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Don Redding: National voices


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Don Redding: National voices

  1. 1. National VoicesLay influence on commissioning Don Redding, Director of Policy Nuffield Trust seminar 4th May 2011
  2. 2. In this presentation• Historical context• Performance of PCTs• Where do GPs come in?• Charities’ perspective on the Bill
  3. 3. Sourceso Patient and public involvement in PCT commissioning, Picker Institute Europe, 2007o Patient and public engagement - the early impact of World Class Commissioning, Picker Institute Europe, 2009o The quality of patient engagement and involvement in primary care, Picker Institute Europe/King’s Fund, 2010o Evidence to the Commons Public Bill Committee on the Health and Social Care Bill 2010, National Voices, 2010
  4. 4. Historical context• Before 2006, ‘involvement’ focused mainly on providers – legal duty to consult + PPI Forums• Separation of commissioning and provision• LINKs – from 2007/08 – local h&sc ‘economy’• PCTs & World Class Commissioning, 2007• ‘Real Involvement’, DH, 2008
  5. 5. PCTs before WCC• PPI a well established practice, but with limited budgets and expertise• Limited techniques – surveys and consultation• Consultation did not = influence• Challenges: understanding local community and patient experience; reaching ‘seldom heard’; skills/training
  6. 6. Consultation vs influence
  7. 7. The leadership thing (2007)PCTs: “Still aiming to ensure that NHS staff at executive level really understand PPI and most importantly support PPI and not just using words to make them sound as though PPI is important to them. Old cliché, but words are cheap.”National Audit Office: “PCTs have structures and processes for patient and public involvement in place, but patient and public involvement is one of the least well developed components of clinical governance... patients’ expectations have been raised and as yet PCTs are unable to meet these expectations.”
  8. 8. World Class Commissioning3 relevant competencies:  Locally lead the NHS  Work with community leaders  Engage with public and patients -- ‘proactive, meaningful and continuous’‘Real Involvement’: S242 means NHS organisations should aim “to develop relationships over a period of time with continuity on both a personal and organisation level... It is important to be proactive and comprehensive”
  9. 9. PCTs: impact of WCC• New leadership – chief exec/board level• Culture change: PPE a ‘must do’, ‘everybody’s business’• Increased budgets and staffing• Patchy evidence of new strategies and techniques – better targeted, more participatory• But public still not ‘influential’ on commissioning or PPI strategies
  10. 10. Influence on PPE strategy, 09
  11. 11. Where do GPs come in?• GP practices not ‘NHS organisations’ – outside scope of S242 and currently outside scope of CQC provider regulations• No statutes, guidance or performance framework for PPE in primary care• PCTs carried the duty to engagePicker: “Established involvement techniques used at general practice level have often sought patients’ feedback on one-off issues, rather than their influential involvement.” (2010)
  12. 12. Engagement in primary care• Mixed leadership – fitful DH interest, BMA lack of interest, RCGP more committed• Patient Participation Groups – 40% of practices – ‘friends’ rather than ‘critical friends’ -- fundraising, service extension• PBCs – no strong evidence; but DH survey shows some increasing interest• Enlightened GPs, eg with community development approachesKing’s Fund: “General practice needs to strike a new deal with patients, in which patients are active participants in decisions about their care and the services they receive.” (2011)
  13. 13. Charities’ perspective on the BillWelcome --• attempt to carry through White Paper agenda, ‘Putting Patients First’• clear separation of ‘patient’ and ‘public’ involvement• involvement duties on NHS-CB and consortia• continuation of LINKs into HealthWatch, and HealthWatch England
  14. 14. Charities’ perspective on the Bill The influence question – will lay people really influence commissioning?• LINKs and scrutiny bodies can monitor, scrutinise and comment• Health and Well Being Boards can monitor and comment• Consortia can consult and survey• Commissioning plans must be publishedBut• No involvement of public in governing consortia• Not clear how to ensure NHS-CB capability
  15. 15. Charities propose...• Statutory definition of what ‘public involvement’ means• Advisory committee to NHS-CB• More lay involvement in HWBs• LINKs elect members of HealthWatch England• Protect LINKs independence and funding• Protect independence of HWE and scrutiny committees
  16. 16. Charities propose...• Commissioning consortia should have Boards of governance (cf select committee)• Boards should have substantial lay membership drawn from practice population – preferably 50%• Role of lay members: to safeguard the public interest in the use of public resources• Requirement on both NHS-CB and consortia to involve relevant patients/service users and organisations in service redesign (the ‘advice’ duty revised)
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