There has never been a better time for patients and the public to become involved in decision-making for healthcare services - although some cynics might disagree.

Patient and public involvement is being built into trusts' plans, with some significant proposals going to public consultation. There are many ways involvement can be achieved. The new statutory local involvement networks, replacing the recently gestated but prematurely deceased patient and public involvement forums, represent the main route. The Darzi report adds more incentives for involvement.

There are many ways - some would say too many - for trusts and GP practices to involve patients and the public in healthcare commissioning and provision. The effectiveness of patient and public involvement is governed by how it is approached by patients, the public and trusts. There must be a will (reluctant or otherwise) to work together with the public. While a reluctant approach does not bode well, it can be overcome over time by building mutual trust and respect.

Patient and public representatives must have a right to work with healthcare services. They must be objective, not merely emotional, which is sometimes difficult.

Strong ties

Over the course of four years, our patient and public involvement forum and its predecessor built an effective working relationship with the local primary care trust. This was helped considerably by informal monthly meetings between our chair and vice-chair and senior PCT personnel, which led to greater understanding, debate on strategy and financial planning, and further embedding of patient and public involvement in trust project teams. These meetings will continue with the local involvement network.

Forum members joined project teams for out of hours services (leading to some major changes), the priorities committee, the independent sector diagnostic centre, the unscheduled care leadership group, risk and governance committees and several others. They also worked on teams initiating practice-based commissioning, community audiology services and a county-wide diabetes retinopathy screening programme.

An important role was toassess the quality of services, recognising good service and making improvement recommendations where appropriate, which were commonly adopted. These working relationships enabled the forum to make valuable contributions to the trust's annual health checks.

More changes ahead

The coming months will see further significant changes, including increased emphasis on the patient journey, integration of health and social care needs, and shifting services to the community.

Although the emphasis appears to be on the provision of high-quality care, patients find themselves in the middle of a constantly changing maze with no sign of an emergency exit. Patients therefore need not only guidance and information, but also to offer their own constructive advice.

The challenge is to build on the achievements and the strengths of the former PPI forums to:

  • find and recruit the right people and groups - from health and social care - onto the LINks;
  • to establish effective working relationships between LINks and local trusts and social services;
  • for the trusts and social services to establish good mutual working relationships to ensure a smooth journey for patients;
  • to work together to achieve change where change is needed and resist change where it is not;
  • for trusts to have the courage and insight to ensure patients have the services they need, where they need them, when they need them.

For this to happen, patients and the public have a vital role to play.Interesting times lie ahead.

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