Patient and Public Involvement
NHS England(1) recommends that NHS Commissioners should:
- Make arrangements for and promote individual participation in care and treatment through commissioning activity.
- Listen and act upon patient and carer feedback at all stages of the commissioning cycle – from needs assessment to contract management.
- Engage with patients, carers and the public when redesigning or reconfiguring healthcare services, demonstrating how this has informed decisions.
- Make arrangements for the public to be engaged in governance arrangements by ensuring that the CCG governing body includes at least two lay people.
- Publish evidence of what ‘patient and public voice’ activity has been conducted, its impact and the difference it has made.
- CCGs will publish the feedback they receive from local Healthwatch about health and care services in their locality
According to NHS England (2), evidence suggests that engaging and involving communities in the planning, design and delivery of health and care services can lead to a more joined-up, co-ordinated and efficient services that are more responsive to local community needs. Public participation can also help to build partnerships with communities and identify areas for service improvement.
NHS England (3) suggests that services are better designed around the needs of patients, service users and carers when they are involved in the commissioning process. Enabling public participation also provides other specific benefits for those who contribute including:
- Improved self confidence;
- Better understanding by the public of how the NHS operates;
- More appropriate use of health services;
- Shared responsibilities for health care between NHS services and the public.
Continual and open dialogue between commissioners, local leaders, community members and other stakeholders fosters a culture of transparency and trust. Commissioning decisions are better supported when people are involved in identifying problems and designing solutions that work.
The recent report, Changing care, improving quality (June 2013)(4) developed by the Academy of Medical Royal Colleges, NHS Confederation and National Voices, calls for meaningful engagement of key stakeholders, including the public, patients and health professionals in proactive well planned service changes.
Insight gathered from the public helps to improve services and outcomes as well as potentially helping to spot failures.
Listening to and using the voice of patients and the public were never more forcefully presented than in the Francis report.
The use of patient and staff focus groups in the Keogh review into the quality of care and treatment provided by 14 hospital trusts in England was probably the single most powerful aspect of the review process and ensured that a cultural assessment, not just a technical assessment, could be made.
Experience shared from Coastal West Sussex CCG:
“Once the annual commissioning priorities have been set for your CCG, as part of any scoping or service development the patient voice is very powerful. Nationally available information via Patient Voices is helpful and other groups such as the voluntary sector particularly specific groups such as Epilepsy Society and Epilepsy Action will often have intelligence though past patient surveys for you to use. It is helpful to have patient representatives as part of a multi-disciplinary steering group when the commissioning process moves into the co-design phase. The NHS is legally obliged under Health & Social Care Act 2012 as a statutory duty to involve the public in all the commissioning steps through to implementation. The timing for engagement should begin early while plans are still under consideration so views can be genuinely taken into account. Timeframes should be proportionate and realistic to allow stakeholders sufficient time to provide a considered response and the length of time will depend on the size of service improvement or redesign. It is worth noting and not underestimating the amount of resource good patient engagement takes. Resource is categorized as the amount of time it takes overall, the number and skill set of people needed to conduct the patient engagement process, to include any analysis, and the amount of funding that will need to be allocated from a CCG budget.”
1-3: Patients and information directorate, NHS England, 2013. ‘Transforming participation in health and care – the NHS belongs to us all’, available at http://www.england.nhs.uk/wp-content/uploads/2013/09/trans-part-hc-guid1.pdf
4: NHS Confederation and National Voices, 2013, ‘Changing care, improving quality’.