• The body responsible for the oversight of PPI should be accountable to a Parliamentary Select Committee with a facility for direct referrals to that Committee by service users, carers and other members of the public.
• All personnel responsible for the governance PPI should be brought under the remit of the Standards Board.
• CPPIH and its successor organisation should have a clear and accessible whistleblowing policy with readily available links to whistleblowing bodies such as Public Concern at Work(ext link) and Freedom to Care(ext link) (Freedom to Care’s code on accountability should also be considered).
• The internal complaints procedure should be carefully revised to simplify it and obviate possible misuses of power. An independent agency should monitor second stage complaints. A simple resolution to this would have been to bring second stage complaints into the Healthcare Commission(ext link) remit but it is recognised that the Healthcare Commission itself may be a favourite to take over responsibility for PPI. An alternative could be The Centre for Public Scrutiny.(ext link)
• As recently promised by the Government but then reneged on, volunteers should be swiftly brought under the protection of legislation dealing with discrimination.
• Volunteers should be afforded the same protections as those in employment law and have the same rights as employees to have matters heard by an Employment Tribunal.
• Whichever organisation assumes the oversight of PPIFs, it should immediately enter into consultative discussions with the NHS Appointments Commission(ext link) and service user and carer organisations about the recruitment of appropriate volunteers.
• The parameters around benefits should be reviewed to minimise deterrents for service users’ and carers’ full involvement in PPI.
• In the interests of real PPIF independence and a minimisation of vested interests, the regulations should be revised to exclude any person with a continuing NHS or Social Services or other corporate commitment whether employed or not. There should also be a requirement for members to be publicly open and transparent. The regulations should link to a freely and publicly available PPIF Code of Practice. The NHS Appointments Commission should review the current membership with these changes in mind. The Appointments Commission should also immediately review current forum membership to ensure that para (3) (a) of the Membership and Procedure Regulations 2003 is being observed.
• Recruitment and appointment procedures should record an assessment of prior experience and an assessment of prior learning for each member.
• Recruitment and appointment processes should involve service users and carers.
• Retrospective CRB(ext link) checks should be executed immediately and with urgency. All new forum members should be CRB checked.
• The NHS Appointments Commission should take over recruitment immediately.
• CPPIH should be immediately removed from the re-organisation process and this should be conducted by a federation of service users and carers.
• PPIFs should be encouraged NOT to organise themselves as formal business committees. A ‘team’ approach operating on more ‘organic’ lines would seem more appropriate with team members taking on overlapping roles: i.e. liaison, local contact, advocacy, public speaker, etc.
• There should be avoidance of a position in which one person can dominate the team to pursue their own agenda.
• Activities should focus on processes rather than events. Reaching out to consult service users, carers and members of the public, especially those who are disaffected and those who have communication difficulties, should be a priority. Making decisions and taking actions based on forum members’ opinions, however well informed, should be discouraged. There should be a focus on ‘evidence based’ processes.
• Process and meetings should ensure at least equal access to those living in rural areas. Positive discrimination in favour of those living in rural areas may be appropriate and required in some instances.
• Where trusts cover large geographical areas a core and cluster approach should be adopted.
• Future means of facilitation, office and equipment provision and secretarial support for PPIFs should be rethought. Existing Forum Support Organisations should be discontinued.
• Perhaps one model for consideration could be local high street shop front premises for each PPIF with administrative and secretarial support on hand.
• New organisations or individuals used for PPIF facilitation should have a working knowledge of service user and carer involvement. They should take account of the special needs of rural areas.
• The new governing body should practice openness, honesty and integrity - not just pay lip service to these. And they should be accountable for upholding ‘Nolan’ standards.
• Strategic/operational discussions and meetings should be held directly with the PPIFs.
• The new governing body should immediately make information about itself and PPIFs publicly available and this should include setting up specialist regional websites with local satellites fully accessible to the public.
• The new governing body should, from the earliest date, individually engage existing forum members in an appraisal of present skills, knowledge, abilities and experience towards an assessment of immediate training needs.
• The above appraisal process should be part of the recruitment and appointment of new members.
• The new governing body should engage with the kinds of organisations detailed at the end of para 7.4. The objects are: to develop training and education modules for all involved in the running of PPI and; to develop packages of education about PPI for NHS staff and the public.
• Essential training needs should be met at the point of the appointment of forum members and there should be a secondary rolling programme of training which is regularly reviewed in partnership with the above organisations.
• Education and training should be competent and rigourous continuous processes and not something tacked on as internal amateur activities by management and administrative staff.
• All training and education processes should involve service users and carers.
Needless to say, these were ignored by the Department of Health but they remain valid and lobbying your constituency MP based on these and/or your own recommendations would be valuable action
(1) It is the duty of every body to which this section applies to make arrangements with a view to securing, as respects health services for which it is responsible, that persons to whom those services are being or may be provided are, directly or through representatives, involved in and consulted on-
(a) the planning of the provision of those services,
(b) the development and consideration of proposals for changes in the way those services are provided, and
(c) decisions to be made by that body affecting the operation of those services.
(2) This section applies to-
(a) Health Authorities,
(b) Primary Care Trusts, and
(c) NHS trusts.
(3) For the purposes of this section a body is responsible for health services-
(a) if the body provides or is to provide those services to individuals, or
(b) if another person provides, or is to provide, those services to individuals-
(i) at that body's direction,
(ii) on its behalf, or
(iii) in accordance with an agreement or arrangements made by that body with that other person;
and references in this section to the provision of services include references to the provision of services jointly with another person.
The OCPA also has an existing stringent Code of Practice, available from the website and a solid complaints policy.
However, it is obvious that changes will need to be made to accommodate the appointments of volunteers, and there will need to be a high adherence to the Investing in Volunteers Standard for the use of volunteers which is managed by Volunteering England.
•Promote freedom of choice as the prerequisite of informed consent,
•Define the needs of patients and carers from their point of view.
•Provide a voice for many organisations and interest groups that represent groups whose voice is not normally heard at the highest political level.
•Offers a wide range of information in the form of books, leaflets and newsletters through a national network of information centres and services.
•Co-ordinates the strategies of interest groups to ensure that their efforts are not scattered but focussed on certain goals. Publishes an annual report, which receives widespread media coverage and there are also plans to produce ratings of hospitals’ performance against patient-defined standards.
•Integrates citizens and users’ views in order to promote quality from a patients’ point of view. The Federation works as an equal partner with the Dutch Royal Colleges and the Hospital Association in developing guidelines for good practice.
•Has funded research studies and is producing a handbook for health professionals pointing up the gaps between what patients want and what professionals provide.
The Federation have made some powerful interventions over the years. They went to court to protect patients affected by a strike of doctors and nurses, as a result there was a court ruling about what was and what was not allowed during strikes. They also organised a boycott where a hospital department was considered unsafe. As a result of the publicity the number of patients dropped by 80% in a week and management was forced to take immediate action.
•Insurers and local health providers are required by law to have formal “patient/user councils”.
•Hospitals and insurers offer places on boards and committees to patient representatives as good practice.
Patient representatives are also involved in complaints committees as a legal requirement. The Federation, the Royal College of Physicians and the National Hospital Association meet on a joint board that supports and runs a national network of patient/consumer advice centres in the community and complaints bureaux in hospitals (required by law). Patients register complaints and are advised how to take them forward, if necessary support and/or mediation will be provided. If the patient is not satisfied the patient/consumer bureaux will follow up the issue on their behalf.
Key features for the success of the Federation are considered to be:
•NFPCO crosses the divide between Government and the voluntary sector making a strong collective voice
•It does not try to speak for all patients but enables different groups to speak through them
•The patient/public participation system is based on a legislation giving clear rights and powers. The Experience of the Federation is that goodwill is not enough.
•Patients and consumer groups are well funded by the States.
•The Federation is able to provide a strong collective voice in the media.
Further information: http://www.npcf.nl/menu/i_engels.html
The Investing in Volunteers website tells us:
“Introduction to Investing in Volunteers
Investing in Volunteers is the new UK quality standard for volunteer management. If your organisation involves volunteers, achieving the Investing in Volunteers standard will enable your organisation to make the best use of this valuable people resource.
The Standard comprises of 10 Indicators of volunteer management best practice, supported by 55 practices, based on four key areas of volunteer management:
• planning for volunteer involvement
• recruiting volunteers
• selecting and matching volunteers
• supporting and retaining volunteers.
Investing in Volunteers is being managed by the four development agencies of the UK Volunteering Forum: Volunteering England, Volunteer Development Scotland, Volunteer Development Agency in Northern Ireland, and Wales Council for Voluntary Action.”