Table Of ContentINVOLVING PATIENTS
AND THE PUBLIC
How to do it better
Second edition
Ruth Chambers, Chris Drinkwater
and Elizabeth Boath
Boca Raton London New York
Radcliffe Medical Press
CRC Press is an imprint of the
Taylor & Francis Group, an informa business
First published 2003 by Radcliffe Publishing
Published 2018 by CRC Press
Taylor & Francis Group
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© 2003 Ruth Chambers, Chris Drinkwater and Elizabeth Boath
CRC Press is an imprint of Taylor & Francis Group, an lnforma business
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ISBN-13: 978-1-85775-994-5 (pbk)
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About the authors v
Chapter 1 Achieving a meaningful dialogue with patients
and the general public 1
Chapter 2 Patient and public involvement in the new NHS 11
• National representation and standards 12
• Working in communities and trusts 13
• Helping individuals 16
• Summary 16
Chapter 3 Using questionnaire and interview surveys to
gather information and views from patients and the general
public 19
• Questionnaire surveys 20
• Patient satisfaction surveys 27
• Interviewing 31
Chapter 4 Working in groups, gauging public opinion,
gaining consensus 37
• Focus groups 37
• Paying for consumer participation 40
• Involving patients through user, support, participation or
voluntary groups 43
• Gaining the general public’s opinion 47
• Community development 57
• Consensus exercises 63
• Informal feedback from patients 68
Chapter 5 Doing it right: boring but necessary 71
• How to sample a population 72
• Validity and reliability of a questionnaire 79
• Ethical approval 80
• Obtaining and storing data 80
• Template to evaluate the extent to which best practice was
employed in undertaking a consultation exercise or survey 84
Chapter 6 Choosing the right method for the right reasons 89
• Stage 1: Take stock - why do it at all? 89
• Stage 2: Map out your skills and strengths for setting up a
user involvement or public engagement exercise 90
• Stage 3: Do your colleagues value the patients’ or public’s
views? 91
• Stage 4: How to start - making it happen 92
• Stage 5: Involving patients and the public appropriately 93
• How to do it - alternative pathways to user and public
involvement 96
• Approximate costings of alternative methods 117
Chapter 7 Giving patients and the public more
information 123
• Informing patients and carers better 123
• Informing the general public, including non-users
of NHS services 128
• Communicating information 128
Appendix: Health information for health professionals,
patients and the public 135
• Useful organisations 135
• Useful material for patients, managers and health
professionals 143
• Patient support groups 146
• Useful British websites 149
• Media - useful contacts 150
Index 151
Ruth Chambers has been a general practitioner for more than 20 years.
Her interest in involving patients and the public in making decisions
about healthcare and services has evolved during many development
projects across the NHS. The information and tips given in the book
have come from personal experience of many of the quantitative and
qualitative methods described. She has run focus groups and other
types of small group discussions, undertaken many questionnaire surveys
delivered by post, telephone, in newspapers or as face-to-face inter
views and tried out consensus methods such as the Delphi technique. Ruth
is the programme lead for the Teaching PCT in North Staffordshire
and Professor of Primary Care Development at Staffordshire
University.
Other influences in the thinking behind the contents and direction of
the book have been gained from Ruth’s time as Chair of Staffordshire
Medical Audit Advisory Group, membership of the Royal College of
General Practitioners’ Council and education lead for the NHS Alliance
Executive.
Chris Drinkwater has worked as an inner city GP in Newcastle-upon-
Tyne for 23 years. Chris is now Professor of Primary Care Development
and Head of the Centre for Primary and Community Care Learning at
the University of Northumbria. The overall aim of the Centre is to
work with the primary and community care services in order to
support the development of high quality services, which are sensitive
to the needs and expectations of local people.
During the early 1990s Chris led the project group responsible for
setting up the West End Health Resource Centre, a prototype healthy
living centre which was opened by Tony Blair in 1996. He remains
heavily involved in the continuing development of the Centre as com
pany secretary for the charitable trust that runs the building. He was
awarded a CBE in 1999 for his role in the development of the Centre
and in 2000 he became an Honorary Fellow of the Faculty of Public
Health Medicine.
From 1995 to 1998 he was the Sir Roy Griffiths/Age Concem/Prince of
Wales/Royal College of General Practitioners Educational Fellow for
Older People. He was Vice Chair of the Expert Advisory Group on
Models of Primary and Community Care for Older People for the
National Service Framework for Older People and he is a member of
the National Older People’s Care Group Workforce Team. He is
Chair of the Health Focus Group for the Newcastle Westgate NDC
Partnership, the Public Health Lead for the NHS Alliance and a
member of the Alliance Executive.
Elizabeth Boath is the Head of Centre for Health Policy and Practice
at Staffordshire University. Liz has a PhD, an honours degree in
Psychology, and a Certificate in Teaching and Learning in Higher
Education. Over the past decade, she has been involved in designing
and facilitating a wide range of educational initiatives, workshops and
courses for health professionals and lay people, including the innovative
Consumers as Researchers training course. Elizabeth’s research interests
include patient and public involvement, perinatal mental health and
teenage pregnancy.
Achieving a meaningful
dialogue with patients
and the general public
You have to be sincere about wanting to involve patients and the public
in making decisions about their own care or about local health services
for any such exercise to be successful. You cannot expect ordinary
people to put forward their views or take part in any discussion if they
think that decisions have already been made and the consultation is
just a public relations sham. People were talking about making consumer
involvement in the NHS a reality in the early 1990s.1 A decade later
and the NHS has changed out of all recognition with the establishment
of primary care trusts. New proposals have been put in place to replace
community health councils (CHCs) with Patients’ Forums (PFs),
Patient Advice and Liaison Services (PALS), and Independent Com
plaints Advisory Services (ICAS).2 As yet these new structures have
had little impact but they underline an increasing drive to make the NHS
more responsive to the voice of patients and the public. The acid test
will be ‘how have these new structures made things better for patients?’
For those working in the NHS having the skills to involve patients
and the public is becoming increasingly important. Trust executives
and some of those working in health authorities have had some ex
perience of facing public meetings or holding other consultations but
many people working in the NHS have no real experience of involving
patients or the public in healthcare, over and above their day-to-day
interaction with patients.3
Involvement may occur at three levels:
(1) for patients and their own care
(2) for patients and the public about the range and quality of health
services
(3) in setting priorities and planning and organising service developments.
There is a mounting body of evidence to support the advantages of greater
user and public involvement in the NHS.4-6 The National Consumer
Council cites examples of partnership working between the NHS and users
of local health services that have resulted in more efficient use of local
community resources, more effective health services and more account
ability for public funds.4 Community development work in Newcastle-
upon-Tyne has demonstrated how primary care practitioners come to regard
the community as a ‘key asset in creating solutions’ and become respon
sive to the community’s view.5 The NHS Executive expect both people’s
health and healthcare to be improved by participation as in the box below.
The value of greater public participation in the NHS6
Benefits to the NHS
► Restoration of public confidence.
► Improved outcomes for individual patients.
► More appropriate use of health services.
► Potential for greater cost effectiveness.
► Contribution to problem resolution.
► Sharing with the public responsibilities for healthcare.
Benefits to people
► Better outcomes of treatment and care.
► An enhanced sense of self-esteem and capacity to control their
own lives.
► A more satisfying experience of using health services.
► More accessible, sensitive and responsive health services.
► Improved health.
► A greater sense of ownership of the NHS.
Benefits to public health
► Reduction in health inequalities.
► Improved health.
► Greater understanding of the links between health and the circum
stances in which people live their lives.
► More healthy environmental, social and economic policies.
Benefits to communities and to society as a whole
► Improved social cohesion.
► A healthier democracy - reducing the democratic deficit.
► A health service better able to meet the needs of citizens.
► More attention to crosscutting policy issues and closer co-operation
between agencies with a role to play in health improvement.
Successive NHS documents have emphasised a vision of a changed
culture and practice where user involvement and public engagement
are integral to all NHS activities and accountability to the public is
more explicit.710 The NHS is becoming more customer focused, where
the ‘customer’ is taken as meaning a patient or user, a carer of a
patient, a group of patients or people with similar characteristics or
the general public. Involving people in planning services and making
decisions about local healthcare does increase their ownership of the
NHS and gives them more understanding of how the NHS operates
and the problems it faces. Closeness to the customer is reckoned to be
a key characteristic of an effective organisation.
The NHS Executive vision
‘The needs of the patient not the needs of the institutions will be at
the heart of the new NHS’7
‘... making sure that the NHS responds more quickly to patients’
needs’8
‘... rebuild public confidence in the NHS as a public service,
accountable to patients, open to the public and shaped by their
views’7
‘... ensure that consumer involvement in the NHS R & D pro
gramme improves the way research is prioritised, commissioned and
disseminated’9
‘... patients and carers need to be involved ... in their own care and
in the planning, monitoring and development of health services’8
‘From 1 January 2003, NHS trusts, primary care trusts and strategic
health authorities have a statutory duty to involve and consult the
public’.10
There have been some good examples of patient and public involvement
where substantial changes have arisen as a result of health authorities
consulting local people about the direction of future plans, contracts
and services. But many other consultations have been of dubious quality
and not been sustained. Some of the reasons for this are thought to be
that:
► many public engagement initiatives are really public relations exercises
in disguise
► methods of consultation may be dependent on practitioners’ and
commissioners’ preferences and limited capabilities rather than
being the best method(s) for the aim(s) of a particular consultation
so that the results are not as meaningful as they might be
► there may be a lack of commitment from the consulting organisation
or healthcare unit to act on the views obtained
