Authorities (AHA) and the Community Health Councils (CHC). It should be stressed that in respect of CHC membership, there is no bar if the community or a local interest group nominates a health professional, administrator, or paraprofessional, and while informal "conflict of interest" safeguards do operate, there have been very few significant problems. Furthermore, many CHCs "co-opt" (ie. cooperate) local health professionals to informal subcommittees, and it is not uncommon to see the chief of a medical service, a senior nurse, a medical social worker, and a ward aid as members of CHC task forces or working parties. Many health service workers have the added ad·antage of both working in the service, often "at the shop front", and also living in the close neighborhood. The information and knowledge which they bring to the CHC and also to management and planning are of particular value and are to existing structures for joint complementary staff consultations. Many aspects of the selection and appointment procedures for HSA and SHCC members whether they be consumer or provider membershave shortcomings, not least those of artificiality. The concerns regarding the equity of consumer appointments have been voiced generally, but there are also problems regarding provider appointments. Perhaps this is due to the remoteness of the HSA from the operations of health care services which is largely a consequence of planning and management being divorced from one another. The HSA is still heavily institution-oriented rather than system-oriented, and its plans are developed around service monitoring rather than assessed outcomes. This suggests that provider appointments should be drawn more from people working in the field, and particularly from those involved in growing inter-agency arrangements for the provision of health care and social services. Certainly the public health nurse and the social worker, being trained observers and epidemiologically oriented, have more pertinent information about the state and needs of the population than do the solo-practice podiatrist, chiropractor, dentist, or even that rare bird, the family physician. b) In the House Bill proposed Amendment, Section 209, consumer representation is amended to include members who were not direct providers during the preceding twelve months. While this is clearly aimed at allowing former consumer members of neighborhood health centers of HMO boards to serve on HSAs and SHCCs where, under previous legislation, they could not except after a protracted period, it still does not permit a body of consumer board membership drawn from the widest reservoir of active and knowledgeable community representatives. The Senate Bill Section 110 deletes the requirement that a consumer not be a provider during the preceding twelve months, and since much of the criticism of consumer representation on HSAS has centered upon members' inability to function effectively in committee, and in regard to discussion and development of technical work and proposals, it would seem desirable that, as far as possible, encouragement be given to recruit community people who have practical knowledge of local health provisions and issues, experience in decisionmaking and management, and above all, who are accustomed to being accountable to local constituencies. III. Dual Membership of HSAs and SHCCs Many HSA consumer board members are now becoming members of SHCCs. In some cases, they are resigning their HSA memberships which means that the HSAs are losing experienced and knowledgeable people at the time when they can least afford it. In other cases, the HSA member is serving on both boards, and there are already signs that this dual committment is proving too demanding upon the individual, and resignations are expected. Dual membership would also lead to possible conflicts of interest. For example, the HSA member who is also a SHCC member assumes a part of the corporate responsibilities for both a Health Systems Plan and an eventual State Health Plan, The State Health Plan is made up of the HSPs of the HSAs within the state, and it can be assumed that one of the expected responsibilities of the HSA/SHCC member is as advocate of his or her own HSA's planning proposals. But once the State Plan is ratified, the dual member could be precluded from continuing to advocate local concerns in cases where there were differences over priorities between the state and local HSA. This was one of the main reasons why, in the British National Health Service Reorganization, Community Health Council members were given observer status on Area Health Authorities rather than voting membership. NOTE ON COMMUNITY PARTICIPATION IN THE BRITISH NATIONAL HEALTH Members of the Subcommittee will be aware that, under the National represent their communities on Health Care Planning Teams (HCPT) at the District and Area levels. It can be seen, therefore, that the British Community Health Councils provide their communities, on the one hand with a forum for discussion of local health care and health-related services concerns, and on the other hand with an institutionalized resource to assist them in presenting their needs and aspirations, as well as critique of services, to the managers and planners of the NHS. At a practical level, of course, the CHC provides the community with technical resources for monitoring services and needs. I shall be most happy to answer any questions raised and provide further information which may be required regarding this Testimony. I wish to place on record my thanks to the National Center for Health Services Research and the National Library of Medicine for providing me with the opportunity to study the contemporary American arrangements for health services planning. Julian J. Knox National Library of Medicine 8600 Rockville Pike Behtesda, Maryland 20014 February 1978 I wrote to you January 26 requesting opportunity, on behalf of the Some of our testimony on that legislation will have implications The Mental Health Association strongly supports the concept of integrated health planning with an identifiable mental health component. We therefore will generally support H.R. 10553 and express our appreciation for the introduction of this forward looking piece of legislation, in which for the first time this concept would be clearly articulated in law. For reasons which we will develop in our later testimony, we believe the amendments to P.L. 93-641 should include a requirement that the state authorized mental health planning be incorporated as an identifiable component within the Health Systems Plan and Annual Implementation Plan. We further believe that the state health plan approved by the State Health Co-ordinating Council should be required to include the state authorized mental health plan unless that plan and the planning process underlying it is not consistent with the provisions of P.L. 93-641. |