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Participatory Budgeting and the Big Society. Patient and public involvement post PCTs. Professor Jonathan Tritter Tuesday 9th November 2010 Westminster. What am I going to talk about?. What is involvement? Thinking about types of Patient and Public Involvement

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Patient and public involvement post PCTs

  • Professor Jonathan Tritter

  • Tuesday 9th November 2010 Westminster


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What am I going to talk about?

  • What is involvement?

  • Thinking about types of Patient and Public Involvement

  • Ruminating on the ‘Big Society’?

  • The transformation of PPI – the birth of HealthWatch

  • The fall of PCTs and rise of GP consortia– a new approach to commissioning

  • Reflections


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What is Involvement?

Ways in which residents can draw on their experience and members of the public can apply their priorities to the evaluation, development and organisation of health and social services

  • Patients as individuals

  • Community organisations and carers on behalf of others

  • Members of communities, localities and the public


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A Patient and Public Involvement Typology

  • Involvement in decisions about treatment and care

  • Involvement in service development

    • Planning, Prioritising and Commissioning services

  • Involvement in the evaluation of service provision

    • Regulation and public accountability not patient satisfaction

  • Involvement in teaching

  • Involvement in research

    • At all stages of the research cycle


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Where should PPI input be made?

  • Individual choice

    • Partnership in decision-making

    • Shared responsibility for health

  • PPI on Appointment panels

    • Driving cultural change

    • Challenging assumptions

  • Input to strategic decision making

    • Membership on Boards

    • Not just advisory or information sources


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What is the ‘Big Society’?

  • Changing the role of the voluntary sector?

    • Encouragement to take on a greater role in delivery of public sector services

      “To make these reforms work, we need to give new and existing social enterprises, charities and voluntary groups the long-term incentives they need to develop and deliver innovative and high quality public services.” (Conservative Party March 2010: 1)

    • Shifting responsibility and funding from the state

    • Providing ‘market access’ for the private sector?

      “So government has a crucial role to play in bridging the gap – and indeed, more widely, in connecting private capital to investment in social projects.” (David Cameron, 19 July 2010)


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What is the ‘Big Society’

  • What about inequality?

    • Do people have time to be involved?

    • Is involvement equally distributed?

    • Retreat of the state will hit some more than others:

      “people who have least will benefit least from the transfer of power and responsibility, while those with higher stocks of social and economic resources will be better placed to seize the new opportunities.”

      “The Big Society idea is strong on empowerment and weak on equality.” (New Economics Foundation 2010:3;5)



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The future of PPI: What is HealthWatch?

  • Proposed rebranding of LINks as HealthWatch

    • “Local Involvement Networks (LINks) will become the local HealthWatch... “ (DH 2010:19)

    • Is it just a new name or is it a different role?

    • Will people know what HealthWatch is?

  • Already there is confusion over the spelling

    • HealthWatch, Healthwatch and Health Watch are all found on different NHS websites

  • There is even an existing charity called HealthWatch

    • Registered Charity (No 1003392) since 1991, promoting Evidence Based Medicine (http://www.healthwatch-uk.org)


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What is HealthWatch?

A local voice?

  • “Local Involvement Networks (LINks) will become the local HealthWatch, creating a strong local infrastructure, and we will enhance the role of local authorities in promoting choice and complaints advocacy, through the HealthWatch arrangements they commission. “ (Ibid.)

    A national voice?

  • “We will strengthen the collective voice of patients and the public through arrangements led by local authorities, and at national level, through a powerful new consumer champion, HealthWatch England, located in the Care Quality Commission.”

    (DH 2010:19)


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What about involvement in commissioning?

Local Government and Public Involvement in Health Act (2007)

  • Most radical aspect was not creating LINKs but a statutory responsibility on PCTs to ensure involvement in commissioning

    “promoting, and supporting, the involvement of people in the commissioning, provision and scrutiny of local care services;

    (b) enabling people to monitor … and to review … the commissioning and provision of local care services;

    (c) obtaining the views of people about their needs for, and their experiences of, local care services; and

    (d) making views …known, and reports and recommendations about how local care services could or ought to be improved,

    to persons responsible for commissioning, providing, managing or scrutinising local care services.” (Part 14 Section 221 subsection 2)


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What about involvement in commissioning?

  • Planned dissolution of Health Overview and Scrutiny Committees and Primary Care Trusts

  • Instead, local authorities

    “will take on the function of joining up the commissioning of local NHS services, social care and health improvement “ (DH 2010:30)

    And

    • “Local HealthWatch representatives will also play a formal role to ensure that feedback from patients and service users is reflected in commissioning plans. “ (Ibid)

    • But how will this work in relation to GP consortia?

    • Who actually will have the power to commission (and contract)?


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What about involvement in commissioning?

“GP consortia will have a duty of public and patient involvement, and will need to engage patients and the public in their neighbourhoods in the commissioning process. Through its local infrastructure, HealthWatch will provide evidence about local communities and their needs and aspirations.” (DH 2010:29-30)

  • But the track record of GPs on PPI is abysmal and has reinforced health and social inequalities (NAPP, 2007)

    • 25% of surveyed GP practices had a Patient Participation Group

    • Smaller practices and areas of high need and deprivation were less likely to have Patient Participation Groups

    • GPs claim knowledge about what patients want because they see patients every day

    • But which patients do they see and which do they not see`


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What is HealthWatch for?

Replacing LINks but retaining a local voice?

  • “Local authorities will be able to commission local HealthWatch or HealthWatch England to provide advocacy and support, helping people access and make choices about services, and supporting individuals who want to make a complaint. In particular, they will support people who lack the means or capacity to make choices; “ (DH 2010: 19)

  • Is this involvement?

  • Or is it the promotion of consumerism and transforming patients from members of a community into individual healthcare shoppers?


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Reflections

  • Redefining the role of the State

  • Redefining the role of citizens

    • What about accountability?

    • What about sustainability?

    • What about inequalities?

    • What are the implications of increased individual choice on a system premised on rationing?

      Action by businesses or third sector organisations can supplement but not replace functions of the state, not least because they usually serve specialised interests, rather than the nation as a whole.


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