A Funny Thing Happened on the Way to the Forum? Reforming Patient and Public Involvement in the NHS in England

Abstract

This article explores the introduction of a new system of patient and public involvement (PPI) in the NHS in England. After seeking to clarify the terminology found in this field, the article explores the background to the new system, why proposals were brought forward by the government and how they were implemented. The article also examines the main criticisms of the new system, which include under-resourcing, lack of capacity, complexity and fragmentation. The article concludes by drawing out lessons for future reform in this field.

Moving from rational to normative ideologies of control over public involvement: A case of continued managerial dominance

“…Often suggesting PI was a peripheral element of commissioning processes, managers attempted to implement policy through a directive and constraining approach, meaning that PI was not integrated into strategic decision making. By determining the agenda for the PI group, and taking over meetings that deviated from their agenda, these managers parallel research findings about limiting actions of professionals towards PI (Baggott, 2005;Boivin et al, 2014;Callaghan & Wistow, 2006). Whilst one PI representative, also involved as a lay member of the organisation board, suggested they had some level of influence with managerial staff, this was only achieved by co-option into a managerially framed role.…”

“…Therefore, whilst there was an awareness of the need for a normative approach to integrate PI, rational managerial control continued to manipulate PI outputs, encouraging conformity, rather than innovation, through engagement. In these settings, despite rhetoric of normative control, managers continued to engage in rational control to determine who is involved in PI, what contribution they can make, and how that contribution is interpreted within decisions that align with managerial priorities (Baggott, 2005;Rutter et al, 2004). This contrasts with contexts such as health research, where a more normative approach encourages a focus on active collaboration and coproduction of knowledge, and where PI representatives define the research agenda (INVOLVE 2012).…”

“…While involvement in healthcare research settings has developed with a clear architecture and policy support (Staniszewska et al, 2011), development of PI in health service development has been more diverse. In health service development, a lack of consensus of terminology, and overlapping structures (Mockford et al, 2011), potentially undermine PI, limiting the ability of the public to influence, or contribute appropriately to, strategic discussions (Baggott, 2005). However, others suggest that limitations of PI, such as perceived lack of impact on organisational outcomes (Contandriopoulos, 2004), cannot be associated entirely with the coherence of policy or the structures in place to encourage PI.…”

“…Despite the flexibility of policy, and the potential for interpretation in different settings, research situated across multiple healthcare organisational contexts criticises the way PI is operationalised as tokenistic, not central to decision making processes, and even constructed as a mechanism for manipulating the public, rather than empowering them (Baggott, 2005). Considering the problematic translation of policy into practice, many attribute limitations of PI to the influence of professional hierarchies on the involvement, or exclusion, of members of the public during decision making processes (Litva et al, 2002;Rutter et al, 2004).…”

“…Despite the benefits of PI for health and social care services (Mockford et al 2011), much existing research suggests that, while there is strong policy support, its potential contribution is stymied by contested terminology, limitations in the underpinning evidence base, different attitudes to PI, and variable attempts at implementation (Staniszewska et al 2011, Baggott, 2005Contandriopoulos, 2004). Commentators note the impact of professional hierarchies on the translation of PI policy into practice in public sector organisations (Boivin et al, 2014;Litva et al, 2002;Martin, 2011;Rutter et al, 2004), but neglect the impact of managerial influences on PI (Renedo et al, 2015).…”