13. Following the workshop - reflections on the CHC review document
Following the workshop, we received comments from experienced and committed former CHC members:
* What is on offer is not markedly different from what we have at the moment, except that the whole CHC mechanism is more centrally driven.
* The CHC review proposed local area committees, but this will not be effective unless resources are made available to sustain extra work, especially were areas are currently underperforming.
* Ambiguity still remains within the NHS II consultation. There is much mention of localism and the importance of the third sector, but it is not at all clear how this chimes with the CHC role and the call for greater direct engagement by citizens.
* The 1974 CHC model is no longer fit for purpose in that citizen and service user expectations go beyond health, and now combine health and social care solutions.
* The remodelling of CHCs should have prompted an opportunity to integrate consideration of health and social care issues, noting the local authority and third sector role on both the CHC and SRG. Does this lack of progress, at a pivotal juncture, reflect the absence of thinking through these issues involving different political structures, with much less political control of social care experience and how this varies across Wales? This leaves unanswered the question of the beneficial impact of social care spending on the care and wellbeing of older people, as compared with an extra pound spent on the NHS.
* It is a great pity that we still have two separate planning structures for health and social care within WAG, with some liaison, but not effective co-planning.
* New CHCs will be faced with large bureaucratic, centrally managed organisations, focused upon the demands of Ministers and senior civil servants. A greater sense of strategic action will be required for CHCs to impact in this new environment.
* As a starting point, CHCs should have access to all patient/service user complaints, suitably anonymised, and automatically notified of investigations related to service user safety/public protection and the action taken by the employer/the professional regulator (if any) to prevent failures in the health system/approach to regulation.
* To avoid a tick box approach to the patient/service user experience will require a new approach to developing a system, able to use information technology with a human face to highlight issues, concerns, priorities and areas for improvement. With local authority agreement, given the large number of older people using the public library service, could they be used to key in information once people have recovered from illness.
* The effectiveness of the new arrangement, with all the extra duties envisaged, will depend upon the effectiveness of CHC staff, chairpersons and lay members - their training, mentoring and support - which should be informed by new and imaginative methods of data capture and reaching out to people. See, for example, the attached food survey questionnaire, which is also available on line. http://www.welshfoodalliance.org.uk/survey
A Cardiff patient brought to our attention a GP survey being undertaken on behalf of the Assembly Government. The problem is that it did not provide an opportunity to raise concerns inside the surgery. However, this could be achieved at little if any extra cost to government, through the professional health regulation branch of the Assembly who could promote and support patient involvement through promoting and supporting patient involvement in 360 degree questionnaires to be used as part of the GP revalidation process. See previous submission by David Smith, dated 31st December 2008. Why can we not use new web technology to enable citizens to comment directly on services provided in GP practices and more generally across the NHS and social care?
A former regional health authority member brought our attention to English NHS developments. She discovered that from 1 April 2009,
http://www.kingsfund.org.uk/publications/articles/proms_counting_what.html the NHS will become the first health system in the world routinely to collect patient-reported outcome measures. Newly released guidance for PCTs and hospitals sets out what needs to be collected, when, and by whom and how the new data will be integrated with other routine patient statistics.
The NHS Standard Contract makes it a requirement that the monthly clinical quality performance report should include patient-reported outcome data for four areas - operations on hips, knees, hernias and varicose veins. Nationally, (England) this should mean around 250,000 patients a year will be reporting on the state of their health.
The Kings Fund says, "It's hard to overstate how profound the impact of PROMs could be for the NHS, patients and the public. For the first time there will be a quantified measure of both the generic and disease-specific quality of care patients receive from the NHS. PROMs go way beyond simply asking 'Are you satisfied?' Using detailed questionnaires they will elicit patients' assessments of aspects of their health-related quality of life - how mobile they are, their mental state, their overall health etc. Similar questionnaires have been used for years in clinical trials and more recently by BUPA to evaluate their consultants' quality of care and to feed back to patients".
Meanwhile, issues concerning more effective patient and public engagement in the Clinical Governance process have been raised, but this has elicited no response from the responsible official.
Policy Advisor, Welsh Food Alliance and the former Welsh Lay Member of the CHRE
16th February 2009
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