The Francis Report and LINks/Healthwatch

The “Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry chaired by Robert Francis” – aka ‘the Francis Report’ – was published last week.

If you work in health, or patient involvement, then you must at the very least read the Executive Summary. It is very readable and concise and I’d recommend you print off a copy for bedtime reading and scribble on it.

I’m publishing on this blog the particular points that I think that LINks/Healthwatches need to read, digest, ponder and respond to. I think they are really important (and in fact, I’ve copied these paragraphs and put them in our LINk Legacy Document to be passed on to Healthwatch Somerset).

N.B. For the full chapter looking at patient involvement, you need to read Chapter 6 of Volume 1 of the full report.

Extracts from The Executive Summary:

The voice of the local community

  • 1.17 It is a significant part of the Stafford story that patients and relatives felt excluded from effective participation in the patients’ care. The concept of patient and public involvement in health service provision starts and should be at its most effective at the front line.
  • 1.18 Analysis of the patient surveys of the Trust conducted by the HCC and the Picker Institute shows that they contained disturbing indicators that all was not well from long before the intervention of the HCC.
  • 1.19 Community Health Councils (CHCs) were almost invariably compared favourably in the evidence with the structures which succeeded them. It is now quite clear that what replaced them, two attempts at reorganisation in 10 years, failed to produce an improved voice for patients and the public, but achieved the opposite. The relatively representative and professional nature of CHCs was replaced by a system of small, virtually self-selected volunteer groups which were free to represent their own views without having to harvest and communicate the views of others. Neither of the systems which followed was likely to develop the means or the authority to provide an effective channel of communication through which the healthcare system could benefit from the enormous resource of patient and public experience waiting to be exploited.
  • 1.20 Patient and Public Involvement Forums (PPIFs) relied on a variably effective, locally provided infrastructure. The system gave rise to an inherent conflict between the host, which was intended to provide a support service but in practice was required to lead with proposals and initiatives offered to lay members, and members of the forum, who were likely to have no prior relevant experience and to be qualified only by reason of previous contact with the hospital to be scrutinised.
  • 1.21 In the case of the Trust’s PPIF, the evidence shows quite clearly the failure of this form of patient and public involvement to achieve anything but mutual acrimony between members and between members and the host. A preoccupation with constitutional and procedural matters and a degree of diffidence towards the Trust prevented much progress.
  • 1.22 If anything, local Involvement Networks (LINks) were an even greater failure. The, albeit unrealised, potential for consistency represented by the Commission for Patient and Public Involvement in Health (CPPIH) was removed, leaving each local authority to devise its own working arrangements. Not surprisingly, in Stafford the squabbling that had been such a feature of the previous system continued and no constructive work was achieved at all.
  • 1.23 Thus, the public of Stafford were left with no effective voice – other than CURE – throughout the worst crisis any district general hospital in the NHS can ever have known.
  • 1.24 Under the new reforms, local healthwatch is intended to be the local consumer voice with a key role in influencing local commissioning decisions through representation on the local Health and Well-being Board. They will be expected to build on existing LINks functions. The responsibility for establishing Local Healthwatch will rest with the local authorities in the same way as it had for LINks. As is the position with LINks, the DH does not intend to prescribe an operational model, leaving this to local discretion. It does not prejudice local involvement in
  • the development and maintenance of the local healthcare system for there to be consistency throughout the country in the basic structure of the organisation designed to promote and provide the channel for local involvement. Without such a framework, there is a danger of repetition of the arguments which so debilitated Staffordshire LINks.
  • 1.25 The local authority scrutiny committees did not detect or appreciate the significance of any signs suggesting serious deficiencies at the Trust. The evidence before the Inquiry exposed a number of weaknesses in the concept of scrutiny, which may mean that it will be an unreliable detector of concerns, however capable and conscientious committee members may be.
  • 1.26 Local MPs received feedback and concerns about the Trust. However, these were largely just passed on to others without follow up or analysis of their cumulative implications. MPs are accountable to their electorate, but they are not necessarily experts in healthcare and are certainly not regulators. They might wish to consider how to increase their sensitivity with regard to the detection of local problems in healthcare.
  • 1.27 There are a wide range of routes through which patients and the public can feed comments into health services and hold them to account. However, in the case of Stafford, these routes have been largely ineffective and received little support or guidance.
  • 1.28 Local opinion is not most effectively collected, analysed and deployed by untrained members of the public without professional resources available to them, but the means used should always be informed by the needs of the public and patients. Most areas will have many health interest groups with a wealth of experience and expertise available to them, and it is necessary that any body seeking to collect and deploy local opinion should avail itself of, but not be led by, what groups offer.

Extract from the Table of Recommendations:

  • Patient, public and local scrutiny
    145 Structure of Local Healthwatch There should be a consistent basic structure for Local Healthwatch throughout the country, in accordance with the principles set out in Chapter 6: Patient and public local involvement and scrutiny.
  • 146 Finance and oversight of Local Healthwatch
    Local authorities should be required to pass over the centrally provided funds allocated to its Local Healthwatch, while requiring the latter to account to it for its stewardship of the money. Transparent respect for the independence of Local Healthwatch should not be allowed to inhibit a responsible local authority – or Healthwatch England as appropriate – intervening.
  • 147 Coordination of local public scrutiny bodies
    Guidance should be given to promote the coordination and cooperation between Local Healthwatch, Health and Wellbeing Boards, and local government scrutiny committees.
  • 148 Training
    The complexities of the health service are such that proper training must be available to the leadership of Local Healthwatch as well as, when the occasion arises, expert advice.
  • 149 Expert assistance
    Scrutiny committees should be provided with appropriate support to enable them to carry out their scrutiny role, including easily accessible guidance and benchmarks.
  • 150 Inspection powers
    Scrutiny committees should have powers to inspect providers, rather than relying on local patient involvement structures to carry out this role, or should actively work with those structures to trigger and follow up inspections where appropriate, rather than receiving reports without comment or suggestions for action.
  • 151 Complaints to MPs
    MPs are advised to consider adopting some simple system for identifying trends in the complaints and information they received from constituents. They should also consider whether individual complaints imply concerns of wider significance than the impact on one individual patient.

Other useful links:

What to do with this data:

  • Read it and digest it.
  • Circulate it to your LINk volunteers and colleagues.
  • Consider how you will respond to the recommendations and lessons learned.
  • Ask your local CCG and providers how they are responding to the recommendations.
Advertisements

Joint Strategic Needs Assessments (JSNAs)

Today I attended a conference about JSNAs, which has inspired me to write with some basic JSNA info for you!

Joint Strategic Needs Assessments (JSNA): What’s that then?
JSNAs are generally big fat documents with lots of accompanying documents.  Sometimes they are big fat web-based “E-tools” – different things happen in different areas. Either way, they are:

  • Joint: Jointly researched and written by the local NHS and local authority (council) but also involving other partners;
  • Strategic Needs Assessment: Assessing the health and wellbeing needs of local people in order to strategically inform commissioning decisions (what services do we need?).

They are local documents looking at the local area – and every local authority area has to have one.  Or as the Department of Health puts it:

The Local Government and Public Involvement in Health Act 2007 requires PCTs and local authorities to produce a Joint Strategic Needs Assessment (JSNA) of the health and wellbeing of their local community.

JSNAs tell the local story: they include a great deal of data in terms of statistics about the local population from as many sources as the JSNA team can get their paws on.  The idea is to compile as full a picture as possible about what is happening in the local area in terms of health, wealth, housing, social care, education, age, caring responsibilities, demographics, and as many things as you can craft into a pie chart or bar graph as humanly possible. It also includes lots of qualitative data and information from local people about their views of life in the area.

JSNAs are re-published every three years, which involves lots of new research and report writing (and more bar charts). This is called a “refresh” of the JSNA.

How do I find my local JSNA?
If you don’t already have a copy taking up most of your desk, then you should be able to find your local JSNA by searching your local authority’s website. It might be hard to find this document, or it might be split into smaller documents. If you can’t find it, drop your local friendly LINk commissioner an email and ask where you can find it (and maybe whine a bit about it not being easily accessible on their website).

What is the JSNA used for?
The JSNA is used to inform commissioning of services. For example, if there is a lack of mental health provision in one area, then the JSNA would provide the evidence to support commissioning a service there.

Are JSNAs staying in the new reformed world of health and social care?
The JSNA is one of the few things that will survive into the new reformed world intact: with both the same name and the same – but enhanced – function.  The JSNA will be the research that underpins and informs the Health & Wellbeing Strategy, which will be the ‘actions’ that come out of the ‘research’ of the JSNA. The Health & Wellbeing Strategy will be the responsibility of the Health & Wellbeing Board, which, as I’m sure you are bored of hearing by now, will comprise commissioners of both Health and Social Care, with the added bonus of a HealthWatch Representative to be the voice for local residents at the commissioning table.

One thing that will change is that in the future, responsibility for the production of the JSNA will be given to the local authority, as PCTs are being abolished.  (In the past, some PCTs have lead on producing the JSNA.)

What does this have to do with the LINk?
Every areas JSNA is different. But ideally, JSNAs should include ‘the public voice’; a reflection of what local people say about health and wellbeing.  This is where the LINk can come in. The LINk should work closely with the JSNA project team in order to ensure that the local voice is heard and represented in the JSNA. There are many ways of doing this. You could create a survey specifically to gather information for the JSNA. You could collect information and stories from local people, or feed in the issues that you already have. You could run workshops or public events.

Working with voluntary groups:
The JSNA is a very important piece of work for voluntary, community and user-led groups (civil society groups). This is because those groups are often excellent sources of what is working, and what is not working, in the local community. They may know where there are gaps in services. It is also important for voluntary and community organisations because through the JSNA they can raise awareness of the needs that they are meeting in the local community. What would happen if they were not providing their services? What would happen if existing services were no longer commissioned through them?  This is a great opportunity to drive those points home to the people who actually commission services.

The LINk could help by coordinating a means for voluntary and community groups to have their say in the JSNA: perhaps through meetings, or through surveys, or through establishing a ‘civil society forum’. You can also make sure that civil society groups know about the JSNA by publicising  information through your newsletters and informing people who their key contacts into the JSNA should be.

Websites for useful information:

What to do with this data:

  • Find your JSNA: Look up your local JSNA on your council’s website.
  • Find out who your JSNA Leads are: You should have one in the NHS and one in the local authority (very possibly someone with ‘Information’ in their job title).
  • Find out what is happening in your area with regards to the JSNA: Different areas have different timescales. Some areas might “refresh” their JSNA regularly, perhaps looking at certain themes or certain smaller areas. Find out what is happening in your area.
  • Email councillors and ask them how they are using their JSNA to inform their decisions and debate: Some might look at it regularly, in order to back up their decisions. Others might not have heard of it. Now is the time to remind people that the JSNA is going to be an essential part of service planning in the future.
  • Plan how you will contribute to the JSNA: There are some Best Practice Examples here to give you some ideas.
  • Plan how you will involve user-led, voluntary and other organisations: How will you raise awareness of the JSNA? How can you bring commissioners and these groups together? And how will you make sure that groups from across all sectors of society are represented and have the chance to have their voice heard?