I was one half of a rather heated exchange of views over the weekend about the Health and Social Care Bill, which as just limped over the Parliamentary finish line into law, battered, bruised and in a slightly different shape to when it set out – but in law nonetheless and now the Health & Social Care Act. My sparring partner said ‘but I thought it was all about patient voice. How can you, of all people, be opposed to that?’. And of course, I’m not. Bigger issues of the Bill aside, let’s look at what we know about patient voice and how this might now play out.
If patient views are to be at the heart of the new arrangements there needs to be a way of making sure people’s voices are heard, but this is no simple task. The Clinical Commissioning Group (the group that will be making decisions about how health money is spent at a very local level, made up of GPs and health professionals) will be obliged to prove that they have adequate engagement mechanisms in place but of course we cynics in the voluntary sector want to know exactly what that means. The answer is that no one knows yet.
The CCG has just drafted a paper on Engagement in health (full catchy title: Brighton & Hove Clinical Commissioning Group (CCG) proposal for reviewing and developing its engagement with patients, carers, the public, strategic partners and stakeholders by 31st March 2013) which sets out its current thinking about how this will happen. The first part of the paper is a really useful trot through what partnerships and engagement mechanisms exist at the moment, if you’re in to that kind of thing, although it is not clear which of these will exist in the medium to long term.
The detail of their current proposal for involving patients in the new world of Clinical Commissioning is on page nine, and a handy diagram is provided. In a consultation on this yesterday we spent a long time discussing how this model might work and while we were glad to be involved in a (relatively) early stage of the discussions, many concerns were expressed. These included: complexity of the model, resources that would be needed for this to be meaningful, the relevance of the locality tier of the model, what notice would actually be taken of the ‘shadow board’, ability of patients to take part in a meaningful and representative way, barriers to involvement that would be faced by specific groups of people such as those with learning difficulties, concern that the two lay reps on the Clinical Commissioning Group would have an impossible task or their roles would be tokenistic…and more.
To these I would add my own fear that a clinical commissioning group made up almost exclusively of GPs may have a narrow view, based on their own experiences and assumptions, they will need to work really hard, and demonstrate patience and commitment to engaging well across all the different groups in their areas. This will not be easy. In addition, the paper states clearly that they wish to work with the Council to integrate engagement – which is of course shorthand for ‘we need to save money’.
So, while we welcome involvement in this stage of discussions, and applaud the CCG for their efforts to make this meaningful, I am still fearful that the massive changes that are going on in health will not enable all patient voices to be heard, just a certain kind of voice that likes to engage in complex structures, cares enough to commit to many hours a week and who is probably pretty well engaged already.