comment: CPPIH's demise must renew determination to respond to local concerns

Published: 29/07/2004, Volume II4, No. 5916 Page 15

The Commission for Patient and Public Involvement in Health was born amid the storm over the scrapping of community health councils. The appointment of chair Sharon Grant was beset with widespread rumours of political expediency and the organisation struggled to achieve sufficient momentum from the word go. Patient forums clawed their way into existence, receiving widely varying levels of help and advice from the forum support organisations contracted by CPPIH.

CPPIH's credibility in the NHS and outside was holed below the water line. Its abolition (news, pages 8-9) is both necessary and welcome.

Those close to CPPIH and the decision to close it down will no doubt expend much energy in debating who is to blame for the organisation's failure. Most in the service will simply be left with a hollow feeling that - despite many good intentions - putting patients in a position of power and influence is still proving the most obvious missing piece in the reform jigsaw.

Health service managers across the country have become frustrated by the lack of progress made by patient forums. They know that patient involvement is the key to giving real weight to the choice and responsiveness agenda. They understand that an informed patient lobby is one of the best tools for driving through reform against entrenched special interests in the NHS.

But time and again, they find themselves trapped between a centrally driven agenda that leaves little room to respond to the wishes of public or patient groups, and representative bodies which are either under-powered or pursuing a resolutely singleinterest line. The will is there, but in many parts of the country the path to progress has yet to be found.

Last week, the Department of Health announced that trusts were going to be required to set their own local targets to stand alongside a radically slimmed-down set of national objectives. This is a golden opportunity to embed the wishes of public and patients in the future direction of the health service.

But as we have seen, the NHS is not in a good position to make the most of this opportunity and there is no quick fix on the horizon. Managers must, as ever, trust their instincts on the importance of public and patient involvement in reform and continue to support and encourage those who seek to play a part in improving the health service. It is this local relationship, rather than anything that happens in Whitehall or Westminster, that will deliver real change.