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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.

Both authors have been involved as lay members in research and other activities for a number of years, ensuring they represent the views of members of the public. This chapter identifies what is, and what is not, patient and public involvement as well as highlighting the importance of involving members of the public in all aspects of the research process. Best practice is explored as identified in the UK Standards for Public Involvement 2019 and the UK Policy Framework for Health and Social Care Research 2020. The implications of the Mental Capacity Act and its wording on research matters are also considered. Case studies have been incorporated to highlight the impact of involving patients and members of the public in all aspects of the research process. These include the lessons learnt by researchers and lay members of the team. The aspiration is to move towards more collaboration between members of the public and researchers; therefore, we discuss co-production of research or community-based participatory research (CBPR). We highlight the need for a better partnership between researchers and members of the public. The benefits of this are explored along with the consequences for all involved.

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.

Purpose – The chapter aims to understand what kind of policy approach has been more successful in facilitating the involvement of patients and the public in the design and provision of health-care services at the local level and the explanatory factors justifying the implementation outcome.Methodology – By applying Richard Matland's ambiguity/conflict policy implementation model, the chapter analyses the impact of a number of policies introduced after 1997 in the English National Health Service that targeted final users and the local population in decision-making processes.Findings – The evidence shows that policies emphasising the importance of context-specific contingencies can be more effectively implemented when room for interpretation and discretion in selecting the appropriate means for involvement is given. In this way, the overall aims/purposes of health policies can be locally reshaped by allowing the adoption of flexible strategies within the implementation process.Practical implications – A strong leadership at the top of public sector organisations and, in particular, from the board of directors is needed to steer and facilitate a consensus oriented outcome in organisational decision-making processes that aim to incorporate the views and opinions of patients and the public.Social implications – Local initiatives in increasing participation, for specific purposes, are bound to be more successful than a general initiative, expecting comparatively uniform implementation.