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Primary care groups (PCGs) and primary care trusts (PCTs) are required to ensure that patient and public involvement underpins all activity. In Part 1, the literature review revealed many challenges to implementing this important measure of performance that would test those with responsibility for achieving a meaningful outcome for all stakeholders. Part 2 reports on a local study that used qualitative data from key stakeholders to examine how one PCG was responding to the involvement agenda. The findings revealed cynicism and doubt among board members about the purpose and value of involvement, despite which some progress had been made in engaging with local voluntary groups. However, the experience of involvement among local patients had not always been a positive one. It is suggested that issues of power and organisational culture will need to be tackled through greater investment in clinical and managerial staff development.

Exploring a brief history of patient and public involvement as a pathway to the present, the article considers whether we are close to achieving a system of public engagement in health and social care that can be truly held to account as enabling people to influence the decisions that affect their lives. Considering the most recent legislation and in particular local involvement networks the article looks more closely at ‘quality’ in public involvement and focuses on how we can work together through personal responsibility to achieve it.

This paper summarises five years' experience of patient and public involvement in primary care, citing examples from the Lanark practice and Clydesdale Local Health Care Co‐operative (LHCC) in Lanarkshire, Scotland. Strategic development and models which align primary care structures within a framework for patient and public involvement are described, along with barriers to implementation. Examples derived from clinical governance, health promotion and needs assessment include patient and carer involvement in significant event analysis and audit, joint training and patient‐held record cards. Positive outcomes reported are effective dialogue between health professionals, patients and the public, service developments and quality improvements. The success of initiatives is retrospectively assessed against the Audit Commission's critical success factors.

The purpose of this paper is to consider the issues which emerge when an autonomous, professional, member‐led organisation attempts to demonstrate its accountability to patients through lay involvement in its standard‐setting processes.

The paper reports a project, which is still in progress and could be described as action research. Data were collected through participant observation in a series of discussions and working groups. A limited literature search was carried out at the start of the initiative but found little which relates to lay involvement in professional bodies.

The paper finds that patient involvement in a professional body is unlikely by itself to be a useful mechanism for delivering greater professional accountability.

The paper is a single case study and can only suggest hypotheses for further research.

The paper shows that professional bodies of various types are increasingly being asked to demonstrate public involvement in their decision making. It is important to identify the most effective mechanisms for this and the limitations inherent in the structures of organisations, which are accountable primarily to their members.

The paper shows that individual doctors are held to account through a number of mechanisms, but little attention has been given to how medical professional bodies can be made more accountable for the collective power they hold. Patient involvement is interpreted within a consumerist model, which focuses on the doctor‐patient relationship and ignores the considerable strategic influence which medical royal colleges exercise within the health service.

Primary care groups are required to demonstrate that patients and the public are involved in the planning, delivery and evaluation of the services they provide. However, a review of the literature suggests that managers' ability will be greatly tested if they are to achieve meaningful progress in this area. Some suggestions are made to assist managers in this important role. In the next issue of MCC, Part 2 reports findings from a locality case study.

With the recent publication of The Engagement Cycle (DH, 2009a), exploring the issues surrounding patient and public involvement (PPI) in World Class Commissioning, it seems timely to look at how this type of involvement/engagement has developed in recent years. Set against official rhetoric that emphasises the importance of PPI in the NHS, this paper is informed by evidence emerging from a three‐year research project into the development of practice‐based commissioning conducted at Manchester University. It is suggested that commissioners (primary care trusts and practice‐based commissioners) need to think deeply about the meaning of public involvement in their context, while at national level strategies should be flexible enough to allow a diversity of approaches which may ultimately allow PPI to flourish.

The purpose of this paper is to examine the role of service user and carer involvement in NHS research and describe the nature of this involvement in three specialist mental health Trusts. It also aims to discuss the value of service user and carer involvement and present the perspective of the service user and research manager.

The paper reviews patient and public involvement policy and practice in the NHS and NHS research. It examines the effectiveness of involvement activity and utilises a case example to demonstrate the impact of patient/service user involvement on the NHS and the individuals who take part.

The paper concludes that service user involvement is essential if research is to support the development of health services that clearly reflect the needs of the service user and impact positively on service quality.

Service user involvement is an established element of NHS research and development at both national and local level. The Department of Health strategy for research, Best Research for Best Health, reiterates both the importance of research that benefits the patient and the involvement of the service user in the research process. Despite this, the changes in Department of Health support funding for research, introduced by the strategy, may inadvertently lead to some NHS Trusts experiencing difficulty in resourcing this important activity.

The paper illustrates the effectiveness of successful patient and public involvement in research. It also identifies how involvement has developed in a fragmented and uncoordinated way and how it is threatened by a failure to embed it more consistently in research infrastructure.

The purpose of this paper is to compare user involvement in the case of assisted reproductive technologies in England and Portugal through the concepts of voice, choice and co-production, assessing the implications for user empowerment.

This qualitative study draws primarily on policy review and uses exploratory semi-structured interviews with key informants as a way of illustrating points. Data on the following themes was compared: voice (users’ representativeness on licensing bodies and channels of communication between users and doctors); choice (funding and accessibility criteria; choice of fertility centres, doctors and level of care); and co-production (criteria through which users actively engage with health professionals in planning the treatment).

Inter- and intra-healthcare systems variations between the two countries on choice and co-production were identified. Differences between funding and accessibility, regions, public and private sectors and attitudes towards doctor-patient relationship (paternalistic/partnership) were the key issues. Although consumer choice and indicators of co-production are evident in treatment pathways in both countries, user empowerment is not. This is limited by inequalities in accessibility criteria, dependence on doctors’ individual perspectives and lack of genuine and formal hearing of citizens’ voice.

Enhancing users’ involvement claims for individual and organizational cultures reflecting user-centred values. Effective ways to incorporate users’ knowledge in shared decision making and co-design are needed to empower patients and to improve the delivery of care.

Reducing waste in health care can result in savings that could be used to meet the projected shortfall in NHS funding or to meet the care needs of vulnerable groups. Patients and their families can contribute to the identification and reduction of waste. To do so their understanding of the costs of health care and treatment needs to be increased. The paper aims to discuss these issues.

The approach formed part of the Close Partnering work stream of the NHS Future Focused Finance (FFF) programme. Included in this was a review of the literature relating to waste reduction, patient engagement and reference to experts in the field of public and patient engagement. Engagement of the patient voice in the NHS FFF programme to provide the patient perspective and engage in discussions with patients. Discussions with experts in patient and public involvement and clinicians were also undertaken.

The public and patients have little awareness of NHS finances and generally perceive efforts to reduce costs and achieve efficiencies as impacting on the quality of care. Engaging the public and patients in discussions about the costs of health care is challenging and existing methodologies for patient and public engagement may not be appropriate for what could be termed difficult conversations.

Increasing patient awareness of the costs of health care and treatment may result in patients and the public demanding greater involvement in decisions about health care expenditure and use of resources.

Difficult conversations with patients and the public about the costs of health and their role in reducing waste are rarely invited. This paper brings to the fore the issues and challenges that such discussions engender.

This paper aims to set out a framework that can be used for locating strategies for incorporating patient and public involvement (PPI) in the wider process of translative healthcare research.

This paper is analytical and synthesizes knowledge from several disciplines in order to provide a coherent framework for understanding the scope and purpose of PPI. The framework sets out four idealised strategies for PPI based on mode and purpose of involvement. The paper concludes by summarising a range of implications for organisations involved in the governance of translative healthcare research.

The framework defines four idealised strategies for PPI in translative healthcare research. The strategies range in purpose from collecting patient data, through to improving public involvement and knowledge with respect to healthcare research.

The framework presented has direct relevance for agencies concerned with the management and governance of translative healthcare research. The framework is relevant when either designing or auditing research pathways in terms of PPI activities. The framework is also important in highlighting to healthcare leaders, researchers, patients and the wider public, the potential role of participation in healthcare research.

This paper's value is that it combines perspectives from the wider literature on innovation, user‐led design and participation, to the problem of translative healthcare research.