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NORTH WEST LONDON PATIENTS' PARLIAMENT

Patient and Public Involvement in Strategic Decision-Making in North West London

Parliament Governance Materials


© Health Link

Strengthening public influence on health

CONTENTS

1. CONSTITUTION

2. STANDING ORDERS

3. APPENDIX A PROTOCOL

4. APPENDIX B PARLIAMENT CODE

5. APPENDIX C MEMBER DECLARATION

6. APPENDIX D DECLARATION AND REGISTER OF INTERESTS

CONSTITUTION

1. Aim

North West London Strategic Health Authority supports local NHS organisations to deliver an equitable, patient-led NHS across North West London and to improve the health of the residents of the London boroughs of Ealing, Hillingdon, Brent, Harrow, Hounslow, Kensington and Chelsea, Hammersmith and Fulham and the City of Westminster, (known as the North West London sector). The aim of the North West London Patients’ Parliament is to bring a patient perspective to that work by

promoting equality of access to high quality health services across North West London;
promoting the patients’ interest in the planning, decisions and policy-making of the North West London Strategic Health Authority;
facilitating the involvement of the residents of North West London, including disadvantaged or diverse communities, in the work of the Strategic Health Authority.
2. Objectives:

The North West London Patients’ Parliament will:

Contribute a diverse patient and public perspective to the following activities by the Strategic Health Authority:
- Planning health services
- Planning changes in how health services are provided
- Decision-making which affects the operation of health services
Advise the Strategic Health Authority on how to fulfill its patient and public involvement duties under Section 11 of Health and Social Care Act 2001
Support the Strategic Health Authority in implementing the Race Relations (Amendment) Act 2000, the Disability Discrimination Act 1995 and any other Equal Opportunities legislation.
3. How the Patients’ Parliament will work towards its objectives

3.1 Principles for the Parliament:

The North West London Patients’ Parliament will adopt the following principles in its work:


Partnership: The Patients’ Parliament will work in partnership with the North West London Strategic Health Authority, in accordance with the Protocol attached at Appendix A.
Equal Opportunities: The Patients’ Parliament aims to promote and practise Equal Opportunities in all its internal and external activities, avoiding:
- Direct or indirect discrimination in the recruitment of Parliament Members
- Victimization, discrimination or harassment by a Parliament Member, which in either case, may lead to disqualification from the Parliament.
Inclusion: The Patients’ Parliament will work towards involving groups who are unable or unwilling to engage in formal processes, in its work. Such groups may include (depending on the work concerned) black and ethnic minority groups, faith groups, homeless people, refugees and asylum seekers, care home residents, children and young people, carers, those who are disabled, or suffer long term conditions and who are on low incomes or otherwise disadvantaged in time, skills or motivation.
Networking: The Patients’ Parliament will share its work with existing patient and public involvement structures and networks covering N W London, including PPI Forums and Overview and Scrutiny Committees.
Geographical equity: the Parliament shall have regard to equity across the sector. No Parliament Member shall promote the interests of their own area of residence over those of the sector as a whole, although the Parliament as a whole must have regard to health inequalities and the need to address them.
Constructive review: the Patients’ Parliament will make constructive and practical recommendations to the Strategic Health Authority on how best to serve the public and patients’ interest across North West London
Evaluation: the Patients' Parliament will monitor, evaluate and report on progress in meeting its agreed objectives, to improve its accountability and develop its capacity.
3.2 Principles for Parliament Members
Parliament Members will be required to adopt the Nolan Principles of Public Life in their role within the Parliament, namely:

Accountability
Honesty
Integrity
Leadership
Objectivity
Openness
Selflessness
4. Accountability of the Parliament
The Patients’ Parliament is accountable for meeting its objectives to the residents of North West London Strategic Health Authority. Individual Patients’ Parliament Members are accountable for their own conduct to the Patients’ Parliament through the Chair. All Parliament Members shall agree to be bound by the Parliament Code for Patients’ Parliament Members (attached at Appendix B)

5. Patients’ Parliament Membership
5.1 A Membership Committee comprising the Chair of the Parliament, a representative of Health Link, a trainer nominated by Health Link and an independent assessor, will appoint Parliament Members on the basis of merit.

5.2 There will be up to 25 Patients’ Parliament Members. Membership of the Parliament shall comprise at least two members from each of the eight boroughs in the North West London sector (not including the Chair), with other members being co-opted on an ad hoc basis when their expertise is needed.

5.3 Parliament Members shall serve a term of two years or until earlier resignation or termination in accordance with Standing Orders.

5.4 Any resident over 18 living in the North West sector is eligible for membership of the Patients’ Parliament if they have been a patient of the NHS during the ten years preceding their application.

5.5 A person shall be disqualified from membership of the Patients’ Parliament if the person:

a) is
­ an employee, officer or member of any NHS organisation including the Strategic Health Authority; or
­ employee, officer or member of any company or organisation which holds a contract for the provision of health services to any NHS organisation; or
­ a member of a Local Authority Health Overview and Scrutiny Committee; or
­ a provider of staff support to the Patients' Forum under a contract between the Commission and an organisation of which they are an employee, officer member or representative;

b) has within the preceding five years been dismissed, other than through redundancy, from any paid employment with a health service body; or
c) has had their previous tenure as chairman, member or director of a health service body terminated on the grounds that
­ it was not in the interests of the health service that they should continue to hold office; or
­ they failed, without reasonable cause, to attend any meeting of that body for a period of 3 months or more; or
­ they failed to declare a pecuniary interest or withdraw from consideration of any matter in respect of which they had a pecuniary interest;
d) is an undischarged bankrupt.
e) has previously been removed from trusteeship of a charity by a Court or the Charity Commissioners.
f) is subject to a national disqualification imposed by the Family Health Services Appeal Authority or the National Health Service Tribunal; or
g) has been refused nomination or approval to fill a vacancy for a medical practitioner or refused admission to, or removed or suspended from, a primary care list, and has not subsequently been approved or, as the case may be, included in a primary care list; or

6. Register of Interests
A Register of Interests shall be maintained by the Parliament recording any interests of Members which may conflict with the aims and objectives of the Parliament

7. Secretariat
7.1 Health Link shall provide the secretariat to the Patients’ Parliament, facilitate the work of the Parliament, advise on governance and provide support to Members, including payment of reasonable expenses, for a period of three years.

7.2 Health Link shall act impartially and promote and protect the independence of the Patients' Parliament.

7.3 Health Link is accountable under its contract with the Strategic Health Authority for its performance and the Strategic Health Authority shall take advice from the Patients' Parliament Members in any review, renewal or enforcement process arising from that contract.

8. Independence and Right to Challenge

The Parliament will be facilitated as an independent organisation by Health Link. Health Link works to the principles of the Compact on Relations between Government and the Voluntary sector, and has the right, as a voluntary sector organisation, to campaign, to comment on policy, and to challenge policy, ‘irrespective of any funding relationship that might exist, and to determine and manage its own affairs.’(Compact on Relations between the Government and the Voluntary Sector Home Office 1998)

STANDING ORDERS

1. Meetings
The Patients’ Parliament shall meet six times a year.

2. Officers
2.1 At each Annual General meeting Parliament Members shall elect a Chair to preside over meetings of the Parliament and liaise with the Strategic Health Authority and the Parliament’s network.

2.2 The Chair shall

preside at meetings.
have overall responsibility for Equal Opportunities
act as spokesperson for the Patients' Parliament in consultation with the Vice Chair whenever possible.
2.3 At each Annual General Meeting, the Patients’ Parliament shall elect a Vice Chair to preside over general meetings of Parliament in the absence of the Chair.

2.4. All elections to Chair or Vice Chair shall by a simple majority of those entitled to vote, irrespective of whether there is more than one prospective candidate.

2.5 Until the first General Meeting of the Parliament in January 2006, Elizabeth Manero of Health Link shall preside at meetings and fulfill the functions of Chair
until the election of a Chair in January 2006.

2.6. In standing for election, prospective officers indicate their agreement to undertake whatever training is prescribed for them by the Membership Committee if they are elected.

3. Notice of Meetings
Written notice, giving time, place and business of the meeting shall be sent to every member at least 7 days before the date of the meeting by post, unless individual members elect to receive it by email.

4. Conduct of meetings
4.1 All meetings of the Patients’ Parliament will be open to the public but the Parliament may resolve to meet in private if information is to be discussed or disclosed which the Parliament Code requires to be kept confidential.

4.2 Meeting papers will be available on the North West London Strategic Health Authority website as soon as they are sent to Parliament Members.

4.3 In the absence of the Chair and the Vice Chair, those present may appoint a member to preside at a meeting.

4.4 No business shall be transacted at the meeting unless at least one third of the Parliament Members, including at least one Member from each of the eight North West London boroughs, is present

4.5 The minutes of meetings shall be made, recording actions agreed and Parliament Members present. Agreed minutes shall be available for inspection by Parliament Members and others through Health Link.

4.6 All Motions must be proposed by one Member and seconded by another.
Any Member wishing to move a Motion at a meeting shall send a copy of the Motion to Health Link at least 5 days before the date of the meeting with details of the Proposer and Seconder.

4.7 Emergency Motions with a Proposer and Seconder may be accepted at the discretion of the Chair at the start of any meeting.

4.8 Representatives of the Strategic Health Authority may be invited to attend meetings of the Patients’ Parliament by invitation, as observers and shall nominate an officer to liaise with the Parliament and act as first point of contact.

4.9 Members of the public may attend all meetings of the Patients’ Parliament held in public and speak at the discretion of the Chair, but not vote.

4.10 The proceedings of meetings shall not be taped without the consent of the person presiding.

4.11 The Chair may at his or her discretion limit the time for which each speaker may speak, adjourn the meeting or exclude any person acting in a way which disrupts the proper process of the Patients' Parliament.

5. Voting
5.1 Decisions may be taken by consensus unless a Parliament Member requests a vote, in which case that member shall form a Motion upon which the Parliament Members shall vote, if seconded.

5.2 Each Member present shall have one vote.

5.3 Except on an amendment to the Constitution and Standing Orders, decisions shall be made by a simple majority of those present. In the case of an equality of votes, the person presiding shall have the casting vote.

5.4 Amendments to the Constitution and Standing Orders or Motions to suspend Standing Orders shall require a majority of two thirds of those present.

5.5 If a Member so wishes, his/her vote shall be recorded by name.

6. Membership
6.1 All Members shall sign a Declaration in the form attached at Appendix C confirming their agreement to:

abide by the Parliament Code
observe the Protocol with the Strategic Health Authority.
Undertake the training from time to time prescribed by the Membership Committee.
6.2 Members shall disclose any pecuniary interest (direct or indirect) they may have in any matter under consideration by the Parliament and shall withdraw from Parliament discussion on that matter.

7. Complaints
7.1 All complaints made about Parliament Members, the Strategic Health Authority or Health Link shall be resolved informally if possible.

7.2 A complaint made about the conduct of a member by another member, by the Strategic Health Authority or by any other person, which cannot be resolved informally, shall be subject to the following Complaints Procedure:

a) The complaint shall be made in writing to the Chair, with a copy to Health Link, within six months of the incident complained of.
b) If the Chair is unable to resolve the complaint to the satisfaction of the complainant, it may be referred to the Membership Committee within 28 days of the decision of the Chair;
c) The Membership Committee shall consider the complaint, taking evidence for all parties, and shall rule on the complaint within a period of six weeks of receipt. The decision of the Membership committee shall be final.

7.3 Complaints about Health Link shall be considered by a sub-committee of the Patients' Parliament led by the Chair, who may make recommendations to the Strategic Health Authority.

7.4 Complaints about the Strategic Health Authority by a Patients' Parliament member shall be governed by the NHS (Complaints) Regulation 2004 as a complaint concerning the Strategic Health Authority functions under Section 11 of the Health and Social Care Act 2001.

8. Termination of Membership
8.1 The membership of a Parliament Member may be terminated by the Membership Committee if the Committee unanimously concludes that it is not in the interest of the Patients’ Parliament for that person to continue as a member because he or she has acted in substantial breach of the Parliament Code and the Chair and Vice Chair recommends disqualification to the Membership Committee.

8.2 A Parliament Member shall be disqualified where he or she fails to attend 2 consecutive general meetings without giving a good reason

9. Support for Members
In any process related to a complaint about a member or the termination of their membership, Health Link shall, at the request of the member concerned, select an independent person (not including a legally qualified person) to act as a supporter to the member concerned and shall pay the reasonable expenses of that person.

10. Disputes between the Patients' Parliament and the North West London Strategic Health Authority

10.1 If it is not possible to resolve a dispute between the Strategic Health Authority the Patients' Parliament through informal discussion, an external mediator or facilitator will be appointed to investigate the concerns and help resolve them.

10.2 Both parties shall agree upon the person appointed to act as a mediator and their expenses shall be borne by the Strategic Health Authority.

10.3 As a public body, the Strategic Health Authority can ultimately be called to account by the Ombudsman in connection with a complaint relating to its functions

11. Special Meetings
11.1 The Chair may call a meeting at any time.

11.2 A Special Meeting shall be called at any time if requested by at least one third of the Parliament Members.

11.3 The Strategic Health Authority may request a special meeting of the Patients' Parliament, which may be agreed at the discretion of the Chair

11.4 The agenda for Special Meeting will only include apologies for absence and the item for which the meeting has been called.

12. Annual review and report
12.1 Each year the Patients’ Parliament shall hold a Review meeting where Patients’ Parliament Members and Strategic Health Authority staff will identify how far objectives were met and what they have learnt.

12.2 Each year the Patients’ Parliament shall hold an Annual General Meeting where it will present to the Strategic Health Authority its annual report of activities and elect the officers.

13. Sub committees
13.1 The Patients’ Parliament may appoint sub committees consisting wholly or partly of Parliament Members.

13.2 A sub committee will have no formal decision-making power and may only make recommendations to the Parliament based on its findings.

13.3 Sub committees may co-opt non Parliament Members. Any person who is co-opted to a subcommittee will be required to abide by the Parliament Code.

14. Annual Review
This Constitution and Standing Order and the documents attached as Appendices shall be reviewed by the Patients' Parliament in discussion with the nominated representative of the Strategic Health Authority once a year as part of the Annual Review.

APPENDIX A:

PROTOCOL BETWEEN THE NW LONDON PATIENTS' PARLIAMENT AND THE NORTH WEST LONDON STRATEGIC HEALTH AUTHORITY

1. Purpose - The North West London Patients’ Parliament has been established by the North West London Strategic Health Authority to bring a patient perspective to its work

2. Role of North West London Strategic Health Authority – The NHS in the North West London sector consists of 10 hospitals, 8 Primary Care Trusts (who plan and fund local services and provide non hospital care) and two Mental Health Trusts. North West London Strategic Health Authority is responsible for:

Promoting a comprehensive health service in the London boroughs of Ealing, Hillingdon, Brent, Harrow, Hounslow, Kensington and Chelsea, Hammersmith and Fulham and the City of Westminster, (known as the North West London sector).
Managing NHS organisations in the sector so that the quality of healthcare is improved and monitored, against standards set by the Department of Health
Consulting and involving patients and patient representatives in planning services, planning changes in services and any decisions affecting how services operate.
The functions of the Strategic Health Authority are laid down by law and they are instructed by the Department of Health on what they are expected to achieve.

3. Role of Patients’ Parliament – the Parliament is responsible for:

promoting equality of access to quality health services across North West London;
promoting the patients’ interest in the planning, decisions and policy-making of the North West London Strategic Health Authority;
facilitating the involvement of the residents of North West London, including disadvantaged or diverse communities, in the work of the Strategic Health Authority.
The Patients’ Parliament is an arms-length body funded by the Strategic Health Authority but supported and facilitated by an independent not for profit organisation, Health Link.

4. Commitments of the North West London Strategic Health Authority –
The Strategic Health Authority makes the following commitments to the Patients’ Parliament:

a) Respect: to respect the independence of the Parliament

b) Consultation: to invite the Parliament to discuss plans as they are being developed
c) Partnership: to take account of the views of the Patients’ Parliament and explain its reasons if it does not follow any Parliament recommendations and to nominate a lead officer to act as first point of contact for the Parliament.
d) Information: to provide information that appears to the Parliament to be necessary for the effective conduct of its business, excluding information
­ relating to an individual in connection with their employment or their health, or which otherwise requires their consent to disclosure under Data Protection Act where such consent is not forthcoming.
­ which is exempt under the Freedom of Information Act)
e) Local connection: to facilitate placements for Parliament Members in local NHS organisations as part of their training
f) Meeting rooms: to facilitate the use of local NHS facilities for Parliament meetings if required.

5. Commitments of the Patients’ Parliament - the Patients’ Parliament makes the following commitments to the Strategic Health Authority:

a) Constructive Contribution: to contribute constructively to the work of the Strategic Health Authority
b) Inclusion: actively to seek out the views of the most diverse range of residents in the North West London sector and give due weight to these views in its discussions and recommendations
c) Confidentiality under the law: to keep confidential any information which relates to, and identifies a living individual or is confidential by law
d) Agreed Confidentiality: to keep to any agreement made with the Strategic Health Authority to keep information confidential in accordance with the Parliament Code and the Constitution and Standing Orders.
e) Overriding Public Interest – to discuss in advance with the Strategic Health Authority any proposal to breach agreed confidentiality because of overriding public interest. Such action shall require a Motion passed by the Parliament in accordance with its Standing Orders and the Disputes Procedure set out in the Parliament’s Standing Orders may be invoked.
f) Media and the press: to discuss with the Strategic Health Authority any press release the Patients’ Parliament proposes to issue, at least one working day in advance of planned release to agree the accuracy of its content and to report the content of any impromptu discussion between the press and the Parliament to the Strategic Health Authority as soon as practically possible.

g) Annual work programme – to develop a work plan for each year, taking account of the work programme of the Strategic Health Authority and any issues identified by the Parliament as relevant to the health of the population of North West London, which is within the functions of the Strategic Health Authority.



6. Disputes and complaints
Any disputes or complaints shall be discussed informally in the first instance by the Strategic Health Authority representative and the Chair.

If such informal discussion does not resolve the dispute or complaint the Strategic Health Authority or the Patients’ Parliament may follow the Disputes or Complaints Procedure in Patients’ Parliament Constitution and Standing Orders.

APPENDIX B

CODE OF CONDUCT FOR PARLIAMENT MEMBERS

Members of the Patients’ Parliament are committed to local NHS services and give significant personal time to this. This guidance applies to all Members, including co-opted Members. It aims to ensure that Members are aware of the expectations and responsibilities placed on them and the standards to which they should adhere as they take part in public life.
The effectiveness of the Patients’ Parliament depends in part on the public’s perception of their reputation and standing. The Patients’ Parliament is likely to be more effective if it has a reputation for speaking with authority on the basis of direct experience and knowledge of the views and opinions of patients and the local communities.

1. Personal Commitment
Before appointment, all Members will sign a declaration stating that they will act in accordance with this Code.

2. Values that underpin the work of the Patients’ Parliament
a) Accountability: Parliament Members are accountable for their decisions and actions to the public and must submit themselves to whatever scrutiny is appropriate to their role
b) Honesty: Parliament Members have a duty to declare any private interests relating to their role in the Parliament and to take steps to resolve any conflicts arising in a way that protects the public interest.
c) Integrity: Parliament Members should not place themselves under any financial or other obligation to outside individuals or organisations that might seek to influence them in the performance of their official duties.
d) Objectivity: judgments made by Parliament Members must be based on fact, rationality and evidence avoiding partiality or prejudice
e) Openness. Parliament Members should be as open as possible about all the decisions and actions that they take. They should give reasons for their decisions and restrict information only when their Parliament Code demands this.
f) Selflessness: Parliament Members should act solely in the public interest and not in order to gain financial or other benefits for themselves, their family or their friends.

3. Equal Opportunities and diversity
a) The Parliament aims to ensure that

Equal Opportunities are promoted and practised in all its activities
Members and volunteers have Equality of Opportunity within the Parliament
No one receives less favourable treatment on the grounds of gender, race, disability, colour, nationality, ethnic or national origin, marital status, sexuality, responsibility for dependants, religion, trade union activity or age.
b) The Chair has overall responsibility for Equal Opportunities and will ensure that the policy is properly implemented, monitored and periodically reviewed in accordance with the relevant statutory provisions. Members who have concerns about Equal Opportunities in the Parliament should raise this with the Chair or Vice Chair in the first instance.

4. Personal conduct
a) Members should conduct themselves in a manner, which maintains the integrity of the Patients’ Parliament and its standing with the public, the NHS and other bodies with which they communicate.
b) Members are expected to conduct themselves with courtesy and consideration for others, whilst retaining the ability to be constructively critical where this is appropriate.
c) Members should normally only act as a representative of the Parliament, whether in a public forum or in private or informal discussion, with the prior knowledge and approval of the Chair.
d) Members’ behaviour should accord with the spirit and the detail of the Parliaments Equal Opportunities policy. Racist, sexist, homophobic and other discriminatory remarks and behaviour will not be tolerated.
e) Members should not use their Membership to gain media or other attention to further their personal, organisational, commercial or party political interests.
f) Members should always aim to act impartially and not be influenced by personal, social, political, and professional or business relationships, and should declare a potential conflict of interest where they may have one. They should not pursue causes or problems of particular individuals, groups or nominating bodies to the exclusion of their wider responsibilities.

5. Corporate responsibility
a) Members have a responsibility to respect and promote the corporate or collective decision of the Parliament, even though this may conflict with their personal view.
b) Members are free to comment as they wish as individuals. However, if they decide to do so they should make it clear that they are expressing their personal view and not the Parliament’s view. This applies particularly if the Parliament has yet to decide on an issue or has decided in a way with which they personally disagree.

6. Financial accountability
Members should obtain authorisation from the Secretariat before incurring expenses on parliamentary business and be able to account for them. Unauthorised expenditure may be challenged by health service auditors and in extreme cases can leave the individual member open to legal proceedings.

7. Geographical equity
Members are appointed to the Parliament to represent the interests of the whole of the population covered by the NW London Strategic Health Authority. They should actively seek to make contact with minority and disadvantaged groups in order to be able to represent all sections of the community regardless of their own interests or preferences.

8. Declaration of interests
a) All potential Members should consider whether there is or will be the possibility of a relevant and material conflict of interest arising if they join the Parliament. If there is a possible conflict of interest they should discuss the issue with Health Link before joining.
b) If a new member has a conflict of interest, or the possibility of one exists or becomes apparent during their tenure, this should be declared and recorded immediately it is identified. The onus to declare an interest lies with the member. Members could be challenged for not disclosing an interest if one came to light. The Parliament holds a Register of Interests that is open to public inspection on request.
c) If a conflict or interest arises during the course of Parliamentary business, the member should declare the interest immediately. The Patients’ Parliament will decide in each individual case if it is appropriate for the member to take part in the relevant parts of the discussion. Members having any concerns about actual or potential conflicts of interest should discuss them with the Chair.

9. Confidentiality
In carrying out the work of the Parliament, Members do not require information about individual patient’s identity, illness, condition, or nature of treatment, and should not seek it. If patients willingly disclose such information in the course of discussions, Members should receive this in the strictest confidence.
a) The Parliament may from time to time receive information that exempt from disclosure under the Freedom of Information Act.
b) If the Patients’ Parliament has agreed to receive such information in confidence Members should respect this confidence and not disclose the information to unauthorised persons or bodies without consent of the Strategic Health Authority, or other body which provides the information.
c) In certain circumstances, however, the duty to maintain confidence could be overridden, for example by statutory requirement, common law or where the public interest favours disclosure.
d) Any member, who disagrees with a proposal being presented to the Parliament in confidence by a health body, should raise this with the Chair, who may take up the issue with the Strategic Health Authority. It is open to a Member to invoke the Disputes Procedure set out in the Parliament’s Constitution and Standing Orders through the Parliament. Any member acting unilaterally in disclosing such information may be subject to a formal complaint.

10. Gifts and hospitality
Members should be very careful about accepting any offer of a gift or hospitality made to them because they are Members of the Patients’ Parliament. Articles of low intrinsic value, such as diaries or calendars, modest and reasonable hospitality, (e.g. a working lunch) or small tokens of gratitude may be accepted, but anything of greater value or significance should be politely but firmly declined. If in any doubt Members should consult their Chair prior to accepting any gift.

11. Dealing with the media
a) All contacts with the media should go through the Chair. If the media approaches a Member because they are Members of the Parliament, the enquiry or request should be referred to the Chair.
b) When speaking as a Member of the Patients’ Parliament, whether to the press, in a public forum or in a private or informal discussion, Members should ensure that they reflect the current policies or view of the Parliament. They should do so only with the prior knowledge and approval of the Chair but when this is not practicable they should report their action to the Chair as soon as possible.
c) Members should make sure that the comments are well considered, sensible, well informed, in good faith, in the public interest and without malice, and that they enhance the reputation and status of the Parliament.

APPENDIX C

MEMBER DECLARATION

1. I declare that:

­ I am over age 18
­ I reside in the North West sector
­ I have been an NHS patient at some time during the last ten years

2. I am not:

­ an employee, officer or member of any NHS organisation including the Strategic Health Authority; nor
­ an employee, officer or member of any company or organisation which holds a contract for the provision of health services to any NHS organisation; nor
­ a member of an Local Authority Health Overview and Scrutiny Committee; nor
­ a provider of staff support to the Patients' Forum under a contract between the Commission and an organisation of which they are an employee, officer member or representative;
­ an undischarged bankrupt
­ under a disqualification order under the Company Directors Act 1986
­ under a national disqualification imposed by the Family Health Services Appeal Authority or the National Health Service Tribunal; or

3. I have not

­ within the preceding five years been dismissed, other through redundancy, from any paid employment with a health service body; or
­ had any previous tenure as chairman, member or director of a health service body terminated on the grounds that
i. it was not in the interests of the health service that I continue to hold office; or
ii. I failed, without reasonable cause, to attend any meeting of that body for a period of 3 months or more; or
iii. I failed to declare a pecuniary interest or withdraw from consideration of any matter in respect of which I had a pecuniary interest;
­ been removed from trusteeship of a charity by a Court or the Charity Commissioners.
­ been refused nomination or approval to fill a vacancy for a medical practitioner or refused admission to, or removed or suspended from, a primary care list, and not subsequently been approved or, as the case may be, included in a primary care list; or

4. I am aware that the Strategic Health Authority may undertake a Criminal Records Check if my work on the PP should require it.

5. I undertake to fulfill my responsibilities and duties as a Member of the Patients’ Parliament in good faith, in accordance with the law and within the Parliament's objectives.

6. I agree to undertake the training prescribed from time to time by the Parliament’s Membership Committee.

7. I have read the Parliament Code for Patients’ Parliament Members and agree to abide by this.

8. I have read the Protocol for Relations with the Strategic health authority and agree to observe this.

9. I do not have any financial interests in conflict with those of the Patients’ Parliament (in person or through family or business connections) except those which I have formally notified a conflict of interest statement.

10. I will declare any such interest at any meeting where the Patients' Parliament is required to make a decision which affects my personal interests. I will absent myself entirely from any decision on the matter and not vote on it.

11. I undertake to notify Health Link or the North West London Strategic Health Authority if I any of my circumstances referred to above should change during my tenure.



Signed……………………………………………………Dated………................................

APPENDIX D

DECLARATION OF INTERESTS

Print Name………………………………………………………

I, ……………………………………..as a Member of the North West London Patients’ Parliament set out below my interests, as required by the Parliament’ conflicts of interest policy
Category Details of the interest and whether it applies to the Parliament Member or a member of their immediate family or other personal connection
Current employment and any previous employment in which you continue to have a financial interest
Appointments (voluntary or otherwise) e.g. trusteeships, directorships.
Membership of a political party (specify)
Membership of any professional bodies, special interest groups or mutual support organisations.
Gifts or hospitality offered to you by external bodies and whether this was declined or accepted in the last 12 months
Any contractual relationship with the North West London Strategic Health Authority or other NHS bodies
Any other conflicts that are not covered by the above

To the best of my knowledge, the above information is complete and correct. I undertake to update as necessary the information provided, and to review the accuracy of the information on an annual basis. I give my consent for it to be used for the purpose described in the Constitution and Standing Orders and Parliament Code but for no other purpose.


Signed…………………………………………………….

Print Name……………………………………………………

Date:………………………….



Name of Member Description of interest Relate to Member or person closely connected to Member? Current Interest Y/N Date registered
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