Horizontal or Vertical Support: Dilemmas for Patient Advice and Liaison Services in the NHS

Every hospital, mental health, primary care and specialist trust in the English National Health Service (NHS) should have a Patient Advice and Liaison Service (PALS), to provide information and support to NHS patients with questions or concerns. PALS should also act as a catalyst for service improvement. This article draws on findings from a qualitative study of London PALS. In particular, itfocuses on data generated during observation ofmeetings ofPALS staff in each ofLondon'sfive Strategic Health Authority (SHA) sectors, over a period of nearly two years. It describes two types of support received by PALS staff horizontal peer support (the sector meetings themselves; other informal and local PALS contacts; the National PALS Development Group) and vertical hierarchical support (the trusts where PALS are based; Strategic Health Authorities; the Department of Health (DoH)). PALS staff appreciated horizontal support more unequivocally than vertical. Both types of support (horizontal and vertical) reflect parallel government agendas. The Government intends the NHS to become a much flatter hierarchy, and in non-hierarchical structures, staff are expected to look to peers for support. However, a centralised performance management regime also requires staff to look upwards for guidance. As 'boundary spanners ' working between services and service users, PALS staffare at risk of isolation, and need both types ofsupport to be effective