Leadership, Passion and Patient and Public Involvement

Now that the NHS England Guidance on Transforming Participation in Health and Care is out I thought I would return to one of the areas that I think needs exploring further.

First, lets 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 – it 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 and on making it happen. This is a leadership issue.

Leading Patient and Public Involvement

As I said in an earlier blog I think that there are a small number of organisations who have  leadership 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 who services improve wellbeing like Housing, Education etc.

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 they provide the services means that this is the arena where the bulk of PPI happens. I think this is a challenge for commissioners.

Delivery  of Voice and Advocacy

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

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 – as I have said in earlier blogs 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.

I think that their 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.

Here is a diagram that tries to encompass some of this:

So 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-Exec PPI leads, relevant directors, Healthwatch it should also have strong links with big NHS provider organisation PPI leads, and link to the local authority and VCS.
• 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 etc 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 – its an emotional one! People get involved because they are 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!

What do you think?