Where next for User Involvement?
Professor Jonathan Tritter Chief Executive NHS Centre for Involvement Presentation at
Public Involvement in the NHS: Is LINks the way Forward? Friend’s Meeting House, Coventry 25 June 2007
Outline:
- The evolution of Involvement in UK Health Policy
- Thinking about Involvement
- Introducing the NHS Centre for Involvement
- How are we organised and what do we do
- The Future of Patient and Public in England
- PPI in Commissioning
- Local Involvement Networks
Patient and Public Involvement in the NHS
Long history:
- 1974 - Establishment of Community Health Councils
- 1992 - Citizen’ Charter Initiative
- 1999 - Patient and Public Involvement in the New NHS
- 2001 - The Health and Social Care Act 2001
- 2002 - NHS Reform and Health Care Professionals Act 2002
- 2006 - The Local Government and Public Involvement in Health Bill
Does User = Patient, Carer, Consumer, Customer or Citizen?
For the UK Government
User Involvement = Patient and Public Involvement
“This is a package of radical reform. It will enhance and encourage the involvement of citizens in redesigning the health service from the patient’s point of view.” (Department of Health, 2000: 95)
Choice and Involvement? Foundation Trusts
Why involve users?
Legitimacy - Of approach - Funding and organisation
Relevance
Different kinds of questions
Focus on process and experience not just outcomes
Participation
Support, Co-production and Compliance
Impact
- Efficiency and effectiveness of care
- More acceptable patient pathway
Conceptualising user involvement
User participation in decisions about treatment and care
User involvement in service development
Planning and design of services
Commissioning
User evaluation of service provision
Public Accountability rather than Patient Satisfaction
Regulation
User involvement in teaching
User involvement in research
At all stages of the research cycle
Potential Pitfalls of User Involvement
- Marketisation
- Individualisation rather than collectivisation
- Customer surveys not involvement
- Private sector
- Cream skimming
- Undermining risk pooling
- Tokenism
- Capture by medical elite
- Capture by managerial elite
- Capture by local political elite
- Apathy or unwillingness to be ‘involved’
- Tensions between ‘choice’ and ‘involvement’
Involvement to Impact
PPI accepted practice
Lack of clarity about how to do it
about who to involve
Direct and Indirect involvement
- Direct: people playing a part in making decisions
- Indirect: people as source of experience, ideas and information
Need to focus on Impact
Making a difference
Evidence that PPI has had an influence on practice
The NHS Centre for Involvement
Response to an European-wide Tender
Successful Consortium
- University of Warwick
- LMTA - an alliance for health
- Centre for Public Scrutiny
The Centre announced on 24 May 2006 The Health Minister Rosie Winterton
Start of set-up phase from 1 June 2006
Formal launch 28 November 2006
Funded for three years in the first instance
What the Centre does:
Supporting NHS staff and organisations across England to engage with patients and the public more effectively and implement change based on their information
Working with NHS organisations and staff to integrate user involvement systems into everyday working
Fulfilling obligations under Section 11 Health and Social Care Act 2001 (and its successor)
Working with the Healthcare Commission - The Regulator on how to inspect compliance
Organising our Work:
- Research and Best Practice
- Gathering and generating evidence
- Methodological development
Organisational Development
- Working with NHS Organisations to build PPI Systems
- Meeting Core Standard 17
Learning and Support
- Identifying and responding to needs
- Curriculum development
- Identification and accreditation of providers
The People Bank
Patient-Citizen Exchange & PPI Professionals Exchange
Horizon Scanning: UK Policy Challenges
Local Involvement Networks (LINks)
Voluntary and Community organisations
Health and Social Care
Patient and public involvement in commissioning
Practice Based Commissioning
Increased commissioning from non-NHS providers
Increased Patient Choice
Local Government and Public Involvement in Health Bill (2006)
Local Involvement Networks (LINks)
- Promoting and supporting the involvement of people in the commissioning, provision and scrutiny of local care services
- Obtaining the views of people about their needs for, and their experiences of local care services
- Making the views known through reports and recommendations about how local care services might be improved (Part 11 Section 153 subsection 2)
2nd Reading in House of Lords
In to committee 21 June
DH response to Parliamentary Health Select Committee Inquiry in to PPI 11 June 2007
Expected Royal Assent October 2007
LINks Operational from 1 April 2008
Host organisations commissioned for three years from 1 April 2008
How will LINks Work?
LINks will assist NHS provider organisations to engage with the local community to improve services
LINks will set their own agenda and focus on issues of concern to local people and seek to influence change
LINks will be integral in commissioning decisions to ensure they reflect the views of local people
National Voices
National LINks
Established in all Local Authority who commission social services 153 across England
LINks will be supported by a Host organisation
Contracted by Local Authority
Commission/deliver tailored programme of learning and support
New money from DH (circa £100k/year)
Formula based
Pooling resources with LA involvement activities on social services
LINks and accountability
- Accounting to the local community
- To the regulator(s)
- To local providers
- To local commissioners
Accounting for the views of local people
- Priorities for local services
- Evaluation of local services
- Responsiveness by local services
PPI and Commissioning
PPI at all points in the commissioning cycle
- Plan
- Contract
- Monitor
- Revise
- Commissioning along Patient Pathways
- PPI in Practice Based Commissioning
- Opportunities
- Problems
Piloting LINks
9 Pilot and Early Adopter Sites across the country
- Capturing the Learning
- Ongoing dissemination through NCI website
- Initial report of learning early July 2007
Working with:
- the Healthcare Commission,
- the Commission for Patient and Public Involvement in Health
- Department of Health (and others)
Governance arrangements to balance stakeholders
Wariness and mistrust of Local Authorities
Establishing set of ‘ground rules’ for behaviour and the consequences of inappropriate behaviour
Geography is important
Community profiling and mapping the voluntary sector central to effective set up
LINks annual reports should be analysed to identify regional and national issues
Feedback to individual LINks
Need for clarity and control of payments to individual LINks members
Little attention to collaboration between LINks
Particular concern for Ambulance Services
Little attention to defining success criteria or measurement of impact
Procurement of a Host
Some work on pooling resources for Host to cover three LINks areas
Limited work on how a LINk identifies an issue and engages with the topic
“One of the key roles of civil society organizations is to hold health care providers as well as governments accountable for what they do and how they do it….yet without mechanisms enabling people to hold officials accountable, stewardship may falter. To enable effective pressure for accountability, accurate information about health and health systems performance is required throughout civil society.” (WHO, 2003: 126)
The NHS Centre for Involvement
- Modelling and facilitating transformation
- Building capacity
- Supporting a sustainable approach to change
Contact us at: nhscentreforinvolvement@warwick.ac.uk