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Just how much influence is the government genuinely prepared to give service users in shaping care trusts?

The effectiveness of patient and public involvement forums (PPIFs) for mental health and social care trusts is diminished by the structures and funding systems in which they operate.

The roles and powers of PPIFs include: monitoring and reviewing services directly provided by the trust (or organisations that the trust has paid to provide services for patients); getting the views of patients, users and carers about those services; and making reports and recommendations to the trust based on the views of patients and the public.

But to monitor a user’s experience of mental health services effectively, a forum would need to look at the whole journey from the point at which someone goes to see their GP, through rehabilitation and community care, to their return to everyday life. Only a few people are referred on to secondary mental health care, yet the forum is not empowered to inquire into services at primary care level.

PPIFs can comment though, as part of the trust’s annual health check, on whether a particular trust has met the Healthcare Commission’s core standards. But funding arrangements may not allow them to carry out the important job of monitoring whether the needs of mental health patients are being adequately met.

Often, the relationship between health and local government is lacking. In some mental health trusts, local authorities “work in partnership” with the health service but do not pool their budgets. In many areas numerous community care services required to meet the national service framework for mental health are provided by private and voluntary providers under local authority contract. But, where budgets are not pooled, a mental health and social care trust PPIF can only concern itself with services funded by the NHS. This can prevent the PPIF properly monitoring community care services for people with mental health problems.

Given all this, how much influence can the public really have over what goes on?

The writer is a member of a mental health and social care PPIF