Tuesday, 20 January 2004
"Every Voice Counts, Not Just Patients"
Andrew Craig responds to Florin and Dixon’s BMJ article on public involvement:
Editor - Florin and Dixon’s dissection of the rationale for public involvement in health care is curious1. They philosophise about its meaning and even its desirability when, for everyday NHS purposes, the Health and Social Care Act 2001 settled the issue. Section 11 of the Act is an unambiguous “must do”: NHS Trusts, PCTs, Strategic Health Authorities and Ambulance Trusts must make arrangements so that ‘persons to whom ….services are being or may be provided are, directly or through representatives, involved in and consulted on’ all aspects of service planning and operation. This is about more than current patients.
We have copious “how to do it” guidance. Patient and public involvement is even one of the six pillars supporting the hallowed temple of clinical governance. Foundation Trust hospitals have been brought within the statutory public involvement net too. The time for speculating is over. Now we need empirical evidence that involvement makes a difference to how services are commissioned and provided and, crucially, how they are perceived and experienced by users.
Health and social care is a continuum of services from the users’ perspective. Their involvement along that continuum is, after all, only a process. It should be leading to shared power in decision-making and genuine user-provider partnerships that improve things for all concerned. There are no short cuts or quick fixes to this type of involvement, as the national evaluation we undertook for the Department of Health of the Pilot Patients’ Forums found2. Joint health and local government investment in realistic community development strategies is needed for sustainable engagement to take root.
It is not a question of needing to shift the emphasis to patient involvement, as Florin and Dixon suggest, at the expense of the more diffuse public involvement dimension. Trying to increase the responsiveness of health services means that every voice counts, not just patients3. But they rightly highlight the underdeveloped opportunities presented by user participation in primary care settings, especially as many users no longer recognise themselves in a depowered “patient role”.
Our local experience in Wandsworth suggests that user participation groups in GP practices can create learning opportunities for mutual trust, responsibility and partnership which will stick when applied on the wider health care canvas. These benefits should not be overlooked in the dash for more involvement. Supporting practice-based participation could open new channels for compliance with consultation and involvement requirements and create a lasting dividend in the form of complex user involvement structures reaching out into the community. But it will take investment as well as good intentions to achieve that.
1 - Florin D, Dixon J. Public involvement in health care BMJ 2004; 328: 159-161
2 - Moore Adamson Craig Partnership (November 2002) Building Capacity for Pilot Patients’ Forums: the experience of recruiter and recruited
(links to Adobe PDF) www.mooreadamsoncraig.co.uk
3 - Anderson W et al. Every Voice Counts: primary care organisations and public involvement. Kings Fund, London: 2002