Whose health, whose care, whose say? Some comments on public involvement in new NHS commissioning arrangements

Abstract

A note on versions:The version presented here may differ from the published version or from the version of record. If you wish to cite this item you are advised to consult the publisher's version. Please see the repository url above for details on accessing the published version and note that access may require a subscription. For more information, please contact eprints@nottingham.ac.ukThis is an electronic version of an article published in Critical Public Health 19(1): 123-132. The journal is available online at informaworld http://www.ingentaconnect.com/content/routledg/ccph.

A critical account of the rise and spread of ‘leadership’: The case of UK healthcare

“…This discourse of leadership (and empowerment) aligns well with other changes in policy in the NHS: the adoption of "decentralization" as a mantra for reform (Greener et al 2009); the efforts to shift the balance of power from acute hospitals to primary care-based commissioners (DoH, 2001); the creation of foundation hospital trusts as a means of promoting community ownership of secondary-care provision, with representation of frontline staff and patients as members and governors (Walshe, 2003); and the increased involvement of patients and the public in commissioning decision-making through Local Involvement Networks (Martin, 2009). Yet the pluralization of leadership sits rather less comfortably with what many commentators agree has been an increasing centralization of power in the NHS since 1997 (Greener et al 2009).…”

How to empower patients, and involve the public

“…PPI then is about services being shaped by patient groups rather than the priorities of NHS Trusts (Bradshaw 2008, Martin 2009) and about making NHS managers, nurses and other clinicians more responsive to collective patient identified needs (Attree et al 2010). It also redefines the state-citizen relationship (Tritter and McCallum 2006) by going beyond the patient as consumer exercising individual choice to a form of 'participatory citizenship' (Martin 2009).…”

“…To this end statutory obligations have been placed on NHS Trusts to ensure PPI in all strategic decision making (Cotterell et at 2010). This is seen as a way to improve the quality of services (Martin 2009) by 'redrawing' (Tritter and McCallum 2006) or 'transforming' (Tritter andMcCallum 2006, Fudge, Wolfe andMckevitt 2008) lay-professional power relations.…”

“…It also redefines the state-citizen relationship (Tritter and McCallum 2006) by going beyond the patient as consumer exercising individual choice to a form of 'participatory citizenship' (Martin 2009). …”

“…The emphasis is on active decision making by patients and their representatives and is the NHS equivalent of the customer focused language of commerce and the consumer culture. The underpinning principles are consumer autonomy and championing the consumer voice in an NHS market increasingly concerned to facilitate patient choice (Martin 2009). As such they are underpinned by consumer watchdog initiatives such as Patient advice and liaison services (DoH 2002).…”