NHS North West held a listening event on 24th May 2011 to give the public, staff and stakeholders the opportunity to give their feedback. We also used existing events and forums as opportunities to engage around 'Working Together for a Stronger NHS'.
The feedback from this event was fed into the NHS Futures Forum who will consider this feedback and the current proposals and, where appropriate, adapt their proposals in light of this engagement and discussion. Outlined below are the general thoughts and issues highlighted at the event.
It needs to be stated that the event demonstrated that everyone present was very passionate about protecting the NHS, professionals and lay people alike.
1. Need to see evidence that the NHS, patients, the public and all interested stakeholders comments are being listening to and have an opportunity to make a real difference to the Health and Social Care Bill i.e. this is not a stunt and therefore a pointless exercise.
2. Clear routes of public accountability – transparency of decisions
• Recognise the need for accountability of GP Commissioning Consortia (GPCC) both with the National Commissioning Board (NCB) and local communities (Health & Wellbeing Board and HealthWatch) to deliver true local decision making. Will any such decision needing to taken place in public with papers published around why and how a decision has been reached.
• Concerns about GPCC accountability / relationship with local authorities especially where GPCC may not be coterminous or cover more than one local authority.
• GPCC / NCB should be required to engage / involve with HealthWatch and relevant groups of patients and the pubic when drawing up plans and set out in their annual report eg Duty to Involve.
• HealthWatch need to have the appropriate skills and resources to deliver their enhance role and act as monitors for patients and the public with GPCC.
• Clarity is needed on how patients and the public can complain in the new system. This is also true for the role of Patient Advice and Liaison Services currently in PCTs which provide vital local contact and intelligence to organisations.
3. Strong clinical leadership and high quality management
• Clear and transparent processes required to ensure a full range of healthcare professionals are involved in commissioning of patient pathways. Establishing clinical advisory bodies to support a number of consortia within areas should be considered. This would allow commissioning decisions to be informed by strong clinical evidence.
4. What does choice really mean?
• Competition and choice is an important element in the drive to improve quality but it only where this is understood by patients and the public.
• Competition is may NHS staff, patients and the public means ‘privatisation’. While it was acknowledged that in some cases the use of the independent sector to provide services was merited, most felt that these decision had been forced on local communities / local NHS. It was therefore suggested that a national framework be development which could established the use of the independent sector. A similar approach could also be used for the 3rd sector. The framework would be used locally with GPCC taking account of local conditions, need and finances and thus avoid concerns around destabilising existing services.
• Concerns around the role of GPs acting as both commissioners and providers and how this could affect decision / choice patients can make around treatment options and referrals.
• The risk of providers ‘cherry picking’ is one that also needs to be addressed. Two areas of concerns were raised. Firstly that new providers seek to take on less risky and more lucrative services leading current providers with the remaining more complex services. Secondly that some services are interdependent with the viability of one depending on the existence of the another and thus destabilising organisations rather than just individual services within them.
5. Strong workforce planning and transparency in decision making
• The voice of employers and evidence on the need of services must be given proper weight alongside the view of clinicians.
• All organisations involved require good governance structures including public board meeting and adequate audit / evaluation arrangements where decisions are taken especially.
• Where there are not enough trained staff in a specific area or specialism, this can impact on the quality, patient experience and waiting times. Where there are too many staff this represent poor value for money. It is essential we ensure that future workforce can support new models of care.
• It is important that local skills networks are empower to shape their own way of working and where advice / support is needed that is available building of the expertise within the current Deaneries.
• Strong system leadership will also be required went there is a need to address issues which require collaboration.
You can view the general feedback we received, and the feedback we got on each theme, via the links below.
- NHS North West Listening Exercise Feedback - General Feedback
- NHS North West Listening Exercise Feedback - Choice and Competition
- NHS North West Listening Exercise Feedback - Patient Involvement and Public Accountability
- NHS North West Listening Exercise Feedback - Clinical Advice and Leadership
- NHS North West Listening Exercise Feedback - Education and Training
If you have any queries on any of the above, or if you would like further information, please feel free to contact comms@northwest.nhs.uk