A NEW PUBLIC INVOLVEMENT STRUCTURE FOR NHSSCOTLAND
CONTEXT AND CURRENT POSITION
1. The Health White Paper, ' Partnership for Care' 3, requires the public to be involved in discussions about the changing pattern of healthcare services with decisions taken in an open, honest and informed way. This means seeking the public's views from the earliest stages, defining issues clearly, exploring possible options, and examining these in an open way with good evidence. It means using modern methods of communication and involvement to ensure that the widest range of individuals and communities affected by changes are reached. It also requires the NHS to feedback to those consulted and in so doing demonstrate that their views have been listened to, understood and acted upon. In addition, there needs to be strong, independent external scrutiny of local health systems to see that these duties are carried out. Support to assist NHS bodies, individuals and communities take part effectively in public involvement activities is also needed.
2. The health council4 structure and roles now need to be redesigned to support the new emphasis and focus on patient and public involvement in the NHS. This will mark a substantial shift in both its role and structure.
3. The commitment to public and patient involvement means important new duties for NHS Boards and Trusts for which these bodies will be clearly accountable. Rebuilding our NHS5 says:
The new Performance Assessment Framework will place equal weight on the quality of clinical and service delivery, financial management and public involvement. And the performance of the local NHS system will be assessed independently from a patient and public perspective.
Accountability will be open and transparent; involve independent assessment and include evidence-based clinical and service standards applied consistently across the NHS in Scotland .
4. The requirement to involve patients and the public needs to be implemented with flexibility: by definition, involvement must be responsive to the aspirations and concerns expressed by patients and communities locally. Applying rigid or uniform criteria to the way these requirements are implemented is not, therefore, appropriate. A flexible and practical approach is to use the mechanism of outside, independent assessment exercised on behalf of patient and public interests. This is the key role which a new health council structure can play.
Local Health Councils
5. Local health councils have been in place in Scotland since 1975. They are independent statutory6 bodies established to represent the views of users on the provisions of health services and to promote public participation in health-related matters. There is one health council in each NHS Board area.
6. Each health council is composed of 15 members 7 appointed by the local NHS Board following procedures agreed in a 1996 review (see paragraph 9). The health council members are supported by a small team, which is managed by a chief officer. NHS Boards are required to provide the health council with the information and administrative support, including accommodation, necessary to carry out its functions.
7. Local health councils have a national association - the Scottish Association of Health Councils - which, as a membership organisation, is entirely funded by its members subscriptions. Currently, 14 out of the 15 Scottish health councils have chosen to be members.
Funding
8. Health councils receive core funding from the Scottish Executive. In 2002/03 funding of 1,979,000 was made available. The formula, which determines the funding of individual health councils, was developed in consultation with the health councils. As noted above, NHS Boards are required to provide their local health council with accommodation and other administrative and support services. A number of Boards also provide additional specific funding for health council services, for example patient information points, research officers, public involvement officers, complaints officers, etc.
Current Health Councils Role
9. The role and remit of health councils has been reviewed on a number of occasions. The most recent review in 1996 (the 'Eckford Review') led to the Scottish Executive Health Department:
putting in place a more equitable method for determining health councils' financial allocations;
supporting the development of guidance to ensure more openness in the membership appointment process; and
the development of a code of conduct for health council members.
10. The major work flowing from the 1996 review was the development of a core performance framework for health councils in Scotland. This framework identified 6 core work activities, which should be common to all health councils. These core activities are:
To act as the voice of patients/public in the health council area
To influence health gain by contributing to a patient-centred health service
To monitor health services
To provide and develop information and advice strategies
To manage health council resources
To contribute to the national voice for patients and the public in health matters.
11. Health councils are required to prepare an annual work plan, aimed at focusing activity on achieving the greatest health gain for the people they serve. Health councils are encouraged to work closely with local NHS Boards and Trusts. This approach has greatly enhanced the performance of many health councils whose work is clearly focused and well delivered.
12. Currently, the amount of strategic partnership working between health councils and NHS Boards and Trusts varies between NHS Board areas throughout Scotland. Health councils recognise the need to change and modernise against the background of Patient Focus and Public Involvement. Under the auspices of the Scottish Association of Health Councils, and with financial support from the Scottish Executive, its member health councils have embarked upon a proactive review process, the outcome of which will inform their input to this consultation process.
Patient Focus and Public Involvement: a commitment to change
13. Patient Focus and Public Involvement recognises that it is no longer good enough to simply do things to people; a modern healthcare service must do things with the people it serves. It aims to achieve:
a service where people are respected, treated as individuals and involved in their own care
a service where individuals, groups and communities are involved in improving the quality of care, in influencing priorities and in planning services
a service designed for and involving users.
14. The framework, which has four broad themes,
aims to make this change in culture a reality. Success in achieving the aims of Patient Focus and Public Involvement will ensure that the health service is responsive to these needs and is focused on action to meet those needs. It is an important part of the quality agenda of continuing service improvement. (Annex 2 provides further information on the Patient Focus and Public Involvement commitments.)
15. This document is concerned with the aim of achieving a service designed for and involving patients, specifically with the structures needed to ensure that the NHS delivers effective patient and public involvement.
16. NHS accountability must be open and transparent, involve independent assessment and include evidence-based clinical and service standards applied consistently across the NHS in Scotland . All of these principles apply equally to accountability for patient and public involvement activities.
17. In addition, there needs to be:
strong, independent external scrutiny on local health systems to see that these duties are carried out;
support to assist individuals and communities to take part effectively in public involvement activities; and
support to assist NHS bodies to take part effectively in public involvement activities.
The Health Department, through the Involving People Team, is providing support to NHS Boards to progress the Patient Focus and Public Involvement agenda.
18. It is part of the job of the local NHS system, in discharging its responsibility for delivering effective public involvement, to support individuals and communities to take part. One of the ways they should do this is to promote the creation and development of local networks of organisations and individuals with a health service interest. This is discussed further in paragraphs 47 - 52.
19. Strong, independent external scrutiny needs to be provided by a robust body independent of the local NHS. This is seen as a key task of a refocused Health Council structure.