A time when the NHS is facing a major funding shortfall might not at first seem the best moment to argue for much more joined up patient and public involvement but financial pressures call for new and different ways of doing things. This means working not just with patients and carers but with local communities and the wider public as well.
In our work with the NHS we have found lots of examples of good practice but very little in the way of joined up thinking, planning and action on PPI. The NHS engages with the public in many different ways which can be summarised as:
- gathering feedback/compliments and complaints – eg friends and family surveys and the work of Patient Advocacy Liaison Services (PALS);
- involving patients and carers in service design and audits – eg Expert by Experience – and in developing innovative approaches – eg patient leaders – and in service user groups – eg in mental health and learning disability services;
- working with patients and the public as part of governance – eg membership of NHS trusts and boards and clinical commissioning groups – and patient reference groups in GP practices;
- recruiting the public to volunteering roles – eg as health champions;
- communicating with the public on a range of issues – eg via websites and newsletters;
- consulting with patients and the public about service plans or strategic direction.
- These different strands of engagement with patients and public are all too often separately organised and managed with little, if any, strategic leadership from the top of organisations. Hence, there is no overarching strategy which maximises engagement. For example, trusts may have hundreds of volunteers but fail to invite them to be part of a community consultation because it is organised by a different part of the organisation.
A lack of joined up thinking also means that members of the public who are engaged in one strand of PPI are unaware of other ways of getting involved, making it harder to move between different roles. This can perpetuate the “usual suspects” being involved in the more high level governance roles.
People who start out as volunteers might be willing to move on to something else once they have built their confidence and feel they have a stake in the organisation, but are not encouraged to do so.
This is particularly true of people from disadvantaged sections of the population who are likely to be underrepresented in governance roles. NHS organisations need to ask themselves whether moving between roles is made easy for people.
Part of the problem is that NHS organisations too often leave public engagement to a small number of comparatively junior specialist staff rather than considering how engagement skills can be built into mainstream management.
The governing bodies of NHS organisations can help address these issues by commissioning a systematic discussion which considers:
- how they currently engage members of the public as citizens, volunteers and service users and how they integrate these different strands;
- what training and development they offer their staff to support them in developing more co-production with the public;
- how their approach to public engagement links with that of other organisations in the community in particular the voluntary, faith and community sector and local government.
- More joined up PPI and better engagement with local communities has the potential to lead to more effective services, which are responsive to need and to more support for the NHS from local people – both essential in these challenging times.