News and Comment

Patient and public involvement is becoming clearer … except for the big bit

Wednesday 30 November 2011

As the Health and Social Care Bill takes its final steps through Parliament its impact on patient and public involvement (PPI) is becoming clearer in some areas, but remains murky in one crucial area.

PPI is about increasing democratic accountability in the NHS and enhancing the power of the patient voice. The opportunities for this range from:

  • Giving individual patients much more of a say in their own health care: ‘no decision about me, without me’
  • Giving patients a voice in the services they use, from service design, through to implementation and evaluation
  • Engaging the public in decisions about local health priorities and proposed reconfigurations

When it comes to clinical commissioning groups (CCGs) the first two of these are quite a comfortable fit. Before CCGs are authorised by the NHS Commissioning Board they will need to have a PPI plan in place. While we have yet to see much in the way of detailed plans, involving individual patients in their own care and larger groups of patients in service design, implementation and evaluation lends itself to working with patients from practice lists and could involve using existing patient participation groups and other user groups.

Still muddy …

What is less clear, however, is how the wider community will be engaged in shaping health services in their area. This type of engagement clearly needs CCGs to reach out beyond their own patient lists to the wider public. It will also necessitate CCGs working together at a federated level. The question that keeps worrying me is where is this federated leadership going to come from?

Currently we are working with a primary care trust (PCT) on such a PPI project. All of the local CCGs are engaged in the project with the leadership and coordination coming from the PCT. The ground covered by the project includes substantial and potentially controversial service reconfigurations.

Press fast forward and play this scenario again in a few years or so and what would happen when difficult and controversial decisions need to be made? Depending on what you read and who you talk to it will either be carried out by private commissioning support organisations, patient representatives taking on a community role, community organisations, local HealthWatch or local authority structures such as health and well-being boards.

From the perspective of the public and patients, the success or otherwise of the government’s health reforms will be partly down to whether in a time of tighter finances and growing demands on health services CCGs are visible in providing leadership when faced with difficult challenges. Legitimacy is hard won but easily lost. As well as focusing on what happens internally by engaging their own patients, CCGs will need to focus on the bigger external picture and think about how they will engage with their wider communities and work with neighbouring CCGs.