PCT — patient representatives

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Patients’ forums and PCTs: models of engagement
NHS influencers might want to take a look at the NHS Alliance’s publication Patients’ forums and PCTs: models of engagement, an in-depth examination of how patient and public involvement might work with the establishment of PPI forums. The report looks closely at how patient and public involvement can be built into PCTs to give local communities a real say in what happens in healthcare, and how PCTs and forums can work productively together. The forums replaced community health councils.

Chris Drinkwater, professor of primary care development, University of Northumbria, and one of the principal authors of the Alliance report, is concerned that the complexity of the new structures with the CPPIH (now to be abolished), the Healthcare Commission, patient advice and liaison services, as well as PCT and trust forums will result in an over-bureaucratic system that will simply swamp efforts to give local people genuine opportunities to have their say and to be listened to.

The Alliance report also emphasises that patient and public involvement is not an end in itself, but a means to an end — a health service that is genuinely responsive to patients and their carers, and that is accountable to local communities. Among the report’s other recommendations are that:

• PCT board members should attend patients’ forum meetings so that they can account for the actions of the trust and listen to views and concerns
• PCT committees should provide an annual report to the patients’ forum explaining how they have carried out their duties for patient involvement
• all PCT documents should include ‘patient impact’ statements and that community development techniques such as patients-as-teachers and critical friends groups should be adopted in all areas.

Patients’ forums and PCTs was commissioned by the Department and the Modernisation Agency. Copies are available from the NHS Alliance.

Centre for Health Information Quality
Also relevant to this area is the work of the Centre for Health Information Quality (CHIQ). Now commissioned by the Department to help improve the quality of health information available to the public, the centre provides training to key NHS communications staff in order to try and improve the way information is communicated with patients (eg, those working in PALS). CHIQ has also been developing quality assurance tools to improve the quality of information, particularly for producers of cancer information. CHIQ works with producers and providers of health information, providing training, consultancy and information appraisal and is part of the Help for Health Trust, the birthplace of NHS Direct Online.

See CHIQ's website at www.hfht.org/chiq.

Toolkit for producing patient information
A toolkit on producing patient information is available and may be worth looking at.

Note particularly that PCTs now have to engage with their public — this is yet another statutory requirement. As an example of this, some interesting documents are available from the work in the Avon area, which has an active stakeholder involvement strategy.

See www.northbristol.nhs.uk/future.

Every PCT has now produced a patient prospectus. This replaced The patient’s charter, an early attempt to get patients to think about their responsibilities towards the NHS. Research by MORI has shown that people have found the guides informative and useful. Some PCTs have tried to use them to influence consumer behaviour to try and get potential patients to use services differently (eg, a greater use of NHS Direct and community pharmacists). Whilst, for example, Westminster PCT has produced a 10-page booklet containing information on the PCT; an explanation of how money was being spent; its top 10 service development targets for the PCT, etc, others have just provided contact information and telephone numbers. Nevertheless they should be useful information sources for local NHS teams. Updated guides are required to be produced in 2004.

Patient contracts
The government has floated the idea of patient contracts, which would see patients signing up to healthier lifestyles in exchange for NHS care. Scotland suggested something similar in its publication Patient rights and responsibilities. But Improving health and social care from the Labour’s National Policy Forum suggests the new contracts (which would ensure a certain standard of care in return for patients following health advice and/or attending appointments) caused a storm of controversy with complaints about nanny states, rationing, etc. ‘This would involve people in their own care, asking them to share the responsibility for their own healthcare and wellbeing. Agreements would be drawn up to help people cut down or quit smoking, to lose weight, to take more exercise or to eat a more nutritious diet.’ More consultation and redrafting seems likely.

The Tories too have come out with an interesting idea on health passports where if patients choose to use private healthcare, the state would cover a proportion of the cost, with the individual (or insurance company) paying the reminder. The idea is actually co-payment.