The arrival of Managing Public Involvement in Healthcare Purchasing is both timely and relevant given the recent changes in UK healthcare. The shift to primary healthcare purchasing has heightened the need to understand the reasons for public involvement and what is appropriate.
The UK lacks an overall policy-making framework defining the central values on which health policy is based. This has resulted in an unstructured approach to public involvement. It presents, among other things, many different reasons for involving the public and a proliferation of strategies and activities to achieve it.
The authors argue that because 'there is no simple policy framework surrounding the development of public involvement' there are 'considerable practical problems for purchasers trying to develop appropriate approaches in local context'. Those whose remit is public involvement need clarity and guidance. The book goes some way to provide it. Simply, it asks, what are the objectives for public involvement, and how will the objectives be met?
The authors respond to the challenge by undertaking a historical and political analysis to provide insights into the motives for involvement. The first three chapters set the context and take us through the history of policy changes over the past 20 years. The next three discuss public involvement in more detail and provide an analysis and history of public involvement in health. The last three deal with methods of involvement and discuss the public's experience of it. The book ends with pointers for the future.
The analysis shows that the policy focus of involvement in the NHS has swung, to and fro, between the individual and the collective. While the approaches or strategies have ranged from consumerist (consultation, complaints, satisfaction surveys and patient information) to more democratic (transparency, accountability, working with user groups, the voluntary sector or the communities).
According to the authors, the objectives for public involvement in health are concerned with citizenship and accountability. While to some these are clear, the authors believe that there is a lack of understanding about how to achieve them effectively.
The strength of this book is in its historical analysis of policy. The book will be useful for any manager or health professional concerned with these issues. But it also challenges them to take on the tension between the focus on the individual versus the focus on the collective, leading to a choice between consumerist and democratic approaches. The authors appear to support a judicial mixture.
The book provides little comment or detail about how public involvement can also contribute to improving health. We agree with the authors that current policy on primary care groups puts a spotlight on public involvement. We also agree that if the 'approach to involvement is based on a consumerist model it may... insofar as it tends to concentrate on individualised contact and on limited types of feedback... inhibit the development of knowledge and experience of a more collective form of involvement. Public involvement is a moral obligation as well as a political and practical one.
Assistant director of public health policy, Bromley health authority.
Principal lecturer in health services research, faculty of health, South Bank University.
overmatter from public domain