Date Published: 14 March 2008

British Medical Association warns of loss of patient voice (UK)

Patients will have less influence over the running of the NHS in England from next month, according to the British Medical Association (BMA).

A new BMA discussion paper stresses the need for clear structures that allow the full involvement of the public and patients in NHS decision-making processes. It is critical of plans to replace existing Patient and Public Involvement (PPI) forums with Local Involvement Networks (LINks).

LINks are due to be introduced in the NHS in England in April 2008. They will be fewer in number (one per local government authority) than PPI forums, and will have no over-arching national body to co-ordinate their work. The funding for LINks will come through local authorities and will not be ringfenced.

Juliet Dunmur, chair of the BMA Patients Liaison Group, said that:

If LINks are given guidance and performance standards, they could provide a new way of empowering patients and the public. However, the new mechanisms have deliberately been left vague in order to allow them to adapt to local circumstances. This begs the question whether they can actually be effective.

Although I believe some will be able to work effectively with local NHS and social care organisations, others will find it impossible to build the capacity to influence powerful organisations or challenge their decisions. This could lead to further inequalities.

The BMA paper is the second in a series of the future of the NHS as it approaches its sixtieth anniversary. It argues that greater public participation in decision-making can foster a better understanding of the realities facing the NHS, but highlights several weaknesses in the plans for LINks, including:

  • They will be poorly funded
  • They will reduce the capacity for patients and the public to exercise genuine influence over healthcare
  • They may be too closely allied to Local Authorities to be independent of local politics
  • Their lack of national co-ordination will not allow sharing of information at a national level

The paper proposes that:

  • New models of involvement should be examined, for example those used by Community Police Consultative Groups
  • PPI activities must be accessible to all relevant groups, with more effort to target marginalised groups
  • The PPI process must be transparent, with feedback mechanisms built in

Dr Hamish Meldrum, Chairman of BMA Council, said that:

The public pay for and use the NHS. They have a right to be involved in its running. Unfortunately, there is little or no confidence that the plans for LINks will improve public engagement, and the likelihood of the new bodies remaining independent seems remote. Engaging ‘ordinary’ people can be difficult but it is crucial that we try harder to achieve this if we are to deliver an NHS that can respond to the needs of the public and patients in the 21st century.”

The full document used to be available for download from:

Source: British Medical Association, UK

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