Jill Palmer On the public's priorities

Published: 05/02/2004, Volume II4, No. 5891 Page 19

The government is promoting public involvement as part of its new health service policy. In fact, it is inviting every one of us to take an active role in health-related decision-making.

Proposals include allowing the public to elect members of foundation trust boards and insisting that primary care trusts 'engage with the public'.

Managers have naturally expressed scepticism about the complexity and confusion of these new arrangements to encourage local people to influence services. They rightly argue that public involvement is very different from patient involvement when decisions are made with their clinician about their own health.

But the people pay for public services so therefore they should shape them more extensively. The voices of patients, carers and the public must be heard and counted.However, applying national policy to a wide variety of local circumstances to create meaningful public involvement is not easy.While it is possible - and indeed beneficial - for the public to relate to and engage with PCTs on a regular basis, it is not the most effective policy for secondary care.

For the vast majority of people, the local trust and future foundation hospital is remote, bureaucratic and unapproachable.

Getting a seat on the foundation hospital board, having to embrace the world of the private finance initiative, strategic decisions, cost analysis and priority-setting is unlikely to inspire or encourage many lay people. It is likely that medics and managers will be reluctant to embrace this directive, resulting in token public involvement with no real impact.And have lay members of the public got the knowledge or ability to improve quality of care, patient satisfaction or health outcomes by changing the way services are run?

An analogy can be drawn with education. Public involvement is far higher in primary education than secondary education.More people join the parent-teacher association and more are willing to sit on the governing body. This is because they relate to the primary level. They take their children to school, they know the teachers, they feel they can make a difference. The secondary school, like the hospital, is far more remote. They rarely visit, do not know the staff well and feel the running of the place is out of their control.

That is why the real future for public involvement must lie with PCTs. It is here the balance between public and expert involvement in decision-making works best.

Many local people want to give something back to their community. The PCT is the perfect place where the objectives of patient involvement can be met. It is the key vehicle for raising awareness of the views and needs of the public and placing them at the centre of health services. People identify with their GP surgery.

For most it is their only contact with the NHS.Here they can make a genuine difference in shaping healthcare - a difference that will benefit patients, whether it involves public health issues, care of the elderly, or the handling of long-term chronic conditions.

Effective public involvement is vital for the future of the health service and healthcare. But do not run before we can walk.Do not push the public onto foundation hospital boards where their views will not be valued and they will become disillusioned and disappointed.

Jill Palmer is former health editor of the Daily Mirror