Noone can have failed to notice Andrew Lansley’s mantra of ‘no decision about me without me’ over the last year. It is, he says, at the centre of the reforms. The scope of patient and public involvement is significant, from increase patient choice, information and involvement in decisions about their own health, to patient and public involvement in decisions about the commissioning and design of services. The extent to which the mantra extends to full public involvement in decision making, or ‘no decision about us, without us’, remains to be seen.
An article in the Health Service Journal (HSJ) yesterday called in to question the Government’s plans to bring “real local democratic accountability and legitimacy” to the NHS. On the day that the Government announced that 75 local HealthWatch pathfinders have been established, concerns about the teeth (and funds) that the bodies will have abound.
The role that patient and public engagement will play in a reformed NHS has been far from clear – and subject to significant scrutiny. Following last year’s consultation on increasing democratic legitimacy in health the Government was forced to rethink its plans, strengthening the role of health and wellbeing boards and committing increased funding for local HealthWatch. And yet the debate was far from over. The focus of a Future Forum working group, it was argued that the Government should include a stronger and clearer definition of patient and public involvement in the Bill. And this included looking again at the role of local HealthWatch organisations. The concept of local bodies with a role in ensuring patient and public involvement in service design and delivery, as well as supporting patient choice, has been largely welcomed, but many respondents to the Future Forum questioned whether the expectations on the body could be met in reality – particularly given limited resources.
The Forum (and indeed the Government) argued that funding for local HealthWatch should not be ring-fenced, but rather that local authorities should be held to account for funding the bodies through both the health and wellbeing board and the authority’s overview and scrutiny functions.
The response to the announcement of the first HealthWatch pathfinders yesterday suggests that this did not allay fears. The pathfinders are intended to test and refine arrangements for the bodies, and yet no start-up funds have been made available to them. Adding insult to penury, the Department of Health consultation on future funding allocations for the bodies was pulled shortly after its publication last week.
Concerns over funding for local public involvement bodies are nothing new, and Local Involvement Networks (LINks), which will be replaced by local HealthWatch bodies, have been subject to claims of underfunding since their inception. When LINks were established in 2007 the then head of the Commission for Patient and Public Involvement in Health said that they were “fatally underfunded” and being set up to fail.
With these tensions and increasing pressure on public service funds, it is not easy to see how this situation will change. The Department of Health has told the HSJ that funding to local HealthWatch bodies will be at least £20,000 above current LINks budgets (the average of which is £100,000) and this will no doubt be a welcome commitment. However, the role and remit of the bodies, and so the demands on their resources, will also increase.
Given the important role of public and patient involvement in the NHS there is much work to do, and this should be a priority for local and national policymakers. As the pathfinder bodies begin to operate and evolve from the LINks model it will be important that they explore new and innovative ways of working and engaging the public – and the Department of Health should do all it can to share examples of best practice.
There are already good examples of effective and efficient engagement – making sure that these are replicated rather than forgotten will be key to ensuring that there really is ‘no decision about us, without us’.