Engaging patients and the public has long been policy mantra. Now legislation is making it a reality. Andy Cowper explains

The Department of Health world class commissioning team's motto of "adding life to years and years to life" clearly signals its belief that without knowing patients' and the public's needs, how can commissioners and providers meet them?

Engaging the public in healthcare has long been a policy mantra but changing organisational forms has not always helped its development into the mainstream. The activist community health councils were replaced by patient and public involvement forums and the Commission for Public and Patient Involvement in Health. These, in turn, were replaced this year by the new local involvement networks.

The statutory duty to consult patients and the public regarding any major service change was legally enshrined in Section 11 of the 2003 Health And Social Care Act. This was the basis of the legal challenge to the decision in Derbyshire to award a tender for GP service provision to UnitedHealth Europe. More recently, legislation has required PCTs to work with local government in assessing population service needs. So not only has engaging the public become the correct way to commission the services they want and need, it is a legal duty for PCT commissioners.

DH patient and public affairs director Joan Saddler says Lord Darzi's next stage review has "identified four key areas - a fair, personalised, effective, and safe service".

She explains: "Patient and public involvement fits with each of those. It is not just about one-off consultations of patients, public and staff, but about using these processes across the cycle of commissioning from planning and designing services to monitoring them.

"It also depends on two things: first, is there an intention - a driver - within the local system that makes PPI a 'must do'? Second, have we got our organisation into a fit state of innovation and drive for excellence to push this through?" Her advice is to "be clear about your intentions, ensure you have the will to make PPI and staff engagement real, and ensure clarity over how you engage people."

At NHS West Midlands, programme specialist for consultation Julia Holding says that public and patient engagement is now part of the mainstream: "I've been working in this area for many years, and it feels that a long period of work has finally come to fruition." But she adds: "There's still some way to go before we get PPI fixed in the NHS psyche."

Why does she think PPI is different this time? Ms Holding quotes NHS chief executive David Nicholson's comment about "hitting targets but missing the point", adding: "It's not just about lining up numbers and throughput; what we must do using PPI is improve quality and care."

Ms Holding argues that the change in commissioning is cultural in nature: "It's not just about the health needs assessment that's fundamental to commissioning, although there are still aspects of data gathering at which we must get better. We need to engage more with the public and patients and get more feedback.

"We have to do these things in different ways. We're getting good at bits of this (data capture, service use and demographics) - but it still feels done to people, not with them. The next bit is about bridging that gap and bringing patients and the public and providers and commissioners closer together. It's not only about data, but about different sorts of intelligence - to help us really understand our population and their needs.

Ms Holding's dictum is that "world class commissioning of healthcare is basically like buying anything for somebody: you wouldn't do it without knowing a) their needs, b) their preference and c) the budget".