Part 14: Patient and Public Involvement in Health and Social Care
Introduction
512.Section 237 of the National Health Service Act 2006 (‘‘the 2006 Act’’) requires the Secretary of State to continue the establishment of Patients' Forums for NHS trusts, Primary Care Trusts and NHS foundation trusts. The principal role of Patients’ Forums is to monitor and review the provision of health services on behalf of patients.
513.Section 243 of the 2006 Act provides for the Commission for Patient and Public Involvement in Health ("CPPIH"). The CPPIH represents, supports, and manages the performance of, Patients’ Forums. It also has a role in advising the Secretary of State on arrangements for public involvement in, and consultation on, matters relating to the health service.
514.Part 14 of the Act makes provision for the abolition of Patients’ Forums and the CPPIH. In their place, it imposes a duty on local authorities to make contractual arrangements for the involvement of people in the commissioning, provision and scrutiny of health services and social services. It is expected that, under the arrangements, particular bodies (whether existing or newly-created) will be given the task of being the means through which such involvement is achieved. Such a body is referred to as a “local involvement network” (although the Act does not require use of that title).
515.Section 242 of the 2006 Act provides for public involvement and consultation on the planning of the provision of health services, proposals for change in the way that those services are provided and decisions to be made affecting the operation of those services. Section 242 applies to health service bodies in England and Wales. Part 14 of the Act amends section 242 as it applies to certain English health-service bodies. Section 242 also applies to NHS trusts all or most of whose hospitals, establishments and facilities are in Wales: the Act does not alter the way in which sections 242 applies to those trusts.
516.Part 14 amends the 2006 Act so as to impose a duty on Strategic Health Authorities to make arrangements to secure that health service users are involved in matters to be set out in regulations.
517.Part 14 amends the 2006 Act to impose a new duty on each Primary Care Trust and Strategic Health Authority to report on consultation arrangements and the influence that the results of consultation have on commissioning decisions.
Local involvement networks
Section 221: Health services and social services: local involvement networks
518.This section imposes a duty on local authorities to make contractual arrangements for the involvement of people in the commissioning, provision and scrutiny of health and social services.
519.Subsection (1) requires each local authority (as defined in section 229) to ensure there are means in place to facilitate the carrying out of the specified activities (listed under subsection (2)). The specified activities are to promote involvement and provide support for the involvement of people in the commissioning, provision and scrutiny of local care services (as defined in subsection (6)). In addition the specified activities will include enabling people to monitor, and review, the commissioning and provision of local care services for the purpose of considering standards of local care and whether and how they could or ought to be improved. The activities also include obtaining the views of people about their needs for, and experiences of, those services and may involve making reports and recommendations to people responsible for commissioning, providing, managing or scrutinising those services about how local care services could be improved.
520.Subsections (4) and (5) provide that the Secretary of State may, by regulations, add to the activities specified in subsection (2) after consulting with such persons as he considers appropriate.
Section 222: Arrangements under section 221(1)
521.This section contains rules about the arrangements that will be made by the local authority for the purposes of ensuring that there is a means to carry out the activities specified in section 221(2).
522.Subsections (2) to (4) have the effect that the local authority will have to enter into contractual arrangements with another person. That person (referred to as the “host”, although not called that in the Act) must not be a local authority, a National Health Service trust, an NHS foundation trust, a Primary Care Trust or a Strategic Health Authority. In addition, the arrangements must ensure that the host cannot also be a local involvement network (as defined in subsection (2)). In other words, these subsections envisage a chain of three different people: local authority – host – local involvement network.
523.Subsection (4), as well as ensuring that a local involvement network is a person distinct from the host, also specifies – with a view to securing the independence of local involvement networks – that a network must not be any of the following:
a local authority
a National Health Service trust
an NHS foundation trust
a Primary Care Trust or
a Strategic Health Authority
524.Subsection (5) ensures that the arrangements can allow for local involvement networks to work together on a regional or national basis in relation to activities specified in section 221(2).
525.Subsection (6) enables arrangements to include the making of payments by the local authority and subsection (7) provides that arrangements must include the required provision about annual reports (see section 227).
Section 223: Arrangements: power to make further provision
526.This section places a duty on the Secretary of State to make regulations providing that the arrangements made by a local authority must require the host to include prescribed provision in the arrangements that the host makes when setting up a local involvement network. In particular, the regulations may require the local authority to require the host to include provisions relating to the ways certain decisions are to be taken by the local involvement network, the authorisation of individuals able to enter the premises of health and social care providers, the use of money by the local involvement network and the consequences if the local involvement network contravenes any provision of its arrangements with the host.
Section 224: Duties of services-providers to respond to local involvement networks
527.This section allows the Secretary of State to make regulations which will impose a duty on services-providers to respond to requests for information made by local involvement networks and deal with reports or recommendations made by local involvement networks. Before making any regulations, the Secretary of State must consult with such persons as he considers appropriate.
528.The meaning of “services-provider” given in sections 224 and 225 includes certain NHS bodies, local authorities (as defined in section 229) and any other person prescribed in regulations made by the Secretary of State.
Section 225: Duties of services-providers to allow entry by local involvement networks
529.This section places a duty on the Secretary of State to make regulations imposing a duty on services-providers to allow authorised representatives of local involvement networks to enter and view, and observe the carrying on of activities on, premises owned or controlled by services-providers. Such visits will enable local involvement networks to carry on, in particular, their activities in connection with the scrutiny and monitoring of local care services. Before making these regulations the Secretary of State must consult with appropriate persons.
530.Subsections (2) and (3) provide that the regulations may include provisions which place conditions, restrictions and limitations on the duty to allow entry by local involvement networks. This will allow the regulations to limit local involvement networks’ access to certain premises or in relation to certain activities to ensure patient safety and dignity or to ensure that their viewing of a facility is appropriate to the carrying on of local involvement networks’ activities. Regulations could, for example, limit access to an operating theatre when an operation is taking place. These provisions may require certain conditions to be satisfied before any duty arises, may describe those authorised representatives to whom the duty may or may not apply, may limit the numbers to whom the duty applies or may limit hours during which the duty applies.
531.Subsection (4) provides that any authorised representative entering premises as a result of these regulations must comply with all applicable conditions and restrictions imposed by the regulations.
Section 226: Local involvement networks: referrals of social care matters
532.This section provides that where a local involvement network refers a matter relating to social care services to an overview and scrutiny committee, that committee must acknowledge receipt of the referral and keep the referrer informed of the committee’s actions in relation to the matter. This section allows the Secretary of State to make regulations providing for the time in which the committee must acknowledge receipt of such a referral.
533.This section relates only to referrals of social care matters because there are existing regulation-making powers in section 244(2) of the 2006 Act which relate to scrutiny of health services. Together, the existing regulation-making powers, and the provisions of this section, will ensure that overview and scrutiny committees are required to respond to local involvement networks on the health and social care matters that they refer.
534.Subsections (3) to (5) require the committee to decide whether its powers are exercisable in relation to the matter and, if they are, whether or not they are to be exercised. In exercising those powers, the committee must take into account relevant information provided by a local involvement network.
Section 227: Local involvement networks: annual reports
535.This section sets out the required provision about annual reports referred to in section 222(7).
536.Section 222(7) requires that arrangements under section 221(1) entered into by a local authority with a host must include the required provision about annual reports. The arrangements will require that an annual report must be prepared, by each local involvement network put in place by the host, on the activities of the local involvement network in each financial year. Where a local involvement network does not produce an annual report, the arrangements must provide for the host to produce it. The arrangements must also require that the report complies with certain requirements set out in subsection (3), that the report must be prepared by 30 June following the end of each financial year and that copies of it should be made publicly available (having had regard to guidance issued by the Secretary of State that may be in force at the time) and sent to the bodies specified in subsection (4).
537.The requirements set out under subsection (3) are that the report must address such matters as the Secretary of State may direct and must include details of amounts spent in relation to the local involvement network’s activities. Where in any financial year there are activities for which a host is required to, but has not, put in place a local involvement network, the host will be required to prepare a report in relation to those activities, including details of amounts spent on those activities (which are likely to include amounts spent in attempting to put in place a local involvement network to carry on those activities).
Section 228: Transitional arrangements
538.This section provides for transitional arrangements between the end of Patients’ Forums and the start of local involvement networks. It places a temporary duty on local authorities to ensure that there are means by which the activities specified in section 221(2) can be carried on in their area in the event that contractual arrangements are not yet in place. Regulations will set the period that the temporary duty will last and may set out the ways in which the temporary duty may or may not be complied with (for example, making it clear that local authorities may not perform the activities themselves) and the reporting requirements that are to be imposed on the local authority and any person undertaking the activities under arrangements made by the local authority.
Section 229: Sections 221 to 228: interpretation and supplementary
539.Subsection (1) defines “local authority” for the purposes of sections 221 to 228.
540.Subsection (2) gives the Secretary of State power to make incidental, supplementary, consequential, transitory or transitional provision or savings when making regulations under sections 221 to 228.
Abolition of Patients' Forums etc
Section 230: Abolition of functions of Patients’ Forums
541.This section abolishes specified functions of Patients’ Forums, the Secretary of State’s regulation-making power to confer rights of entry on members of Patients’ Forums and regulation-making power to make provision about the membership of Patients’ Forums.
542.Subsection (2) makes provision for preparation of final reports and accounts, when the functions of the Patients’ Forums are abolished. Should this happen on a date other than at the end of the financial year, a Patients’ Forum must prepare annual accounts for the final reporting period as if that date were the end of the financial year. The report must be sent to the Commission for Patient and Public Involvement in Health within 2 months of that date.
543.Subsection (3) requires that the final report includes details of anything being done by a Patients’ Forum which is outstanding when these Patients’ Forum functions are abolished.
544.The final reporting period will end when this section comes into force, and runs from the preceding 1 April.
545.A Patients’ Forum is not required to prepare a report or annual accounts in relation to any period after the end of the final reporting period.
Section 231: Abolition of Patients’ Forums
546.This section abolishes Patients’ Forums by omitting the provisions of the 2006 Act which establish Patients’ Forums, provide for the appointment of their members and make provisions about Patients’ Forums’ annual reports.
547.Subsection (2) makes provision for the transfer of property, rights and liabilities of each forum to the Secretary of State for Health. Under subsection (3), any legal proceedings relating to anything transferred may be continued by or in relation to the Secretary of State for Health.
Section 232: Abolition of Commission for Patient and Public Involvement in Health
548.This section abolishes the Commission for Patient and Public Involvement in Health by omitting the provisions in the 2006 Act which establish the Commission and its functions.
549.Subsection (2) makes provision for the transfer of property, rights and liabilities of the Commission to the Secretary of State for Health. Under subsection (3), any legal proceedings relating to anything transferred may be continued by or in relation to the Secretary of State for Health.
550.Subsections (4) and (5) state that the Secretary of State may fix the Commission’s final reporting period once he is satisfied that the Commission has substantially carried out its function of reviewing Patients’ Forums’ final annual reports.
551.The final reporting period must begin on a 1st April, but can be longer or shorter than a year, as the Secretary of State fixes it.
552.The Commission is not required to prepare a report or annual accounts in relation to any period after the end of the final reporting period.
Consultation about health services
Section 233: Duty to involve users of health services
553.This section amends section 242 of the National Health Service Act 2006 (“the 2006 Act”) which sets out the current duty to involve and consult users of health services. This section also inserts new sections 242A and 242B into the 2006 Act.
554.Section 242 applies to Strategic Health Authorities, Primary Care Trusts, NHS trusts and NHS foundation trusts. However, the amendments do not change how section 242 applies to NHS trusts all or most of whose hospitals, establishments and facilities are located in Wales. The amendments do alter how section 242 applies to the rest of the bodies to which the section applies, and the bodies to which the amendments do apply are referred to as “relevant English bodies”. The amendments replace the existing duty imposed by section 242 on relevant English bodies with a new duty to make arrangements to involve the users of health services.
555.The new section 242(1B) provides that relevant English bodies must involve (whether by consultation or provision of information, or in other ways) users of health services in the planning of the provision of services, the development and consideration of proposals for change in the way services are provided and decisions affecting the operation of services. In relation to the development and consideration of proposals for changes to services, or decisions affecting the operation of those services, the duty to involve will arise only where the proposal for change to, or decision affecting the operation of, services would have an impact on the range, or manner of delivery, of services received by the user.
556.New section 242(1G) provides that a relevant English body must have regard to any guidance issued by the Secretary of State as to the discharge of its new duty under that section.
557.New section 242A confers a duty on the Secretary of State to make regulations requiring a Strategic Health Authority to make arrangements to ensure that users of health services are involved in matters specified in regulations. In complying with this duty a Strategic Health Authority must have regard to any guidance issued by the Secretary of State, about how the duty to involve should be carried out and when and how often that involvement should occur.
558.New section 242B gives the Secretary of State the power to make regulations enabling Strategic Health Authorities to give directions, in certain circumstances, to Primary Care Trusts in relation to arrangements that the Primary Care Trust might make for the involvement of patients and the public in accordance with section 242. Those circumstances are where the Strategic Health Authority will be making arrangements for involvement.
Section 234: Reports on consultation
559.This section amends the 2006 Act to impose a duty on Strategic Health Authorities and Primary Care Trusts to report, at times directed by the Secretary of State on consultations they have conducted, or intend to conduct, in relation to commissioning decisions for which they are responsible.
560.The reporting duty in respect of Primary Care Trusts will also apply to consultations not undertaken by a Primary Care Trust itself but which have an impact on commissioning decisions.
561.This section also places a duty on Strategic Health Authorities to prepare a report, at times directed by the Secretary of State, on certain other consultations it has carried out and what influence the views gathered have had on matters specified in that direction.
562.The Secretary of State has a power to give directions in relation to reports on consultation.
