Final Report > Chapter 28: Public Involvement Through Empowerment > What is the agenda for public involvement? > Involvement in local health services

Involvement in local health services

23 In one sense there is nothing particularly new in saying that the public should be involved in their local health service. This was acknowledged as long ago as 1974 when community health councils were first established, and there has long been a requirement on local health services to hold public consultation exercises on proposals to close a hospital. Thus the principle of involving the public in some form is well established. It is the practice that has come to be seen as poor.

24 A sense of frustration with the mechanisms for involvement at a local level contributed, in 2000, to a series of proposals from government to increase the extent of that involvement and to seek to make it more closely engaged with the delivery of healthcare services. A summary of the proposals is at Box C.

25 These proposals represent a significant agenda for change. They have not received universal support, not least as regards the proposed abolition of community health councils (CHCs) and their replacement by Patients' Forums and Patients' Councils. The fear is that the forums and councils will not have sufficient independence and distance from the trust and local health services to inspire confidence and challenge decisions. It is fair to say, however, that CHCs were open to criticism not because they lacked independence but because they lacked power. In a sense, they were a tolerated mechanism for venting public concern, because ultimately they could do nothing.

26 It is of crucial importance that the central goal is kept in sight: that of embedding the involvement of the public in the mainstream of a trust's activities. The involvement of the public must not be some side-show, off to one side. As the NHS White Paper `A First Class Service' stated, the involvement of patients and the public `... should not be a discrete, "add-on" task but part of the way all NHS organisations work.' [12] We agree. What is important now is not to allow the process of involving the public to become overtaken by debates about the precise mechanisms to be used: what groups there should be or how they should relate to each other. That is to lose sight of the central challenge which is how to engage and involve the public and patients so that the quality of care which the NHS and each trust deliver can continuously improve. That is the only agenda. Thus, rather than commenting in detail on current proposals, which may, of course, change, we think it more important to draw out certain general principles to guide decision-making in the future about the mechanisms or structures which are necessary. They are principles which in our view apply to the involvement of the public at both national and local levels.

Footnotes

[12] Department of Health. `A First Class Service; Quality in the New NHS'. London: The Stationery Office, 1998