Alternatives to Litigation: Patient Advocacy: PALS, ICAS, etc.

Introduction

It is unfortunate that we have to begin this information by warning you that the bodies and procedures we are describing are extremely complicated.  We have tried our best to summarise the key information in the most straightforward way possible, but we recognise that this can be a confusing area.  If you are struggling to make sense of any of the bodies and services described on this page, please feel free to get in touch; we will be happy to talk things through with you.

As if things were not complicated enough, you should be aware that different systems apply in England, Northern Ireland, Scotland, and Wales.  On this page, we are only able to discuss in detail the services that are available in England.  We have, however, provided a summary of the system elsewhere in the UK, below.  If you require further information, please feel free to get in touch.

What Do we Mean by "Patient Advocacy"?

An advocate is someone who stands up for someone else, using specific knowledge and skills to argue their cause.  Patient Advocacy is the name given to a range of services through which individual patients are given access to support and representation, especially when they develop concerns about treatment they have received under the NHS.  The Health and Social Care Act of 2001 - which makes the provision of Patient Advocacy a legal requirement - defines this service as "assistance (by way of representation or otherwise) to individuals making or intending to make... a complaint under a procedure operated by a health service body".

Community Health Councils

It can be difficult to understand the current arrangements for the provision of Patient Advocacy without some knowledge of the system that used to be in place.  Until recently, most of the services described on this page were provided in England by organisations called Community Health Councils (CHCs).  CHCs were often referred to as "the NHS Watchdog".  They were responsible for ensuring that NHS organisations recognised the interests of their local communities.  Their work encompassed a wide range of responsibilities, from Patient Advocacy to involvement in "big picture" decisions (e.g. promoting the community's views when closures or changes in services were proposed).  They also had the right to conduct inspections of the NHS premises in their region.

Reforms to this system, including the abolition of CHCs, were first proposed in 2000, in a government paper called "The NHS Plan".  More detail was provided in another document - "Involving Patients and the Public in Healthcare" - in 2001.  After some fairly intense debate, the reforms were ultimately enacted in the National Health Service Reform and Health Care Professions Act of 2002.  (All these documents are available on-line: see the links section at the foot of this page.)

The various functions of CHCs have now been passed on to five new types of organisation.  Responsibility for Patient Advocacy has passed to two different organisations: Patient Advice and Liaison Services (PALS), and Independent Complaints Advocacy Services (ICAS).  We discuss both these services in detail, below.

The other three types of organisation that have been created to take over from CHCs are Patient & Public Involvement (PPI) Forums; the Commission for Patient and Public Involvement in Health (CPPIH); and local authority Overview and Scrutiny Committees (OSCs).  These bodies have more general responsibilities, and are unlikely to become involved in any individual patient's case.  They are discussed on our Regulatory Bodies page.