Public administration select committee - public services: putting people first?
Memorandum of evidence from the BMA's patient liason group
January 11 2007
Please use the links on the right to view the responses.
Executive summary
In relation to healthcare, the majority of people want a say in how local services are run but, more often than not, have never been asked for their input. In addition they feel that they have no power to influence local service development.
Continued interference by government with formal structures of PPI has damaged their effectiveness, with the naivety of the LINks proposal being an illustration in point. It is clear that the authors of government proposals and legislation do not understand how meaningful patient and public participation and involvement work.
The key is resources and capacity. PPI needs to be properly funded to enable whatever the organisational structure for PPI is at the time to be able to consult with the community it serves. This means engaging with service users, taxpayers and groups who traditionally do not, or cannot, get involved.
Capacity for meaningful engagement is a rare commodity. The government’s response to A stronger local voice barely recognises the imperative to provide administrative and financial support to members of LINks if they are to be effective. There are few people who have the capacity to really engage, and to find ways of engaging others. Capacity is about having time, self-confidence, access to technology, the ability to spend hours reading lengthy and often turgid official documents, political skills, committee experience and the availability to attend meetings during working hours as well as outside them. Those that do have the capacity should be supported.
It is not the case that most people do not have the intellectual ability to participate because it is clear that they do. People can make rational and reasoned decisions about complex matters when given the information and time to do so. (The two case studies given in this response are examples in point.) Too few ordinary members of the public have this capacity, and much more should be done to build it. Without building capacity, LINks will go the same way as their predecessors because they are fundamentally flawed.
PPI does not need to be prescriptive about methodology, but should consider a number of principles to underpin such processes, including that:
- it should be a collaborative process with all voices in discussion helping to develop partnerships between patients, the public, health professionals and policy makers
- the process should be ongoing and not just a periodical or one-off exercise
- feedback mechanisms must be built into all PPI activities
- the processes must be transparent
- PPI activities must be accessible to all relevant groups
- efforts must be made to specifically target hard-to-reach and marginalised groups in order to accommodate equality and equity within the PPI structures and the relevant health services.
About the BMA
1. The British Medical Association is an independent trade union and voluntary professional association which represents doctors from all branches of medicine all over the UK. It has a total membership of over 138,000.
2. The evidence for this select committee inquiry was compiled by the BMA Patient Liaison Group and endorsed by the BMA. The Patient Liaison Group consists of eleven lay members appointed for their knowledge and interest in different aspects of healthcare, and five doctor members. The lay members do not represent any particular patient group, but bring a wide overview and knowledge of health issues to their discussions.