Bill to abolish patients' forums criticised as “disgraceful”

BMJ 2007; 334 doi: (Published 25 January 2007) Cite this as: BMJ 2007;334:177
  1. Clare Dyer, legal correspondent
  1. 1BMJ

    A UK government bill to reform the way patients and the public participate in decisions about local health services had its second reading this week in parliament, where it faces opposition from the Conservatives and Liberal Democrats.

    The Local Government and Public Involvement in Health Bill will abolish patients' forums and replace them with local involvement networks (LINks). It will also modify the duty to consult the public about changes in health service provision.

    In the place of patients' forums, local authorities will be put under a duty to make contractual arrangements for the involvement of people in the commissioning, provision, and scrutiny of health services and social services.

    LINks will cover social care services as well as health, will be established for a geographical area, and will decide locally how members will be appointed and how others will contribute. They are intended to reach out to a wide range of existing local groups.

    The decision to scrap the relatively short lived patients' forums is highly contentious, and opposition MPs protested at the move during the second reading debate on Monday. MPs were concerned that the reform had been inserted in a bill from the Communities and Local Government Department, which was primarily about local government.

    A Conservative MP, John Baron, said it was “disgraceful” that plans to do away with the forums had been “tacked on to a long and contentious bill dealing with local government rather than health.” He spoke of “deep felt anger” about the reforms, adding, “It's almost like ministers are trying to sneak these measures in, hoping no one will notice.”

    Richard Taylor, an independent MP and former NHS consultant, said patients' forums had good links with local communities and health groups and were “thoroughly effective.”

    He added, “I have no objection to reform or change if it is needed. But the constant changes that we have had over the past 20 years that have appeared to be really change for the sake of change I think have been intolerable and in the long run counterproductive.”

    Ruth Kelly, the local government secretary, said some patient forums had as few as eight members, but the new LINks would allow “hundreds, if not thousands” to be involved.

    On Monday the department announced that a government amendment to the bill would require local authorities and primary care trusts to work together to produce a strategic assessment of the health, health care, and social care needs of the local area.

    Examples given were putting more emphasis on tackling obesity or placing a greater focus on home care, which would allow older people to be cared for in their own homes. “These priorities will then form part of the overarching community strategy for the area and could be supported by funding from the Local Area Agreement or other mainstream sources. This means that through different authorities working together, the services provided more fully meet the genuine needs of the community,” said a departmental statement.

    The bill also modifies section 11 of the Health and Social Care Act 2001, which places a duty on strategic health authorities, primary care trusts, and NHS trusts to consult patients and the public in planning services, considering changes, and making decisions that affect how services operate. The section was used last year by residents of a former mining village in Derbyshire to win an appeal court ruling that they had not been properly consulted over plans to contract out their primary care services to a US healthcare company.

    The bill amends the duty to require consultation only on “significant” changes—those that would have a substantial impact on the manner in which services are delivered or the range of services available to users.

    The health reforms in the bill apply to England, with provision for the Welsh assembly to adopt them if it wishes.

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