Background

Community Health Councils (CHCs) were established by Act of Parliament in 1974 to monitor and review the NHS and to recommend improvements. They also had a role in supporting and helping patients with their local health services.

CHCs were abolished in England in 2003, but continue in Wales. The concept of public and patient involvement in healthcare is still pursued. Each country has various organisations (below) to assist in this field.

New legislation came into force in April 2010 regarding the NHS duty to report on consultations. This requires all primary care trusts (PCTs) and strategic health authorities that commission services to explain how they have acted upon feedback from patients and the public. This has been termed 'Real Accountability'. Guidance for NHS organisations and users is available.^[1]

England

The overall structure and organisation of the NHS in England is detailed on the NHS choices website.^[2]

The Care Quality Commission (CQC)^[3][4]

This is the independent regulator of all health and adult social care in England.

Changes dating from April 2010 are:

• All NHS trusts in England must register with the CQC.
• Trusts will be visited by inspectors at least once every 2 years to scrutinise standards
• The CQC has the power to fine, prosecute or close down trusts which fail to meet standards.
• For some trusts, registration under the new system is conditional on improvements being made in areas such as infection control and use of unregistered nursing agencies.

The new regulations are more stringent than the previous CQC setup, in which hospitals completed self-assessments and only around 20% of hospitals were inspected each year.

NHS GP practices and primary care providers must also register with the CQC in 2012:

• From April 2012, primary care providers must be registered with the CQC if they provide only NHS primary medical services contracted by a primary care trust, or if NHS primary medical services are their main purpose.
• This includes NHS GP practices, walk-in centres, out-of-hours services and contracts with the Secretary of State.
• GP practices that are part of a co-operative or federation will need to register (in addition to registration of the co-operative or federation).
• Registration will open from October 2011. The methods of registration will be similar to those for all other providers. Key principles include placing the views of service users at the centre of the system.

Patient Advice and Liaison Services (PALS)^[5]

PALS were set up in England as part of patient and public involvement. The core functions of PALS are to:

• Be identifiable and accessible to patients and carers.
• Provide help in each Trust, with power to negotiate prompt resolution of problems.
• Help patients access independent advice or advocacy.
• Provide information to patients about the Trust's services and other health-related issues.
• Act as a catalyst to improvement by providing the feedback on problems with services.
• Network with other PALS and organisations.
• Support staff in the Trust to develop a responsive culture.

Independent Complaints Advocacy Services (ICAS)^[6]

• ICAS assists patients or carers in pursuing a complaint about NHS care.
• It is funded by the Department of Health and is free to patients. ICAS is independent of any individual NHS organisation.
• The ICAS role is to assist patients through the NHS complaints' process, by explaining the options and supporting patients in their chosen course of action. ICAS do not provide legal or medical advice.

Local Involvement Networks (LINks)^[7][8]

From April 2008, LINks replaced the Patient and Public Involvement Forums. LINks are made up of 'individuals and community groups, working together to improve local health and social care services.'^[9][10]

Role of LINks

LINks aim to represent the views of patients and voluntary bodies to the NHS. They should:

• Enquire about local people's views of their health and social care, and suggest improvements to the service providers.
• Look into specific issues (such as a dirty hospital), make recommendations and obtain a response.
• Obtain information and answers within a specified time.
• Be able to carry out spot checks to see if services are working well.
• Refer issues to the local Overview and Scrutiny Committee if action is not taken.

How should LINks function?

• There is no set structure for a LINk, but the idea is that a LINk will only work effectively if it involves the whole community.
• Each LINk will decide its own priorities and how to operate.
• Funding will come from local councils, who have been given money to finance LINks.
• Each local authority is expected to contract a 'host organisation' to set up and support the LINk. The host is accountable to the LINk.
• The LINks are independent of the Government.
• The principle is that 'everyone's views matter' and anyone can join a LINk. This may include individuals such as carers, service users and community leaders, or groups such as charities, faith groups, tenant organisations and business federations.
• The NHS Centre for Involvement is appointed by the Department of Health as the lead organisation for guidance about LINks.

PCTs and LINks

PCTs are expected to gather views from the public and to empower patients, in accordance with World Class Commissioning Competency 3. The LINk observer-participant on the PCT Board is a representative for the local community.^[11]

Recent research found that the level of engagement between PCT boards and the LINk representative varied. The authors commented that 'The finding that 73% of LINks are attending PCT Board meetings is, however, very positive and demonstrates that most LINks now have contact with the PCT structures, where major decisions about the commissioning of local healthcare are made.' However, the authors were concerned that some PCTs considered it is inappropriate for a LINk representative to sit with Board members, and in other PCTS the LINk's representative required the Chair's permission to speak to the Board.^[11]

Northern Ireland^[12]

The Patient Client Council (PCC) has replaced the four Health and Social Services Councils from April 2009. It is a regional body with 5 local offices.

Role of the PCC:

• To represent the interests of the public by their views on services.
• To engage with Health and Social Care (HSC) organisations to ensure that the needs of the public are addressed by HSC services.
• To promote the involvement of patients and the public in the planning and delivery of HSC.
• To assist individuals in making complaints regarding their healthcare or social care.
• To promote advice and information to the public concerning HSC.

Scotland

The Scottish Executive Health Department (SEHD) manages the 14 health boards in Scotland. Each covers a defined geographical area and is responsible for NHS services in that area. SEHD also manages the other health services (8 special health boards) covering services such as NHS 24 and the ambulance service.

The Scottish Health Council^[13]

This was launched by the Scottish Executive in April 2005 to promote patient-centred care and public involvement in NHS services.^[14]

• It is part of NHS Quality Improvement Scotland (NHS QIS) - below.
• Its role is to ensure that patients' and public views be considered by the health boards, and it can comment on how well the boards perform in this respect.
• The Council has a local office in each Health Board area. Each local office has a Local Advisory Council, made up of volunteers.

NHS Quality Improvement Scotland^[15]

NHS QIS is a special health board working with health services in Scotland to improve care. One of its aims is to be 'engaged with patients, carers and the general public'.

Better Together: Scotland's Patient Experience Programme^[16]

Better Together was launched in February 2008. It co-ordinates research into patients' experiences of the NHS. Patient feedback can then be used to promote improvement in services. The programme will initially focus on 3 areas: inpatients, long-term conditions and GP surgeries.

Wales

There are 7 health boards. They are allocated resources on the basis of their population. They provide all healthcare, in partnership with local government. There are three All Wales trusts, responsible for the ambulance service, cancer services, and public health.^[17]

Community health councils (CHCs)^[18]

From April 2010, there are 8 CHCs in Wales. This is a reduction from the 20 CHCs formerly. The new CHCs are named according to their respective Local Health Board.

CHCs are concerned with all aspects of the Health Service and can give advice to the public. Their work may include:

• Involvement and consultation, e.g with local groups.
• Representing local interests, eg proposing improvements or challenging plans for change.
• Research and information, eg surveys of local need.
• Advice for patients, eg information about local NHS services, and patients' rights.

CHC members are volunteers drawn from local authority nominations and from the voluntary sector. The CHC may co-opt additional members locally if needed. The arrangement for membership numbers will be reviewed in 2012.

Healthcare Inspectorate Wales (HIW)^[19]

• HIW is responsible for providing independent assurance about the quality and safety of NHS and independent healthcare organisations in Wales.
• HIW may also carry out special reviews where there are systematic failures in healthcare services.