NHS bodies commissioning care need to show leadership and passion for involving patients and the public

In the reformed NHS, new mechanisms for involving patients and the public are being developed. In this post Mark Gamsu sets out how Clinicial Commissioning Groups – the GP-led bodies that now commission most local health services – need to show stronger leadership in this area, working in partnership with local authorities and others.

The complex and changing relationships between organisations in patient and public involvement. Credit: Mark Gamsu

NHS England published new guidance last month on Transforming Participation in Health and Care. One of the areas that I think needs exploring further is the leadership role of the new Clinical Commissioning Groups (CCGs) in relation to patient and public involvement (PPI).

First, let’s be clear – the guidance is helpful, it is comprehensive and includes lots of examples of good practice with easy access to back up material. However it is technical guidance – it is concerned with how to do it – and does not directly address the leadership role of the CCG in partnership with the local authority for setting the tone and ambition for patient and public involvement in a place. Not addressing this risks PPI remaining something that can be turned off and on by commissioners because it is not culturally embedded in the local system.

Local authorities and CCGS must work in partnership to lead on promoting good practice on participation locally. This is a leadership issue – here I set out which organisations need to show leadership in this area to ensure we make participation happen.

Leading patient and public involvement

As I said in a previous post for Local Democracy and Health, there are a small number of organisations who have leaderships role for Patient and public involvement at a local authority level. There are not many of them – they are:

The local authority
The Clinical Commissioning Group

Good practice in provider organisations

Then there are those organisations that have a major responsibility in ensuring that their practice with regard to patient and public involvement is as best as it can be. Key ones include:

NHS provider trusts
Social care providers
Voluntary and community sector care service providers
Private sector providers
Other providers whose services improve wellbeing, like housing, education, and so on.

Delivery of voice and advocacy

While they have responsibility within their organisations but no formal responsibility for leading good practice at place level. However, their scale and the fact they provide the services means that this is the arena where the bulk of PPI happens. This is a challenge for commissioners.

The third group of organisations are those funded to support the development of patient and public engagement and delivery of voice – many of these are in the community and voluntary sector these include:

Advocacy organisations, including Healthwatch
Infrastructure organisations such as Councils of Voluntary Service
Healthy living centres and Locality members – who may provide community development services.

Wider organisations

Click to read more posts about democracy in the NHS on Democratic Audit.

Finally, there are organisations who have an important contribution to make to fostering citizenship and engagement – many of these are in the education and learning sector – schools, further education, the Workers Education Association and Universities.

Crucially this is not just an agenda for the health and care system – it is essential that health contributes to citizen engagement more generally. I know this is obvious – but health will struggle to move services from hospital to community or address the social determinants of health unless it recognises that it has a key role in contributing to a wider citizen engagement agenda.

There is a real danger that unless CCGS are clear about their leadership role at local authority level with regard to PPI then their focus will be predominantly on how they commission services rather than also considering how people are enabled to engage, participate and contribute to improving health and wellbeing in an area. The image above encompasses some of the key relationships.

Actions for Clinical Commissioning Groups

Here are some actions that I think fall from this:

First, CCGs need to empower those with a responsibility for PPI in their organisations. This must require some sort of structural mechanism – a strategic PPI committee which reports to the board. Membership should include non-executive director PPI leads, relevant directors, and Healthwatch. It should also have strong links with big NHS provider organisations with PPI leads, and link to the local authority and voluntary and community services.

Second, CCGs should work with local authorities through the Health and Wellbeing Board to develop a local authority level Community Engagement strategy this needs to reach out to a wider agenda that includes the development of volunteering, community development, etc – part of this must include a joint commissioning plan that sets out how key infrastructure organisations are supported.

Third, this is a developing area – no one has the right answer. CCGs need to be seen as one of the key organisations that are interested in co-producing solutions. So, CCGs should use their position to foster an ongoing programme of debate and dialogue sharing ideas, good practice, and so on, to drive innovation and strengthen energy. This needs to be a place where individuals, the community and voluntary sector, health and wellbeing agencies and the academic sector come together.

Patient and public involvement is not a dry technical process – it’s an emotional one! People get involved because they passionate about the health system, concerned about their own health and want to contribute to make things better. We need to work in a way that harnesses this energy and celebrates the challenge!

Note: an earlier version of this post was originally published on the Local Democracy and Health blog. It represents the views of the author, and does not give the position of Democratic Audit or the London School of Economics. Please read our comments policy before commenting. Shortlink: https://buff.ly/19L3Cer

Mark Gamsu is a visiting professor at Leeds Metropolitan University and a lay member of Sheffield CCG. He works on a freelance basis supporting local commissioners and the voluntary sector work together more effectively. Mark has worked for the Department of Health, local government and the voluntary sector. He established and chairs Altogether Better which has trained over 16,000 community health champions. Mark comments regularly on public health and local democracy on his blog www.localdemocracyandhealth.com.