of hours service.

Money

NHS Wandsworth (NHSW) has a surplus at the moment of £6.3million. This gives NSHW some financial headroom to plan for the future. But government rules mean that any surplus has to be spent and not used to help out in a future with less money. So a deficit looks likely after 2011/12 and people will have to use the money they do get more efficiently. The NHSW board is discussing the future strategy needed to cope at their meeting on 29th July.

Other Business

The committee considered a report on user and patient engagement in the groupings of GP practices known as clusters where the situation is very mixed. A reminder was needed that involving patients was not an end in itself – there needed to be a purpose and some results.

NICE Work on Lower Back Pain

NICE is the body that issues advice on how best to treat people and a recent May publication gave guidance on lower back pain. The PCT has to act on such guidance and provide the services that do seem to work and decommission those that do not. The clinical effectiveness group will look at the NICE guidance and advise the PCT on what it needs to do.

For a copy of the full report of the meeting, go to the NHS Wandsworth website featuring Board Reports. All the PEC Lay Member reports can be found on the Resources menu under Health & Social Care.

In this edition of their newsletter, the CQC announces the publication of its Voices Into Action manifesto – their commitment to giving people a bigger say in how health and social care services can be improved. They consulted widely when putting it together and have given good feedback (in line with one of their Voices in Action commitments) on the action they took. telling us for example that the title of the document was changed as a result of feedback at events. The section on governance was clarified and decisions made about which advisory groups the CQC was going to have initially.

The full report of the consultation is available via their news release.

Looking for independent committee members

The Commission is looking for independent members to serve on its Audit and Risk Committee and you can see how to apply here.

You can sign up for the CQC newsletter online.

The full summer newsletter is now available to read here (opens in Adobe PDF).

News in Brief

Jeremy Ambache sets out the four Wandsworth LINk priorities selected out of the 29 suggestions received. Jeremy writes “It was not an easy decision for the Executive. The debate we had at the open meeting was heated and vigorous- but that is good as we had difficult choices to make.”

The four priorities are:

1. Transforming Adult Social Care
2. Health Consultations
3. User and Carer Engagement
4. Hospital Discharge and After Care.

The newsletter also updates you on the consultations on Polyclinics, news about the Springfield Developments and the response made to Adult Services Department of Wandsworth Council on their Service User and Carer Engagement Strategy. A new opportunity to participate has come with an invitation for the LINk to send a representative to the steering group for widening access to psychological therapies.