MSc Social Care, Health and WellbeingMODULE CODE HSC7008M.docx

MSc Social Care, Health and Wellbeing
MODULE CODE: HSC7008
Module Title:
Person Centered Approaches and Service User Involvement in
Health and Social Care
MODULE GUIDE
2019/2020Trimester 1
Level HE7
Contents
21.Module Overview
22.Learning and Teaching Strategy
33.Module Communications
34. Module Description
35. Learning Outcomes and Assessments
6. Assessment Deadlines
4
47. Assessment Feedback
8. Module Calendar
5
9. Formative Assessment
6
10. Indicative Reading
7
11. Guidelines for the Preparation and Submission of Written
Assessments
8

12. Academic Misconduct
10
13. Assessments
10
1414. General Assessment Criteria for Written
Assessments(Level HE7)
1. Module Overview
Module Tutor
Bimpe Kuti
Tel. no.
01204 903796
Email
[email protected]
Office Location
T3-38 – Deane Campus
Drop-in Availability
Arrange via appointment
Weblink to Moodle Class
https://moodle.bolton.ac.uk/course/view.php?id=12087
Weblink to Module Specification
https://modules.bolton.ac.uk/HSC70082. Learning and Teaching
Strategy
This module is delivered via one 3 hour session per week over
12 weeks. It will deliver effective learning and teaching to you
as a student but also an individual working in practice. The 200
notional hours are delivered via a number of strategies that are
effective and popular with our students. These include
classroom work with formal lecturers incorporating discussion
and debate in addressing core concepts, interactive learning
activities/workshop sessions and problem-based learning. The
sessions will be structured around a variety of teaching and
learning methods such as reading exercises, discussions, critical
thinking activities, web-based learning, amongst others, to
provide input to help you develop in professional practice
around person centered care and service user involvement in
health and social care.

In addition, we aim to meet your individual learning needs by
providing scheduled tutorial support where you can meet with
the module tutor to discuss aspects of your studies and receive
personalised advice and guidance. E-learning is also provided
via Moodle to enable you to undertake further study in a place
and at a time that is convenient for you.
You will be expected to prepare for classes by completing
activities set by your tutors, this may include prior reading. The
University’s Virtual Learning Environment (VLE) will provide
access to weekly materials as well as links to additional
resources such as academic journals and useful websites to aid
your learning. In addition, the University’s Library pages
provide access to a host of online resources such as e-journal
and e-book repositories.
Revision sessions are scheduled for week 11 and 12 and in
weeks 13 and 14 the two part assessment are due.3. Module
Communications
The Module Tutor’s contact details are provided at the top of
this page. You must check your University of Bolton email
address and the Moodle area dedicated to this module regularly
as many module communications are channelled through these
media.
Your Module Tutor will normally aim to respond to your email
messages within 2 full working days of receipt. However,
responses will be longer in holiday periods.
4. Module Description
The aim of this module is to enable you to develop knowledge
and understanding of the importance of a person-centered
approach in policy and practice in health and social care. This
module will enable you to consider the ways in which health
and social care services have a mandate to engage with the
needs of those using their services, with active consideration of
their views both personally and in terms of service

development.
Consequently, this module will facilitate in-depth understanding
of the challenges to work in an effective, real way with service
users / carers / communities. The importance of the voice of
interest groups will be considered with the use of a case study /
condition-based approach, from a holistic viewpoint. The
module will help you critically review the process of inclusion /
empowerment. It will give flexibility to consider different
groups of service users, families and carers, which will enable
you to explore experiences both widely and in terms of
experiences, such as mental health, dementia, end of life,
learning disabilities, those living with long-term conditions and
disabilities. This module will fit well with others concerned
with policy development and leadership / collaboration and
integration.5. Learning Outcomes and Assessments
Learning Outcomes
Assessment
LO1: Critically appraise the situation experienced by service
users and ways in which service providers can learn from their
experiences
Assessment 1:
Essay
LO2: Critically evaluate the impact of a person centered
philosophy to the delivery and development of health and social
care services
Assessment 1:
Essay
LO3: Critically analyse empowerment, advocacy and
partnership with reference to theory / ideology
Assessment 1:
Essay
LO4: Recommend, justify and discuss appropriate strategies to
implement a person centered approach with reference to a
specific experience / case study

Assessment 2:
Oral Assessment (Presentation)6. Assessment Deadlines
Assessment item
Due Date
Weight
1
4,000 words Critical Essay
Tuesday 14th January 2020
70%
2
15-20mins–Oral Assessment (Presentation)
Tuesday 17th December 2019
30%7. Assessment Feedback
Feedback on items of assessment can be formal (such as on a
signed feedback form) or informal (such as advice from a tutor
in a tutorial). Feedback is therefore not just your grade or the
comments written on your feedback form, it is advice you get
from your tutor and sometimes your peers about how your work
is progressing, how well you have done, what further actions
you might take.
We recognise the value of prompt feedback on work submitted.
Other than in exceptional circumstances (such as might be
caused by staff illness), you can expect your assignment and
examination work to be marked and feedback provided not more
than15 working daysfrom the deadline date. However, please
note that that such feedback will be provisional and
unconfirmed until the Assessment Board has met and may
therefore be subject to change.
Please take time you read or listen to your assessment feedback.
This can be very useful in determining your strengths and key

areas for development, and can therefore help you improve on
future grades.8. Module Calendar
Week
Day: Tuesday
Time:
9am-12noon
Topic
1
24.09.2019
Introduction to the Module
Assessment Guidelines
Introductory Session
· Exploring the meaning of person centred approach / service
user involvement
2
01.10.2019
Historical perspectives on service user involvement / Person
centred care
· The rationale for service user involvement
3
08.10.2019
NHS guidance on person centered approach / service user
involvement
· Policy Evaluation

4
15.10.2019
Concepts for person centred care / service user involvement
· Theories / models of involvement
5
22.10.2019
Challenges and barriers to service user involvement in health
and social care
6
29.10.2019
Empowerment, Advocacy and partnership
· Person centred approach in relation to empowering service
users
· Theory/ideology
7
05.11.2019
Service User Workshop
· Person centred care – Personalisation
· The role of the expert patient
8
12.11.2019
Case Study – Workshop
· Strategies to implement a person centred approach in care

· Presentation Tutorial
9
19.11.2019
Person centred approach / service user involvement
· A method for health and social care services delivery and
development
10
26.11.2019
Person centred approach / service user involvement
· Implications for service providers and professionals in
practice
· Presentation and Essay Tutorials
11
03.12.2019
Individual Tutorials / Module Evaluation
12
10.12.2019
Assessment Workshops
13
17.12.2019
Assessment 2: Oral Presentation (20 mins)
Submission Deadline – Tuesday 18th December 2018
Printed and electronic copy of presentation submitted to tutor
on day
CHRISTMAS/NEW YEAR BREAK
14
07.01.2020
Trimester 2 – Begins
15
14.01.2020
Assessment 1: 4, 000 words Critical Essay
Submission Deadline – Tuesday 15th January 2019

To be submitted via Turnitn WeblinkNB: Please note that this
module calendar may be subject to change.9. Formative
Assessment
Formative assessment is an important aid to learning. It is
designed to provide you with feedback on your progress and
inform development. It can be used to identify any areas which
would benefit from extra attention on your part, or extra support
from your tutor. Please note that it does not contribute to the
overall formal assessment/mark for the module.
There are opportunities within this module for guidance on
meeting the learning outcomes and learning from the taught
components, which will be linked into the assessment strategy.
There will be facilitated discussions around the key areas,
supported by your individual tutorial sessions.
The importance of your individual tutorial sessions cannot be
underestimated as they enable you to gain advice, support and
feedback on your academic abilities, to support you with
producing your final piece of writing for this module. It also
assists the module tutor to plan future sessions and support.
Formative assessment within this module is provided through a
variety of forms:
· Group activities and discussion
· Events/Guest speakers
· Tutorial (Group & Individual) feedback on assessment drafts
· Group tutorial revision sessions in preparation for assessment
deadline
· IT and research skills workshop
10. Indicative Reading
Adams, R. (2008) Empowerment, participation and social work.

London: Palgrave.
Beresford, P. and Carr, S. (2012) Social Care, Service Users and
User Involvement. London: Jessica Kingsley Publishers
Chao, S. (2009) Toward Health Equity and Patient-
Centeredness: Integrating Health Literacy, Disparities
Reduction, and Quality Improvement: Workshop Summary.
Washington, DC: The National Academies Press.
Department of Health & Public Health England (2014) A
framework for personalized care and population health for
nurses, midwives, health visitors and allied health
professionals. London: DH
Fawcett, B., Fillingham, J., River, D., Smojkis, M. and Ward,
N. (2018) Service user and carer involvement in health and
social care: A retrospective and prospective analysis. London:
Palgrave
Gosling, J. and Martin J. (2012) Making partnerships with
service users and advocacy groups work: How to grow genuine
and respectful relationships in health and social care. London:
Jessica Kingsley Publishers
McPhail, M. (2008) Service user and carer involvement: beyond
good intentions. Edinburgh: Dunedin Academic
Ndoro, S. (2010) Group, Community Participation,
Empowerment and Advocacy; Working with Community
Groups. London: VDM Verley
Nzira, V. and Williams, P. (2008) Anti-Oppressive Practice in
Health and Social Care London: Sage
Thompson, N. (2006) Anti-Discriminatory Practice (4th ed).
Basingstoke: Palgrave
Thompson, N. (2009) Promoting Equality; A learning
development manual. Basingstoke: Palgrave
Thompson, N. (2015) People Skills. Basingstoke: Palgrave
Warren, J. (2007) Service User and Carer Participation in Social
Work. Exeter: Learning Matters
Websites

· Department of Health & Social Care: www.dh.gov.uk
· National Health Service: www.nhs.uk
· The Health Foundation: https://www.health.org.uk/
· INVOLVE: http://www.invo.org.uk/
· National Institute for Health Research (NIHR):
https://www.nihr.ac.uk/
· The King’s Fund: https://www.kingsfund.org.uk/
· NHS England: https://www.england.nhs.uk/
· Care Quality Commission: https://www.cqc.org.uk/get-
involved
· Social Care Institute for Excellence:
https://www.scie.org.uk/11. Guidelines for the Preparation and
Submission of Written Assessments
1. Written assessments should be word-processed in Arial or
Calibri Light font size 12. There should be double-spacing and
each page should be numbered.
2. There should be a title page identifying the programme name,
module title, assessment title, your student number, your
marking tutor and the date of submission.
3. You should include a word-count at the end of the assessment
(excluding references, figures, tables and appendices).
Where a word limit is specified, the following penalty
systems applies:
· Up to 10% over the specified word length = no penalty
· 10 – 20% over the specified indicative word length = 5 marks
subtracted (but if the assessment would normally gain a pass
mark, then the final mark to be no lower than the pass mark for
the assessment).
· More than 20% over the indicative word length = if the
assessment would normally gain a pass mark or more, then the
final mark will capped at the pass mark for the assessment.

4. All written work should be referenced using the standard
University of Bolton referencing style– (For your programme
HARVARD REFERENCING) – see:
https://www.bolton.ac.uk/leaponline/My-Academic-
Development/My-Writing-Techniques/Referencing/Level-
2/Harvard-Referencing.aspx
5. Unless otherwise notified by your Module Tutor, electronic
copies of assignments should be saved as word documents and
uploaded into Turnitin via the Moodle class area. If you
experience problems in uploading your work, then you must
send an electronic copy of your assessment to your Module
Tutor via email BEFORE the due date/time.
6. Please note that when you submit your work to Moodle, it
will automatically be checked for matches against other
electronic information. The individual percentage text matches
may be used as evidence in an academic misconduct
investigation (see Section 13).
7. Late work will be subject to the penalties:
· Up to 7 calendar days late = 10 marks subtracted but if the
assignment would normally gain a pass mark, then the final
mark to be no lower than the pass mark for the assignment.
· More than 7 calendar days late = This will be counted as non-
submission and no marks will be recorded.
Where assessments are graded Pass/Fail only, they will not be
accepted beyond the deadline date for submission and will be
recorded as a Fail. Students may request an extension to the
original published deadline date as described below.
8. In the case of exceptional and unforeseen circumstances, an
extension of up to 14 days after the assessment deadline may be
granted. This must be agreed by your Programme Leader,
following a discussion the Module Tutor. You should complete

an Extension Request Form available from your Tutor and
attach documentary evidence of your circumstances, prior to the
published submission deadline.
Extensions over 14 calendar days should be requested using the
Mitigating Circumstances procedure, with the exception of
extensions for individual projects, at the discretion of the
Programme Leader, may be longer than 14 days.
Requests for extensions which take a submission date past the
end of the module (normally week 15) must be made using the
Mitigating Circumstances procedures.
Some students with registered disabilities will be eligible for
revised submission deadlines. Revised submission deadlines do
not require the completion extension request paperwork.
Please note that the failure of data storage systems is not
considered to be a valid reason for an extension. It is therefore
important that you keep multiple copies of your work on
different storage devices before submitting it.
12. Academic Misconduct
Academic misconduct may be defined as any attempt by a
student to gain an unfair advantage in any assessment. This
includes plagiarism, collusion, commissioning (contract
cheating) amongst other offences. In order to avoid these types
of academic misconduct, you should ensure that all your work is
your own and that sources are attributed using the correct
referencing techniques. You can also check originality through
Turnitin.
Please note that penalties apply if academic misconduct is
proven. See the following link for further details:
https://www.bolton.ac.uk/about/governance/policies/student-
policies/13. Assessments

This assessment strategy has been designed to enable you to
demonstrate that you have met the intended learning outcomes
of the module.
Assessments will be in two parts.
Part 1:
Assessment Number
1
Assessment Type (and weighting)
4,000 words Critical Essay (70%)
Assessment Name
Critical analysis on Service User Involvement in Health and
Social Care
Assessment Submission Date
Tuesday 14th January 2020
To be submitted via Turnitn Weblink
Learning Outcomes Assessed:
LO1: Critically appraise the situation experienced by service
users and ways
in which service providers can learn from their
experiences
LO2: Critically evaluate the impact of a person centred
philosophy to the
delivery and development of health and social care
services
LO3: Critically analyse empowerment, advocacy and
partnership with
reference to theory / ideology
Part 1 - Assignment Brief:
1. Produce a critical and evaluative essay on service user
involvement.
2. Reference should be made to theoretical concepts of service
user involvement, with a critical evaluation of its impact on
delivery/development of care services.
3. Articulate the person-centred approach in health and social

care and critically appraise its importance for service providers.
4. Make links with and critically analyse themes/theory of
power and empowerment throughout this essay.
In addition, the marking tutor will be looking for evidence of
the following:
· Does the essay cover the main points of the topic logically?
· Is the essay presented in an appropriate context?
· Is the essay coherent and well-structured?
· Is there evidence of personal research in relation to the topic
beyond material covered in class?
· Is there evidence of understanding of the topic?
Part 2:
Assessment Number
2
Assessment Type (and weighting)
15-20 mins Oral assessment - Presentation (30%)
Assessment Name
Person Centred Approach – A Case Study
Assessment Submission Date
Tuesday 17th December 2019
Printed and electronic copy of presentation submitted to tutor
on day
Learning Outcomes Assessed:
LO4: Recommend, justify and discuss appropriate strategies to
implement a
person centred approach with reference to a specific
experience / case

study
Part 2 - Assignment Brief:
Please use the oral assessment format provided for the
development of your case study
Presentation
1. You are required to deliver a presentation using a specific
experience or case
study
2. You are required to collate and analyse information from
scholarly and non
scholarly materials
Your presentation will address the following criteria:
•
Introduce your case study
•
Justify why it is important to implement a person centred
approach in case of interest interest
•
Discuss approach service user involvement strategies that relate
and underpin the identified case study
•
Consider the recommendations for practice, for a person centred
approach, relevant to case study
•
Draw some conclusions
The presentation should last 15 – 20 minutes and be designed,
with time for questions

from marking panel at end.
This presentation makes up to 30% of your overall mark for this
module. You must
demonstrate correct referencing throughout your presentation.
The general marking criteria will apply to both parts of your
assignment. In addition,
the marking tutor will be looking for evidence of the following:
•
Does the presentation cover the main points of the chosen topic
logically?
•
Is the material presented in an appropriate context?
•
Is a coherent and well-structured presentation format made?
•
Is there evidence of personal research in relation to the topic
beyond material covered in class?
•
Is there evidence of understanding of the chosen topic?
Specific Assessment Criteria:
(Please note that the General Assessment Criteria will also
apply. Please see section 14)
Distinction (70% and above):
Students will provide an excellent critique of key literature
sources on their chosen topic resulting in clear and logical
conclusions. The literature review will demonstrate excellent
knowledge of the subject area and confident use of appropriate
theoretical models. Creative and well justified recommendations

will be made as to how problems within the field may be
addressed in practice. Extensive research demonstrating use of
a wide range of current secondary research sources will be
evident in the annotated reference list. Academic style and
referencing technique will be excellent.
Merit (60-69%):
Students will provide a cohesive appraisal of key literature
sources on their chosen topic demonstrating critical reasoning
skills. The literature review will demonstrate a sound
knowledge of the subject area and use of appropriate theoretical
models. Specific and detailed recommendations will be made as
to how problems within the field may be addressed in practice.
Research demonstrating use of a wide range of current
secondary research sources will be evident in the annotated
reference list. Academic style and referencing technique will be
good.
Pass (50-59%):
Students will provide a satisfactory appraisal of key literature
sources on their chosen topic demonstrating critical reasoning
skills. The literature review will demonstrate an adequate
knowledge of the subject area and understanding of appropriate
theoretical models. Recommendations will be made as to how
problems within the field may be addressed in practice.
Research demonstrating use of a range of current secondary
research sources will be evident in the annotated reference list.
Academic style and referencing technique will be fair.
Fail (49% and below): Students who do not meet the
requirements of a pass grade will not successfully complete the
assessment activity.
Minimum Secondary Research Source Requirements:
Level HE7 - It is expected that the Reference List will contain

between fifteen to twenty sources. As a MINIMUM the
Reference List should include four refereed academic journals
and five academic book.
14. General Assessment Criteria for Written Assessments
(Level HE7)
%
Relevance
Knowledge
Argument/Analysis
Structure
Presentation
Written English
Research/Referencing
DISTINCTION
Exceptional Quality
85-100%
Directly relevant to title/brief.
Expertly addresses the assumptions of the title and/or the
requirements of the brief.
Demonstrates an exceptional knowledge of theory and practice
for this level.
Insightfully interprets appropriate concepts and theoretical
models.
Demonstrates originality in conceptual understanding.
Presents an exceptional critique of key research material
resulting in clear, original and illuminating conclusions.
Demonstrates distinctive, insightful and creative solutions to
complex problems.

Produces exceptional work that makes a contribution to the
development of knowledge and understanding in the subject
area.
Coherently articulated and logically structured.
An appropriate format is used.
Exceptional presentational style & layout, appropriate to the
type of assignment.
Effective inclusion of figures, tables, plates (FTP).
Exceptionally well written
answer with standard spelling and grammar.
Style is clear, resourceful and academic.
Sources accurately cited in the text.
An extensive range of contemporary and relevant references
cited in the reference list in the correct style.
Excellent Quality
70-84%
Expertly addresses the assumptions of the title and/or the
Demonstrates an excellent knowledge of theory and practice for
this level.
Expertly interprets appropriate concepts and theoretical models.

Demonstrates originality in conceptual understanding.
Presents an excellent critique of key research material resulting
in clear, original and illuminating conclusions.
Demonstrates insightful and creative thinking solutions to
complex problems.
Produces excellent work that makes a contribution to the
area.
Coherently articulated and logically structured.
Excellent presentational style & layout, appropriate to the type
of assignment.
Effective inclusion of figures, tables, plates (FTP).
Excellently written
answer with standard spelling and grammar.
Style is clear, resourceful and academic.
A wide range of contemporary and relevant references cited in
the reference list in the correct style.
MERIT
Good Quality
60-69%
Addresses the assumptions of the title and/or the requirements

of the brief well.
Demonstrates a sound knowledge of theory and practice for this
level.
Comprehensively interprets appropriate concepts and theoretical
models.
Demonstrates originality in conceptual understanding
Presents a cohesive critique of key research material resulting
in clear and original conclusions.
Demonstrates creative solutions to complex problems.
Produces superior work that makes a contribution to the
area
For the most part coherently articulated and logically
constructed.
Very good presentational style & layout, appropriate to the type
of assignment.
Effective inclusion of FTP.
Well written with
standard spelling and grammar. Style is clear and academic.
A range of contemporary and relevant references cited in the
reference list in the correct style.
PASS
Satisfactory Quality
50-59%
Generally addresses the assumptions of the title and/or the

Minor irrelevance in places.
Demonstrates an adequate knowledge of theory and practice for
this level. Some minor omissions.
Satisfactorily interprets some appropriate concepts and
theoretical models.
Demonstrates some originality in conceptual understanding.
Presents some critique of key research material resulting in
original conclusions. Loss of focus in places.
Demonstrates some creativity in solving complex problems.
Produces satisfactory work that makes some contribution to the
area.
Adequate attempt at articulation and logical structure.
An acceptable format is used.
The presentational style & layout is largely correct for the type
of assignment.
Inclusion of FTP but lacks selectivity.
Competently written with minor lapses in spelling and grammar.
Style is legible and mainly academic.
Key contemporary and relevant academic sources are drawn
upon.
Most sources are accurately cited in the text and reference
list/bibliography.

Minor weaknesses evident.
FAIL
Borderline Fail
45-49%
Some implications of issues explored.
Some irrelevant and/or superficial arguments.
Some omissions evident in knowledge of theory and practice at
this level.
Insufficient understanding of appropriate concepts and
theoretical models.
Demonstrates some conceptual understanding in places.
A limited amount of critique of key research material with
description in places. Lacks creativity. Some original
conclusions.
Limited attempt at articulation and problems with structure.
Some formatting errors.
Some weaknesses in the presentational style & layout.
Some inappropriate use of FTP.
Intermittent lapses in grammar and spelling.
Style hinders clarity in places and is not academic throughout.
Limited number of contemporary and relevant sources cited.
Weaknesses in referencing technique.
Fail
30-44%
Significant degree of irrelevance to the title and/or brief.

Issues are addressed at a superficial level and in unchallenging
terms.
Demonstrates weaknesses in knowledge of theory and practice
for this level.
Limited understanding and application of concepts.
A basic argument is presented, but too descriptive or narrative
in style.
Limited originality and creativity.
Conclusions are not clearly stated.
Poorly structured. Lack of articulation.
Format deficient.
For the type of assignment, the presentational style &/or layout
is lacking.
FTP ignored in text or not used where clearly needed.
Deficiencies in spelling and grammar make reading difficult in
places.
Simplistic or repetitious style impairs clarity.
Inappropriate sources and poor referencing technique.
<30%
Relevance to the title and/or brief is intermittent or missing.
The topic is reduced to its vaguest and least challenging terms.
Demonstrates a lack of basic knowledge of either theory or
practice for this level, with little evidence of conceptual
understanding.
Severely limited arguments. Descriptive or narrative in style

with no evidence of critique and originality or creativity.
Conclusions are sparse.
Unstructured.
Lack of articulation.
Format deficient.
For the type of assignment, the presentational style &/or layout
is lacking.
FTP as above.
Poorly written with numerous deficiencies in grammar, spelling,
expression and style.
An absence of academic sources and poor referencing
technique.
12
Example Test 1
1. František, a.s. is a company based in the Czech Republic and
operating mainly in the Czech Republic and Russia. The table
below lists the Government bond rate for local currency bonds
in each of those countries, the sovereign ratings, the CDS
spreads of each of those countries, and the revenues František
expects to generate in each market.
Country
Revenue in Billions of Koruna
Local Currency
Gov’t Bond Rate in Local Currency
Sovereign Rating
Sovereign CDS Spread

Russia
30
Rubles
12%
Ba1
2.5%
Czech Rep.
70
Koruna
1.5%
A1
0.5%
a. Estimate the risk-free rate in Koruna
b. Estimate the market risk premium for the company. Assume
that in these countries equity is 1.5 times riskier than the
government bond. Mature markets have a market risk premium
of 6%. (2 points)
2. Here is information from the beta page for Alphabet, Inc.
(aka Google) based on 2 years of weekly data.
Interpret the intercept of the regression. (What does it tell us
about the company?)
Interpret the R2 of the regression. (What does it tell us about
the company?)
3. IBM is considering an acquisition of Twitter (to augment and
advertise its data mining services). You have collected the
following information about the two companies:

IBM
Twitter
Market Cap (in $Billion)
150
20
Debt (in $Billion)
50
0
Levered Beta
1.0
1.3
Assume both firms have a marginal tax rate of 40%.
a. Estimate the unlevered beta for IBM after the acquisition. (3
points)
b. Assume that IBM will borrow $50 billion. They will use $20
billion to buy out Twitter shareholders. They will use the rest
($30 billion) to buy back stock. Estimate the (levered) beta for
IBM after the acquisition. (2 points)
Example Test 2
1. Odinsa, S.A. is a Colombian construction and infrastructure
development company operating primarily in Colombia, but also
in Chile and Panama, and in the Dominican Republic and other
parts of the Caribbean.

Here is the Beta Regression page returned by Bloomberg for the
company:
The index used for this regression is COLCAP – a Colombian
stock index. (The six largest stocks in the index constitute half
of the index’s market capitalization.)
Interpret the intercept of this regression. (What is it telling us
about the company?)
2. You have been given the following information:
Country
Local Currency Bond Yield
CDS Spread
Standard Deviation in Government Bond
Standard Deviation in Equity
Colombia
7.0%
1.39%
15%
35%
Chile
4.2%
0.96%
10%
20%
a. Estimate the risk-free rate in Colombian pesos.

b. Estimate the market risk premium for operations in Chile.
(You may assume the market risk premium in mature markets is
5%.)
3. You have been asked to estimate a levered beta for Flatline
Medical Co., a company that operates in the pharmaceutical and
healthcare support service industries. You have calculated the
following:
Comparable Firms
Business
Estimated value (in $million)
Regression Beta
D/E ratio
Pharma
$1,200
1.02
15%
Services
$800
0.95
35%
The company has 100 million shares outstanding, trading at $20
per share. (It has no debt.) The tax rate for all companies is
40%.
a. Estimate the levered beta for Flatline, given its current
structure.
b. Now suppose Flatline has decided to sell its healthcare
services division (for $800 million). In addition, it will borrow
$200 million. Finally, it will pay a one-time special dividend of

$600 million. (It will keep the remaining $400 million as cash
for future investment needs.)
Estimate the new levered beta of the company after these
changes.
Example Test 3
1. Transportes Aeromar is an airline based in Mexico City. They
operate domestic passenger service in Mexico and international
service to the United States. Aeromar’s revenue breakdown is
summarized below along with some macroeconomic data.
Country
Revenue (in million $US)
Gov’t Bond Rate (in local currency)
Gov’t Bond Rate (in $US)
Equity Market Standard Deviation
Bond Market Standard Deviation
Mexico
200
7%
5%
24%
16%
US
60
2.5%
2.5%
15%
10%
The market risk premium for the US is 5.5% and the beta for
Aeromar is 1.2. Estimate the cost of equity in Mexican Pesos.
(Note: Mexico’s debt is not AAA rated. You may assume that
Mexico has the same bond rating in Pesos and US$.)

2. Nile.com is an internet retailor which also runs an internet
services business. 75% of the company’s revenue comes from
sales and the rest from services. You have estimated the
following about those industries:
Industry
Average Beta
Average D/E ratio
Internet Retailors
1.23
0.1
Internet Services
1.00
0.2
The company has a market capitalization of $10 billion and also
has $2 billion of debt outstanding. The companies’ tax rate is
40%.
a. Estimate the levered beta for the company.
b. Nile.com has decided to acquire Total Grub, a national
grocery store chain. They plan to issue $3 billion of equity and
use the money to acquire Total Grub. Grocery stores have an
unlevered beta of 0.5. Estimate the new levered beta of the
company (after the acquisition).
Example Test 4
Here are the results of a Beta regression for Bombardier.
1a. Estimate the Jensen’s Alpha (annualized) for Bombardier
during this period?

1b. Give a 67% confidence interval for this estimate of
Bombardier’s Beta.
a.
2. Bombardier is considering an offer to purchase Taneja
Aerospace & Aviation Ltd., an Indian Aircraft manufacturer.
The Indian government has 10-year Rupee denominated bonds
outstanding which are rated BBB- and have a yield to maturity
of 8.3%. The default risk premium on BBB- rated bonds is
2.5%. The Indian equity markets are 1½ times as volatile as the
Indian government bond. The ten-year U.S. Treasury bond
yields 2% and the mature market risk premium is 6%.
Estimate the US dollar cost of equity Bombardier should use for
this investment. (Use information from problem 1 if necessary.)
3. You have gathered the following information about
Bombardier’s two divisions:
The average regression beta for Aerospace companies is 1.1 and
the average D/E ratio of these firms is 30%. The average
regression beta for Railroad companies is 1.44 and the average
D/E ratio of these firms is 25%. The tax rate for all firms is
33%.
The firm’s value comes 55% from the Aerospace division and
45% from the Rail division. The market capitalization of the
company is Can$8.6 billion and it has Can$5 billion in
outstanding debt.

a. Estimate the levered beta for Bombardier today.
b. Suppose the company is thinking of selling the Rail division
for its current value in cash. They plan to use half the money to
retire debt and the other half to pay a one-time dividend to
stockholders. Estimate the levered beta of the firm if they go
ahead with this plan. (
Exam 1 Review
1. Corporate Governance
What are the potential conflicts of interest that face a business
and how do they manifest themselves in practice?
Short answer or multiple choice questions.
2. Beta Regressions

How would you use the intercept to measure stock price
performance?
What does the slope of the regression measure?
What does the R squared of the regression tell you about risk?
Jensen’s Alpha
As we discussed in class, Bloomberg’s regressions require an
adjustment to get to the correct Jensen’s Alpha.
Past exams may have asked for that adjustment. Your exam will
not.
What is the annualized Jensen’s Alpha? Evaluate it.
What is the estimate of the beta of the company based on the
regression and what is the 95% confidence interval of that
estimate?
What is the annualized Jensen’s Alpha? Evaluate it.
The annualized Jensen’s alpha is (1 + (-0.01258))12 - 1
= -14.09%
The company did 14.09% worse than it ‘should have’, per year,
given its riskiness and given the return on the market.
What is the estimate of the beta of the company based on the
regression and what is the 95% confidence interval of that
estimate?
The beta is 1.261 and the standard error of the beta is 0.298
The 95% confidence interval is +/- 2 standard deviations
1.261 +/- 2*0.298 -> 0.665 - 1.857

From betas to expected returns
Beta is a measure of the market risk in an investment.
The expected return on an equity investment, which is also the
cost of equity, can be written as
Cost of Equity = Risk-free Rate + Beta (Risk Premium)
We will focus on the risk-free rate and the market risk premium
in this question.
Risk-free rates and Market Risk Premiums
The risk-free rate should generally be long-term, default free
and currency matched.
The risk premium is often estimated from historical data. The
risk premium can also be estimated from current market data, in
which case it is called an implied equity risk premium.
For emerging markets, an additional country risk premium may
have to be added on. The country risk premium can be
estimated
Simply by added the default spread based on the country rating
to the mature market risk premium
In a more sophisticated way, by estimating the relative equity
market volatility and then adjusting the default spread for this
relative volatility.
For investments across different countries, we can average the
risk premiums in those countries (weighted by size of
investment).
Rather than using the beta from the regression, you decide to
compute a bottom-up beta and you estimate that it is 1.10.
(This is the levered beta.) Next you collect some data to use in
estimating risk-free rates and country risk premiums
You have estimated that the market risk premium for mature

markets is 5.00%. Chile and Brazil have the same rating on
their local currency bonds as they do on their foreign currency
bonds. (Not the same rating as each other.)
Estimate the US dollar cost of equity for LATAM’s Brazilian
operations.
Estimate the Chilean Peso cost of equity for LATAM’s Chilean
operations.
Estimate the US dollar cost of equity for LATAM’s Brazilian
operations.
US dollar cost of equity means US$ risk-free rate = 3%
Brazilian operations means Brazil’s Market Risk Premium
Mature market risk premium = 5%
Brazil’s default risk premium (on bonds) = 5% - 3% = 2%
Ratio of riskiness of Brazil’s stocks to bonds = 28/20
Brazil’s Country Risk Premium = (28/20) * 2% = 2.8%
Brazil’s Market Risk Premium = 5% + 2.8% = 7.8%.
Cost of equity = 3% + 1.1 * 7.8% = 11.58%
Estimate the Chilean Peso cost of equity for LATAM’s Chilean
operations.
Peso cost of equity means Peso risk-free rate.
Chile’s default risk premium = 4% - 3% = 1%
Peso Risk-free Rate = 6.25% - 1% = 5.25%
Chilean operations means Chile’s Market Risk Premium
Mature market risk premium = 5%
Ratio of riskiness of Brazil’s stocks to bonds = 24/16
Chile’s Country Risk Premium = (24/16) * 1% = 1.5%
Chile’s Market Risk Premium = 5% + 1.5% = 6.5%.
Cost of equity = 5.25% + 1.1 * 6.5% = 12.4%

How would we find the cost of equity for the whole company?
Betas and fundamentals
The beta of a firm reflects three fundamental decisions a firm
makes.
The type of business it is in, and the products and services it
provides. The more discretionary these products or services,
the higher the beta.
The cost structure of the business as measured by the operating
leverage.
The financial leverage that the firm takes on; higher financial
leverage leads to higher equity betas.
A multi-industry firm
Hercules Workout Centers is a publicly traded company that
operates gyms across the United States.
The company has 50 million shares outstanding trading at $16
per share and $200 million in debt outstanding.
In addition to its operations, the company has $100 million in
cash.
The marginal tax rate for all companies is 40%.
Assume that the unlevered beta for the gym business is 0.8.
Estimate the levered beta for Hercules (as a company).
Step 1: Create Balance Sheet
Equity = 50M * 16 = 800 ; Debt = 200
Gym = 1,000 - 100 (Cash) =
900Gym900Debt200Cash100Equity80010001000

Step 2: Compute unlevered betas of divisions
In this problem, it is given:
βGym = 0.8
βCash = 0
Step 3: Compute unlevered beta of assets
900/1000 * 0.8 + 100/1000 * 0 = 0.72
Step 4: Lever beta
0.72 * [1 + (1 - 0.4) * 200/800] = 0.828
A change …
Now suppose that Hercules plans to borrow $200 million and to
use this money, plus their $100 million in cash, to buy an
exercise equipment manufacturer for $300 million.
If the unlevered beta of the exercise equipment business is 1.20,
estimate the levered beta of the company after this acquisition.
Estimate the levered beta of the company after this acquisition.
Step 1: Create Balance Sheet
New debt = 200 + 200 = 400
New Equipment asset = 300
New cash = 100 - 100 = 0
No change to
equity.Gym900Debt400Equipment300Equity80012001200
Step 2: Compute unlevered betas of divisions
In this problem, it is given:
βGym = 0.8

βEquipment = 1.2
Step 3: Compute unlevered beta of assets
900/1200 * 0.8 + 300/1200 * 1.2 = 0.9
Step 4: Lever beta
0.9 * [1 + (1 - 0.4) * 400/800] = 1.17
Another Problem
You have been asked to estimate the levered beta for GenCorp,
a corporation with food and tobacco subsidiaries. The tobacco
subsidiary is estimated to be worth $15 billion and the food
subsidiary is estimated to have a value of $10 billion. The firm
has a debt to equity ratio of 1.00. You are provided with the
following information on comparable firms:
All firms are assumed to have a tax rate of 40%. The risk-free
rate is 3.5% and the market risk premium is 5.5%. What is
GenCorp’s cost of equity?
Unlevering betas
This is the lever beta formula in reverse:
Food = 0.92 / [1 + (1 - .4) * (.25)] = 0.8
Tobacco = 1.17 / [1 + (1 - .4) * (.5)] = 0.9
Unlevered Beta of GenCorp
Remember our financial balance
sheet:AssetsLiabilitiesTobacco$15 billionDebt$12.5
billionFood$10 billionEquity$12.5 billion Total$25 billion

Total$25 billion
The unlevered beta of GenCorp will be
15/25 (0.9) + 10/25 (0.8) = 0.86
The Beta of the whole is the weighted average of the betas of
the parts.
24
Levered Beta and Cost of Capital
Unlevered beta = 0.86
D = $12.5B; E = $12.5B
Tax rate = 40%
Rf=3.5%; Risk Premium = 5.5%
Levered Beta for the Firm = 0.86 (1+(1-.4)(12.5/12.5))
= 1.376
Cost of Equity = 3.5% + 1.376 (5.5%) = 11.068%
25
A complication - divestiture
Suppose GenCorp sells the food division for $10B. What
happens to the firm’s cost of
equity?AssetsLiabilitiesTobacco$15 billionDebt$12.5
billionFood Cash$10 billionEquity$12.5 billion Total$25
billion Total$25 billion
The beta of cash is 0. Nothing else changes.
The unlevered beta of GenCorp will be 15/25 (0.9) + 10/25 (0)
= 0.54
= 0.864

Cost of Equity = 3.5% + 0.864 (5.5%) = 8.252%
26
A complication – use cash to pay debt
Suppose GenCorp uses the $10B to pay off debt. What happens
to the firm’s cost of equity?AssetsLiabilitiesTobacco$15
billionDebt$2.5 billionCash $0Equity$12.5 billion Total$15
The unlevered beta of GenCorp will be 0.9 – no problem, but
the debt/equity ratio is now 0.2 (2.5/12.5)
= 1.008
Cost of Equity = 3.5% + 1.008 (5.5%) = 9.044%
27
A complication – use cash to buy back stock
Suppose GenCorp uses the $10B to buy back stock. What
happens to the firm’s cost of
equity?AssetsLiabilitiesTobacco$15 billionDebt$12.5
billionFood Cash$10 billion 0Equity$2.5 billion Total$15
The unlevered beta of GenCorp will be still be 0.9, but NOW
the debt/equity ratio is now 5.0 (12.5/2.5)

= 3.6
Cost of Equity = 3.5% + 3.6 (5.5%) = 23.3%
It is not enough to just say there is a divestiture. We need to
know what they will do with the money in order to say what
happens.
We could do any other choice the same way. (What if they pay
a dividend of $2.5M and pay down debt of $7.5M?)
28
What if we use the $10B to buy an internet firm (Asset Beta =
1.8)?
The unlevered beta of GenCorp is now
15/25 (0.9) + 10/25 (1.8) = 1.26
= 2.02
Cost of Equity = 3.5% + 2.02 (5.5%) =
14.61%AssetsLiabilitiesTobacco$15 billionDebt$12.5
billionInternet$10 billionEquity$12.5 billion Total$25 billion
Total$25 billion
29
What if we use the $10B and borrow another $5B to buy a $15B
internet firm (Beta = 1.8)?
The unlevered beta of GenCorp is now
15/30 (0.9) + 15/30 (1.8) = 1.35
= 2.48
Cost of Equity = 3.5% + 2.48 (5.5%) =

17.14%AssetsLiabilitiesTobacco$15 billionDebt$17.5
billionInternet$15 billionEquity$12.5 billion Total$30 billion
Total$30 billion
Always make sure that your financial balance sheet balances.
No matter how complicated I make this, you can handle it.
30
Test yourself…AssetsUnlevered BetaD/E ratioLevered BetaSell
AssetReplace asset with cashDecreaseNo effectDecreaseBuy
asset with cash on handBuy asset with equity issueBuy asset
with new debtPay dividendBuy back stockRetire debt
Figure out what each action will do to a financial balance sheet
and to the beta. (You may not have enough information for
every answer.)
Take GenCorp and do the most complicated restructuring you
can think of. Find one in the WSJ and replicate it. After a
couple you will see this is not rocket science
31
CHALLENGES & BARRIERS
SERVICE USER INVOLVEMENT
WEEK 5

*
TODAY’S SESSION
Overview of the UK healthcare system and where care is
provided the most and how it is coordinated
Barriers/ challenges to service user involvement
*
The UK healthcare system
Providers and commissioners
*
Partnership
Licensing
Department of Health
NHS Commissioning Board
GP Commissioning Consortia
Providers
Monitor
CQC

Patients & Public
Local
Authorities
Local
HealthWatch
contracts
Accountability
Funding
The NHS being a national organisation, governed by political
and economic agendas already has the ability to control and
condition health services.
*

The UK healthcare system
The role of Clinical Commissioning Groups
Clinical Commissioning Groups (CCGs) are one of the
commissioners of healthcare in the country
CCGs are made up of groups of GP practices (they are
‘clinically led’)
CCGs commission healthcare in Leeds.
They plan and pay for hospital, community and GP healthcare in
the city
There are three CCGs in Leeds
*
The role of primary care
Who does what in healthcare?
Primary care is responsible for 90% of patient contact
*
Service user involvement
What is the role of a service user?

Patients, carers and the public
Commissioners and providers
The evidence base within the literature suggests various barriers
central to SUP, even though there is also a lot of evidence to
suggest that service users are championed nationally
*
CAN YOU THINK OF SOME REASONS WHY THERE ARE
BARRIERS TO SUI & DELIVERING PERSON CENTERED
CARE?
DISCUSS...
*
ACTIVITYSCENARIOS – Different levels of involvement
Identify where scenario fits on ladder, discuss the reasons for
this decision and how this could be improved so that the
scenario may sit higher up the ladder
This ladder helps to clearly put into perspective what
‘participation’ or ‘involvement’ means especially for people
who are initiating a participatory activity.
A feasible question to ask: is it possible to move up this ladder?
For example, are organisations willing to go beyond just

‘consultation’ to enabling the community to act by developing
‘partnerships’ which a step higher.
*
WHAT IS THE ROLE OF A SERVICE USER?There is still the
perceived notion that health organisations hold the power,
which may get in the way of truly engaging with service users.
The ongoing criticism of barriers to real involvement also often
times focus on negative issues that subsequently deter people
from getting involved. This cannot be ignored, because
interactions and relationships with service users form the
foundation for meaningful outcomes in participatory activities
and for SUI to foster
*
BARRIERS / CHALLENGESTokenism characterises the main
barrier to participatory initiatives. Some of the identified
factors that contribute to perceived tokenistic views and that
influence the direction and outcomes of SUI are
power/professional status, varying perspectives on knowledge
and rhetoric to actions These factors could either prevent people
from taking part in involvement activities.
*

BARRIERS / CHALLENGES
CHOICE & CONTROLChoices made by healthcare
professionals can constrain those of service users, which in turn
becomes an exercise of control. The NHS being a national
organisation, governed by political and economic agendas
already has the ability to control and condition health
Therefore, service users’ ability to exercise their own choice
could become constrained at individual and group level.
*
POWER & PROFESSIONAL STATUSLaverack’s (2005)
argument on how power is exercised...
Firstly, the sharing of control (power) with others and
Secondly the use of control (power) to exert influence over
others.
*
POWER& PROFESSIONAL STATUSThree different variations
for health practitioners to consider on exercise of power
according to Laverack (2005, p. 11-14) are:
1. power-from-within: (described as an experience of ‘self’ also
known as individual, personal or psychological empowerment,
means of gaining control over one’s life. Individuals having

some inner sense of self-discipline, self-knowledge and self-
esteem)
*
POWER& PROFESSIONAL STATUSPower according to
Laverack (2005, p. 11-14) are:
2. power-over: (the social relationships in which one party (e.g.
service users) does exactly what another party (e.g.
professional) wishes them to do, and may not be in their best
interests)
3. power-with: (the social relationship in which power-over is
used deliberately, but carefully to increase other people’s
power-from-within, rather than dominate or exploit them)
*
POWER& PROFESSIONAL STATUSThese variations indicate
that the exercise of power in the participatory process itself
shapes the constitution of its interest.
The professional-patient relationship is the active
interactions/relationship between health professionals and
service users

*
POWER REBALANCEThis drive for rebalancing power-
relationships between health providers and service users is
currently being advocated as patient empowerment. Laverack
(2005) stated
“patient empowerment enables people to take control of their
health, well-being and disease management and to participate in
decisions affecting their care”
(Laverack, 2005, p. 39).
High quality care now require healthcare professionals to have
responsibility to address patient centred care, taking into
account the benefit of their professional decisions to individual
people and also implication for other patients and wider systems
*
Professional responsibility to addressHigh quality care require
healthcare professionals to have responsibility to address
patient centred care, taking into account the benefit of their
professional decisions to individual people and also implication
for other patients and wider systems
This requires particular attention to all interactions that take
place within a patient-professional relationship
Evaluating the capacity for shared decision making that is being
extended to service users in ensuring there is a balance within
power relationships

This will enable service users to attribute value to their own
contributions and ensure a perceived sense of equal partnership
with healthcare professionals
*
KNOWLEDGEAnother factor worth consideration in relation to
power balance and professionals’ status is knowledge.
Hodgson and Canvin (2005: p 39) argues that “involvement
cannot proceed unless different kinds of knowledge come to be
considered knowledge”.
Beresford (2005) also explored if service users’ knowledge can
ever have equal status and if it could be classed as evidence?
*
KNOWLEDGEThis question clearly raises issues with voice,
power and control
It also shows that there is still a tendency for service providers /
healthcare professionals to stand from a position of having
superior knowledge in comparison to users who may rely on
their own and/or others experiences
Bringing different knowledge together rather than categorising
and raising tensions of power can result in ‘authentic’

participatory process and strengthen the evidence base practice
in participatory processes.
*
RHETORIC TO ACTION - Meaningful outcomesOften, the
process to achieve meaningful outcomes is not always easily
attainable.
Challenge - health service re-design, development or
improvement is mainly professionally led and new plans tend to
have been discussed by health professionals and commissioners
before service users are brought in to engage with the agenda.
*
RHETORIC TO ACTION - Meaningful outcomesDelays in
communication of informative materials to engage service users
in discussions = service users not being able to make an
informed contribution in the processThis impacts on
authenticity and meaningfulness of users’ involvement
Therefore service users’ expectations do not often align with
their experience of being involved.
*

ENCOURAGED DEPENDENCE A culture is required that does
not encourage dependence.
In clinical settings the barriers to joint or partnership working
can prevent the giving and sharing of information.
It involves moving away from the more traditional prescriptive
approaches, towards joint working between clinician and service
user.
*
CHALLENGE –ISSUES ON SERVICE USER
REPRESENTATIONAlthough participatory initiatives are seen
as a democratic effort...
The numbers of service users actually involved is not
representative of the national call for “all” users to be involved
in health services (Warren, 2008).
*
REPRESENTATIONAccording to Fredriksson and Tritter
(2017) SUI initiatives do not mean that most citizens are
engaged in participatory activities.
They further stated that “it is more accurate to say that a few
citizens actively serve as representatives of a potential
constituency …” (Fredriksson and Triter, 2017: p. 103),
Thus, not all service users participate in the various processes

or procedures of being an involved user.
*
REPRESENTATIONEmphasis on the need for
representativeness of individuals and groups.
One of the fundamental dilemmas of representation of service
users in participation is that only a few individuals have the
power (mostly as a result of being members of local
forums/groups), or confidence to be involved in decisions
around their health systems. LINKS IN WITH
EMPOWERMENT AGENDA FOR SERVICE USERS – NEXT
WEEK’S SESSION
*
REPRESENTATIONREPRESENTATIVENESS – SERVICE
USERSThis creates a challenge for having unrepresentative
group or forums that may not express the views, attitudes and
experiences of the wider people being represented (Hogg, 2007)
Another issue: who a lay member is representing - if
representing users of specific services or simply themselves.
Thus, if representing other users, it raises the question of how
accountable they are to those they represent

*
REPRESENTATION
REPRESENTATIVENESS – SERVICE USERSOne of the
reasons for abolishing PPI forums was that they were not
representative of their communities and the existing system was
too bureaucratic and subject to 'tick the PPI box' (DoH, 2007a,
p. 28). Challenge – How to bring together individual
experiences in a way that it becomes an evaluation of a group of
individuals or a forum that represents the collective views of
groups
in such a way that it influences the decision making process
around healthcare provision.
*
A conceptual framework for SUI
Individual
My say in decisions about care and treatment
Collective
Our say in planning, design and delivery of services
Information
Feedback
Influence
*

A conceptual framework for
SUIInformationFeedbackInfluenceIndividual
My say in decisions about care and treatmentInformation to
patients about treatments (comms)e.g. PALS, complaintse.g.
Expert patient; advocacyCollective
Our say in planning, design and delivery of servicesInformation
to citizens about services (comms)e.g. patient experience data
(surveys, focus groups); consultation; Trends in PALS,
complaints data; LINksRepresentation and involvement in
decision making
OUTCOMES
OUTCOMES
OUTCOMES
*
ACHIEVING SERVICE USER INVOLVEMENT
Choice is central to user involvement and fundamental to
development of good health and care services.
Although choice and involvement should be the norm, we still
do not know what partnership working in practice can achieve
in terms of outcomes and benefits.
Lot more scope for service user involvement and person
centered approaches in care to develop
*

ACHIEVING SERVICE USER INVOLVEMENT
PartnershipPartnerships and involvement can be considered as a
continuum,
from service users who are not engaging
to
those who are fully engaged.
*
DYNAMICS OF PARTICIPATION
Who is participating, why they are participating and how they
are participating?
Who’s processes for which purposes and on what terms have the
participation activity taken place?
These questions can ultimately break down the barriers and
challenges to SUI / PCA
*
Primary
care
NHS
interaction
GP practices
Pharmacies
NHS walk-in centres

Dentists
opticians
Some urgent care
Community
care
-emergency
Occupational therapy
Community gynaecology
services
Podiatry services
Wound prevention and
management service
Secondary
care
–pre-arranged, non-
emergency care, referred by primary care
-elective care – emergency or very
urgent care
Emergency care
Some urgent care
Ambulance trusts
Care trusts
Mental health trusts
NHS trusts (hospitals)
Working Together: A toolkit for health professionals on how to
involve the public

Acknowledgements
This Toolkit has been written with the encouragement and
support from a number of staff and public contributors from
both the West of England Academic Science Network and
People in Health West of England.
In particular I would like to thank the following for their
suggestions, taking the time to read early drafts and
providing me with helpful comments. These include Anna
Burhouse, Rosie Davies, Peter Dixon, Chris Dunn, Dave
Evans, David Evans, Deborah Evans, Andy Gibson, Natasha
Owen, Joanna Parker, Emma Stone, Natasha Swinscoe,
Sandra Tweddl, Adele Webb. In addition I would like to
thank Nathalie Delaney for formatting the text into a Toolkit
template.
Hildegard Dumper
Patient & Public Involvement Manager
People in Health West of England
Licence
Training materials and supporting resources are © West of
England Academic Health Science Network 2016, and
provided under license for use by WEAHSN members under the
following terms:
• Attribution — You must give appropriate credit, provide a link
to the license, and indicate if changes were
made. You may do so in any reasonable manner, but not in any
way that suggests the licensor endorses you or
your use.

• Non Commercial — You may not use the material for
commercial purposes.
• Share Alike — If you remix, transform, or build upon the
material, you must distribute your contributions under
the same license as the original.
• No additional restrictions — You may not apply legal terms or
technological measures that legally restrict
others from doing anything the license permits.
This work is licensed under the Creative Commons Attribution-
NonCommercial-ShareAlike 4.0 International License.
To view a copy of this license, visit
http://creativecommons.org/licenses/by-nc-sa/4.0/ or send a
letter to Creative
Commons, PO Box 1866, Mountain View, CA 94042, USA.
This document is version 1.0 August 2016
Introduction
Introduction Why?
1 2 3 4 5
How? Known issues Useful skills Evaluation Useful resources
1
http://creativecommons.org/licenses/by-nc-sa/4.0/

Contents
Introduction Why?
1 2 3 4 5
Introduction Why?
1 3 4 5
Introduction
Contents
Overview
Why Involve
Terminology
What type of involvement
and when should we use
them?
Getting started
Useful tips
Equalities and diversity

Ethical issues
What skills do I need?
Communication skills
Evaluation Recommended
resources
About People in Health
West of England
About the West of
England Academic
Health Science Network
2
Overview
Why a Public Involvement Toolkit?
As a result of legislation and current policy in health
and social care, involving the public (service users, their
families, carers and citizens) is increasingly becoming
the ‘way we do things’. Co-production as a method of
involvement is also being increasingly promoted. Many
clinicians are unprepared for this and whilst there are
several Toolkits or guides available (see section on Useful
Resources) they are each written with a specific target
audience in mind, such as commissioners or researchers.
There is little available for busy clinicians and other
healthcare professionals who need something they can
use in their daily practice.

The interpretation of ‘involvement’ and co-production
can vary between the different disciplines of health
research, quality improvement, service provision and
commissioning. These can be confusing for staff on the
ground, who then may not be sure whether they are
doing the ‘right’ thing. This Toolkit aims to reassure and
encourage the practical application of involvement and
co-production.
Toolkits by their very nature are intended to be of
immediate practical use. As policy changes, they become
out of date. Users of the Toolkit should bear this in mind.
However the principles of involvement and the practical
applications suggested should apply whatever policy
changes take place.
Who this toolkit is for
Whilst this toolkit has been written with the busy, front line
clinician in mind, it should be useful for anyone who wants
a beginner’s guide to understanding public involvement in
the health sector.
How to use it
The toolkit has been designed to be a quick reference tool
on ‘how to do it’, with links taking you to more detailed
text that explains either the theoretical framework in more
depth or offers practical suggestions. It draws on both
research and quality improvement traditions. Attention is
drawn to where there are differences. Where a topic has
been addressed usefully elsewhere, the reader is directed
to that source.
Definition of involvement

For the purposes of this toolkit, involvement refers to:
All activities and interventions that involve the public
(service users, their families, carers and citizens)
in health research, the design of services and the
shared decisions made about the care of their
health and well-being.
For detailed discussion see the Terminology section.
‘Sandra is an invaluable member of our team. She’s
been with us from the start bringing her contacts
with local and national networks. Sandra has really
helped the vision of our project come alive, bringing
to life what the project will mean for people with
diabetes.’
Dr Elizabeth Dymond, WEAHSN
‘My independence is really important to me.
Although I’ve got a disability (cerebral palsy) in
my head I’m not disabled. So I want to do what
everyone else can do. That’s one of the reasons why
I wanted to take part in the workshops. ‘
Bethan Griffiths attendee at Design Together Live Better
workshop
‘Public members bring another perspective. Having
a fresh wind blowing in now and again (from the lay
perspective) acts as a fail-safe device.’
Public contributor with People in Health West of England
Introduction Why?

1 2 3 4 5
3
Why involve?
Because we have to
There are a number of pieces of legislation that support
the implementation of public involvement, in particular,
The Health & Social Care Act of 2012. This placed duties on
Clinical Commissioning Groups (CCGs) and NHS England to
promote the involvement of patients and carers in decisions
which relate to their care or treatment. The Act also places
a requirement on CCGs and NHS England to ensure public
involvement and consultation in commissioning processes
and decisions.
In support of this, the NHS Standard Contract, that is
applicable to any provider of NHS services, states that
providers must actively engage with the public and involve
them in service redesign and implementation of new
developments. .
The evidence is that it makes interventions more
effective and efficient
There is increasing evidence that patients who are involved in
making decisions about their own condition show faster rates
of recovery. It has also been shown that involving people
in all aspects of the development and provision of health

services makes it more effective; involvement in research
ensures that the focus is on areas that patients and the public
want to know more about and involvement in the design and
provision of services makes sure that services are designed
to fit round the requirements of patients and their carers.
Because it is the right thing to do
It is increasingly recognised that it is ethical to involve patients
and their carers in any decision that affects their health care.
Involving the public at all levels of health helps to create a
culture of openness and transparency and prevent a repeat
of some of the scandals that have hit the headlines such as
occurred in Mid-Staffordshire.
Increases a sense of wellbeing amongst the public
Involving people can make a contribution to the general well-
being of society. Carers and families who are closely involved
in sharing the management of a health condition have a
greater understanding of the issues and the choices available
and as a result are less stressed.
Volunteering generally has been found to be beneficial to
general sense of well-being. The social nature of the activity
and the sense of contributing altruistically to the greater good
of society helps to alleviate loneliness and develop a stronger
feeling of usefulness. Those who are involved in the health
sector as volunteers or as public contributors also benefit and
report an increased sense of well-being.
Health services that meet the needs of the public
A public that is involved at all stages of design and
implementation are more likely to understand the restraints

on the provision of healthcare. The Five Year Forward View
aims to establish health as a social movement. This can only
be done if there is a culture of involvement and inclusivity.
Effectiveness of research
The Chief Medical Officer, Dame Sally Davis has led the way
in promoting public involvement in research to ensure that
research undertaken in the NHS reflects the health needs of
our population. Research that involves the public from the
beginning is more likely to be relevant and effective. Patients
do better in research active Trusts.
Introduction Why?
1 2 3 4 5
4
Terminology
Citizen Engagement
Introduced by NHS England to democratise the relationship
between the public and NHS. The term ‘citizen’ is increasingly
being used to denote a shared responsibility for services
between health professionals and the general public
Co-production
Co-production is often used to describe the relationship
between service user and professional in health and social
care, for example in shared decision-making and social
prescribing. The important ingredient that all these ‘co-‘words

share: co-produce, co-design and co-create, is an approach
which regards each individual, regardless of their role,
as having a valuable contribution to make. Central to this
approach are principles of reciprocity and equality.
Engagement
Information and knowledge is provided and disseminated
Health research
INVOLVE, the body supporting active public involvement in
NHS, public health and social care research defines public
involvement in research as ‘research being carried out ‘with’
or ‘by’ members of the public rather than ‘to’, ‘about’ or ‘for’
them. This includes, for example, working with research
funders to prioritise research, offering advice as members
of a project steering group, commenting on and developing
research materials and undertaking interviews with research
participants.’ (www.invo.org.uk).
Health service improvement
Policy and legislation issued by the NHS defines involvement
in terms of individual patient participation in the planning and
management of their care and patient choice. The Five Year
Forward View refers to NHS Citizens, volunteering, supporting
carers and working with voluntary organisations as some of
the ways of involving the public.
Participation
People taking part in a research study as participants for
example in clinical trials.
Patient Experience
Used in relation to measuring the experience of services and
derived from surveys such as the Friends & Family Test and
other activities.

Patient participation
Refers to the role of patients in shared decision-making
around the management of their condition
Patient Participation Groups (PPGs)
Set up by GP practices to involve their patients in improving
their services
Public Involvement
Patients and members of the public are actively involved in
helping to design and share research projects and service
improvement. There should be a named person in your
organisations leading on public involvement in research
and someone leading on public involvement in service
improvement
The words associated with public involvement are used
interchangably which can be confusing. Here is a guide to some
key terms:
People who engage or get involved can be
called...
• Service User
• Patient
• Carer
• Public Contributor
• Lay Representative
• Patient Representative
• Patient Ambassador
• Expert by Experience
These terms are used depending on personal
preference, the situation or clinical specialty.

Introduction Why?
1 2 3 4 5
How? Known issues Skills needed Evaluation Useful resources
5
http://www.invo.org.uk
What types of involvement and when should we use them?
The individual, including:
• Shared decision-making and self-care
• Participant in a research project
• Helping you co-design services
• Acting as observers
• Giving you individual feedback
Small groups, including
• Existing condition specific support groups
• Advisory groups, steering groups, governance bodies
• Focus groups or discussion groups
Broader engagement activities including
• Events
• Communicating with Trust membership
• Developing relationships with charitable/voluntary sector
• Using social media
Involvement can take place at three different levels:

Involvement as an individual
In addition to their experiences of being a patient, members of
the public bring other useful
skills and experiences. Retired health professionals are able to
bridge the world of patient and
professional and offer an institutional memory, preventing
services from re-inventing the wheel.
Others can act as a critical friend, asking the questions that staff
and patients feel too inhibited
to ask. For more on the roles that public contributors can fulfil,
see the NIHR’s Menu of Service
User Involvement: https://www.crn.nihr.ac.uk/wp-
content/uploads/mentalhealth/sites/21/
Menu-of-service-user-involvement.pdf
Public contributors can also bring a fresh approach to
identifying solutions to service
improvement. For more on this see the Kings Fund Experience
Based Design Toolkit http://www.
kingsfund.org.uk/projects/ebcd/carrying-out-observations
Introduction Why?
1 2 3 4 5
6
https://www.crn.nihr.ac.uk/wp-
content/uploads/mentalhealth/sites/21/Menu-of-service-user-

involvement.pdf
https://www.crn.nihr.ac.uk/wp-
content/uploads/mentalhealth/sites/21/Menu-of-service-user-
involvement.pdf
http://www.kingsfund.org.uk/projects/ebcd/carrying-out-
observations
http://www.kingsfund.org.uk/projects/ebcd/carrying-out-
observations
Involvement as an individual
Joanna Parker is a public contributor on the WEAHSN Patient
Safety Collaborative Board
I formally retired six years ago, having worked at regional and
national levels in healthcare for the last 15 years of my career;
the last seven
specifically in patient safety.
I am a volunteer with Healthwatch South Gloucestershire and
their ‘Enter and View’ lead, and also Chair of the Healthwatch
Advisory Group.
Since my retirement I’ve discovered what it means to be on the
receiving end of healthcare and it has amazed me. I’ve had
positive and negative
experiences, and been the ‘victim’ of two patient safety
incidents. Although I think I can be assertive and articulate and
know my way around the
‘system’, my voice has often not been heard in the care process,
or it is ignored, and I’ve been left feeling disempowered and
disappointed.
My work experience, my experience as a patient, and my belief
that patients should be ‘co-producers’ of care, make me feel

passionate about
trying to improve patient experience and patient safety.
Karen Gleave, from Sirona Care describes how patients can
contribute to staff induction:
Stephen is a service user living in one of our Extra Care
Services, and is a volunteer with Sirona Care & Health. He also
sits on the service user panel/
forum. The panel aims to embed service user voices at the heart
of the organisation and they collaborate on, and are consulted
about, a wide
variety of issues.
I met Stephen just over a year ago when I approached members
of the panel about working with me to provide a service user
perspective on what
it is like to receive a service for the Sirona support worker
Induction. Once Stephen started it became quickly apparent that
he was a “natural” talking
with people and able to get his message across about how
important communication and human factors are when
supporting people. Stephen is
able to bring the scenarios alive for the audience and has made
people laugh, and at times brought people to tears.
On the back of this success, and with the introduction of the
Care Certificate our organisational induction went through a
period of change. Stephen
now talks to all staff at Induction as we felt that his message is
relevant to all staff irrelevant of their role.
Stephen is very eloquent and speaks with such passion as to the
importance of staff teams and particularly support workers in
his daily life. By
Stephen sharing his story he is able to show how the differing

teams and services across Sirona and across Health and Social
Care have supported
him along the whole pathway, from the Social Work Team to
Reablement, Physio, Extra Care etc. and how Sirona has
supported Stephen to “get his
life back.”
Introduction Why?
1 2 3 4 5
7
Focus or discussion groups
The term focus group has a specific meaning in qualitative
research. To avoid confusion, in the context of public
involvement it is advisable to use the term ‘discussion group’.
This describes a workshop that brings people together to
focus on a particular aspect of healthcare. Careful thought
needs to be put into the running of this – how where and
when - and a skilled facilitator used to run it. By bringing
people together experiences get shared and ideas and
suggestions for improvement stimulated. For a useful guide
on how to go about setting up a focus group visit the Scottish
Health Council’s Participation Toolkit on Focus Groups http://
www.scottishhealthcouncil.org/patient__public_participation/
participation_toolkit/the_participation_toolkit.aspx#.

V5jF70YrIsY
Advisory/ steering/ reference groups, governing
bodies/ public involvement forums
The value of having a member of the public participating
at Board level or on advisory and steering groups as a
way of involving the public in your work should not be
underestimated. They provide the voice of the critical friend
and assurance of public accountability.
Sirona Care Services – service user panel
The Service User Panel is made up of members of
the public and service users who have an interest in
health and social care at Sirona. The Panel has been
in existence since 2010. At present we have eleven
members from across Bath & North East Somerset
and South Gloucestershire. The Panel’s role is to be
an organisation-wide body that works at a strategic
planning level within Sirona. The Panel aims to embed
service user voices at the heart of the organisation
and they collaborate on, and are consulted about,
a wide variety of issues. Over the past year they
have been consulted on, amongst other things, the
following:
• Service user information leaflets e.g. a chaperone
poster for the Community Neuro and Stroke
Service, a Stop Abuse leaflet and poster for the
Local Safeguarding Adults Board, a pressure
ulcers leaflet and the End of Life Care Strategy;
• The new Integrated Respiratory Service and the
new Diabetes Specialist Nursing Service in South
Gloucestershire;

• The BANES Your Care Your Way review of health
and social care.
Involvement as part of a group
Introduction Why?
1 2 3 4 5
8
http://www.scottishhealthcouncil.org/patient__public_participat
ion/participation_toolkit/the_participation_toolkit.aspx#.V5jF70
YrIsY
YrIsY
YrIsY
YrIsY
Communication team
Link in with your communications team to organise large scale
events as they will have the expertise and contacts in place.
Trust membership
Most acute services have a membership list of hundreds of

former or current patients with regular mail outs. This network
is
a valuable way to reach out to involve patients, their carers and
families.
Voluntary/ third sector
Many voluntary and 3rd sector organisations have been set
up to support people with specific conditions. Some are large
organisations such as Diabetes UK, MacMillan Trust and
Dementia
UK. Others are small, local self-help organisations. It is always
useful to have initial conversations with these organisations
when
thinking about what kind of involvement is suitable. Most areas
still
have some kind of umbrella organisation that supports voluntary
organisations locally, though with funding cuts these are fast
disappearing. You can find out from them which voluntary
sector
organisations are operational in your area.
For example, at the time of writing, Swindon has Voluntary
Action
Swindon (www.vas-swindon.org), Wiltshire has Community
First
(www.communityfirst.org.uk), Gloucestershire has VCS
Alliance
(www.glosvcsalliance.org.uk/contact) and Bristol VOSCUR
(www.
voscur.org). For other areas try the National Association for

Voluntary and Community Action website (www.navca.org.uk)
The Design Together Live Better (DTLB) initiative
DTLB is a co-design project aimed at sourcing ideas from
members of the public living with challenging health conditions
and
teaming them up with product designers to co-create new
concepts that could significantly increase the quality of life for
many
people.
We brought people together online and at a series of public
workshops. Ideas for new product concepts were discussed and
developed with potential users, and then refined and brought to
life in real time by our design partners, Designability (Bath
Institute of Medical Engineering), through rapid concept
sketching and illustration.
Ten concepts were selected for further exploration by
Designability, three of which were taken onto design and
prototype
development: a seatbelt buckle and harness design that can be
easily fastened with one hand; a ‘companion’ trolley which
offers a more personalised approach than existing walker
trolleys in the home; and a portable bidet that can be used in
public
conveniences.
Broader engagement activities
Introduction Why?
1 2 3 4 5

9
http://www.vas-swindon.org
http://www.communityfirst.org.uk
http://www.glosvcsalliance.org.uk/contact
http://www.voscur.org
http://www.voscur.org
http://www.navca.org.uk
Bethan Griffiths is a student at the National Star College in
Cheltenham, a specialist further education college for people
with disabilities and
acquired brain injuries, and took part in one of the Design
Together, Live Better workshops. This is what she thought of
the experience…
“Maximising independence was the big theme behind the Design
Together, Live Better workshops. My independence is really
important to me.
Although I’ve got a disability (cerebral palsy), in my head I’m
not disabled. So I want to be able to do what everyone else can
do.
“That’s one of the reasons I wanted to take part in the
workshops. I have quite a lot of my own ideas that could help
me and others. I like art and
design and I wanted to be able to share my ideas with others.
“At the workshop in Cheltenham it was nice to hear other
people like you because the things that came up I wouldn’t have
thought of. It didn’t
really apply to me. It opened up my own ideas. It was a really
good experience meeting others in a similar place to me.

“We liked the bidet idea that came out of the workshop – it was
a really clever idea. Kia from Designability came to college to
show us the
prototype. I could see that lots of people would find it very
useful.
“It was great to be able to share my ideas at the workshop… I
hope there will be more opportunities to keep contributing like
this.”
Broader engagement activities
Introduction Why?
1 2 3 4 5
The portable bidet designed by the
Design Together Live Better workshops
is demonstrated at the West of England
Academic Health Science Network annual
conference.
10
Getting started
1. Decide which piece of work you want to involve people
in and which methods would help you achieve what
you want to achieve. Think about what can/ cannot be
achieved by involving people in this way.
2. Identify the resources you have available

• Staffing – who will be managing the project?
• Funding – have you the resources to pay travel
expenses and/or their time (see section on Payment)
• Timing – involving people properly takes longer. What
is your time-line?
• Identifying suitable people – what kind of selection
process would be fair and appropriate?
3. Develop a role description which clearly states the
skills required, the time commitment expected from
your public contributors, the length of their involvement
and payment details (See Useful Resources section for
a sample role description). It is good practice to identify
an end date when their involvement will come to an end.
Depending on the frequency of involvement in the role, a
maximum of two years is advised to allow for fresh skills
and new perspectives to be introduced. This should be
made clear at the outset.
4. Involve your patients or public as early as possible in the
process. Be honest if you are treading new ground and
that you are learning as you go along. This way they will
learn with you and won’t be feeling at a disadvantage.
5. Identify where power imbalances can exist and take
steps to minimise them. For example don’t have meetings
at a time that excludes public contributors from attending
and from taking part in the background thinking and
development of a project.
6. Work with a wide range of people, using different
people for different pieces of work for the greatest range

of perspectives.
7. Aim to build up a bank of skilled and experienced
individuals who are familiar with your organisation on
whom you can draw to participate in advisory groups,
attending one-off focus groups, commenting on materials
etc.
8. Offer a range of methods to maximise involvement.
While face to face is ideal, this may not always be
possible. Offer telephone conferences, Skype, email or
phone calls. This may work best when the project is in ‘full
flow’ rather than at set-up.
Top tips for successful co-design
1. Try and involve public contributors from the
beginning, whilst you are still working things out.
This way they can grow and develop their thinking
alongside the others in the group and contribute
more effectively.
2. Develop a role description (see sample role
description in Useful Resources) which details what
kind of commitment is required and what kind of
payments they can expect to receive.
3. Be clear about the length of commitment required
at the beginning and set an end date. This can be
reviewed as the needs of the project changes.
4. It is good practice to have at least two public
contributors on the group at any one time so
that one person doesn’t have all the pressure of
representing the non-professional/ user voice
and the two public contributors can support each

other. This way you can also draw on different
perspectives.
5. Build in regular time with your public contributors
to review progress.
Introduction Why?
1 2 3 4 5
Don’t re-invent the wheel. Find out what has already been done
and build on the information that is already available.
11
Useful tips
Selection process
For long term pieces of work that will require specific skills
and a substantial time commitment, a selection process is
advised. A role description with the required skills should
be advertised widely. Depending on the number of people
responding, either hold a group interview or a standard
one-to-one interview. Group interviews are useful for
assessing the social skills of individuals. Whether adopting
a group interview or individual interview process, standard
scoring methods should be followed.
Payment
Some form of remuneration should always be given. As a

minimum, travel expenses should be offered. For one-off
meetings, you might want to consider incentives such as a
thank you gift, voucher from a local supermarket or cash.
For more long-term commitments, it is advisable to include
in your budget a fee to pay people for their time. This
demonstrates that you value what they are contributing,
will help you attract a wide range of people and ensure
their commitment and consistency in attendance.
Different Trusts and Universities have different approaches
to the payment of public contributors. You will need to talk
to your Finance Department to work out a fair system.
For more information look at the INVOLVE website. Some
people may find accepting payment affects their benefit
payments. They can obtain advice on a special advice line
set up by INVOLVE to answer their queries.
Support for the role – induction, training
It is good practice to make sure your public contributors
feel supported in their role. They should be given
the name and contact details of the person they are
responsible to and who they can contact with any queries
or concerns. An introduction to the organisation and an
induction programme which enables them to contribute
effectively should always be given. The volunteer
coordinator in your organisation may already have a
suitable induction programme drawn up that you can use.
Managing expectations
Involving members of the public as public contributors are
an important part of the partnership between the NHS
and the public. However managing expectations can be
tricky. Here are some tips that might help you:

• Have clear role descriptions with clear lines of
accountability
• Build in regular review sessions where any
misunderstandings can be ironed out
• A clear end date is also important. This can always
be extended. For long term, continuous involvement
you might want to consider regularly refreshing the
role, every two years for example. This gives you
the opportunity to bring in new skills as your project
develops as well as keep a fresh perspective.
Dos and don’ts for successful meetings
• Do make new members feel welcome – a friendly
smile goes a long way
• Do introduce yourself
• Don’t use jargon and acronyms without explaining
what they are first
• Don’t assume everyone shares the same knowledge
• Do encourage a culture of ‘It’s OK to ask’
• Do make sure papers are sent out beforehand
• Do check whether public members would like hard
copies printed out for them
• Do offer to brief members before meetings and de-
brief after the meetings
Promoting interest in public involvement

The voluntary sector organisations often produce regular
newsletters and welcome information that encourages
people to get involved in their local community. Trusts
have membership lists and can also be happy to promote
involvement opportunities. People in Health West of England
(www.phwe.org.uk) have a website where they list involvement
opportunities as well as distribute a fortnightly electronic
bulletin.
Introduction Why?
1 2 3 4 5
12
http://www.phwe.org.uk
Equality and diversity
There are no easy answers to addressing issues of equalities
and diversity in PPI, mainly because it is about relationship
building and therefore takes time and effort. Key to having a
strong equalities component to your work is making sure you
get to know your public health colleagues and the community
and voluntary sector organisations around you.
Here are some useful tips.
• Your organisation should have an Equalities Policy which
describes how it intends to meet the requirements of the
Equalities Act 2010 and Equalities Delivery System. Find

out who is responsible for leading on this and what has
been drawn up in terms of Equalities in service delivery.
• Understand the population you serve. Find out from your
public health colleagues the local demographics and
the priorities for addressing health inequalities that your
local Health & Wellbeing Board or Joint Strategic Needs
Assessment (JSNA) has identified for your area – what
does your population look like? Is it mainly elderly? Does
it have a strong student population? Is there a significant
ethnic minority population? What are the health
conditions these different groups are likely to experience?
What about people with special access needs e.g. how
do deaf people access your services?
• Be clear about what are you trying to achieve. Some
outcomes you might be trying to achieve are in the box to
the right.
• Are there people with certain characteristics that may be
having particular issues around accessing services such
as people with hearing loss, homeless, young people
or those who don’t speak English? Find ways of meeting
with them to listen to the problems they have and what
you can do to improve their access to the health services
they need. You should be prepared to go out and meet
them in their space, a community/day centre, hostel, café
and so on.
Option 1 - It may be that you just want to make sure your
group of public contributors are generally representative
of the population you serve. In which case make sure
you promote your involvement activities through local
voluntary action organisations (see Section 5.6. for
Voluntary and 3rd Sector links). See where their gaps

are and try and reach out through other means – lunch
clubs, faith groups and so on.
Option 2 - It may be that you want your public
contributors to be more representative of users of your
services. You need to have access to the equalities data
for users of your services – not always easy to come by.
Once again you may want to talk to colleagues in your
local council’s public health department to help you with
this. You should then come up with a rough benchmark
to help you decide what a representative group would
look like.
Option 3 - On the other hand you may want to improve
a particular service that is used predominantly by a
community with shared characteristics.
Example - Involvement in research: Autism in the
Somali Community. This example illustrates the value of
identifying advocates within a seldom heard community to
help you reach others in that community: http://www.phwe.
org.uk/wp-content/uploads/2015/05/Autism-in-Somali-
migrant-community-Exploring-families-perceptions-and-
experiences-of-diagnosis-and-services.pdf
Introduction Why?
1 2 3 4 5
13
http://www.phwe.org.uk/wp-content/uploads/2015/05/Autism-
in-Somali-migrant-community-Exploring-families-perceptions-
and-experiences-of-diagnosis-and-services.pdf

Ethical issues
Public contributors should be regarded as equal members of
the team. However the nature of their status means that care
should be taken over certain areas.
Confidentiality
Make sure public contributors sign a confidentiality agreement
which makes clear the limits of their role. They should not be
able to access patient information without close supervision
by a member of staff. Speaking in public and to the media
should also be done in close conjunction with the appropriate
member of staff.
Disclosure & Barring Service (DBS) checks
Your organisation will have its own policies about DBS checks.
It is worth noting that it is not always necessary for your public
contributors to be DBS checked. As long as they will not be
alone with patients or have access to confidential patient
information, this is not necessary.
Ethics of public involvement in research

The ethics of public involvement in research is related to the
involvement of patients and the public as participants in
research. For more information consult your local Research
Design Service or visit www.invo.org.uk . INVOLVE and the
Health Research Authority guidance makes clear that you do
not need ethical review for public involvement in research.
Introduction Why?
1 2 3 4 5
Public contributors generating ideas at a workshop
14
http://www.invo.org.uk
What skills do I need?
In addition to the professional skills you bring, for public
involvement to be a success, you need a range of
interpersonal skills. This section identifies some of the ones
public members have told us they find most helpful.
Social skills
Being able to reach out and connect with people of all
backgrounds and ages is one of the most important
attributes for good public involvement. Another is the ability
to make people welcome and included. One of the most
common complaints by members of the public involved in
the health sector is the lack of basic common courtesy in

introducing them to the other people in a meeting and vice
versa.
There are number of guides and checklists that can help you
create a welcoming and inclusive environment. As well as the
link in the section on running a Focus Group, INVOLVE have a
useful guide to what to think about when holding a meeting.
http://www.invo.org.uk/getting-started/
Listening skills
Body language conveys as much if not more impact than
words. Some reminders are
• Allow the patients or public contributors to do most of
the talking
• Demonstrate by your body language that you
understand what they are saying.
• Nod and maintain eye contact without staring and
appear interested
• Sit or stand in a similar way and at a comfortable
distance, not too close or not too far away
• Ask the public contributor to repeat or clarify something
to make sure that you have understood correctly
• Repeat back or summarise what has been said to
ensure sure you have understood what is being said
• Do not judge
• Treat everyone respectfully

Facilitation/ group work
Working with the public will always require some form of
group work and facilitation skills, whether this is with a formal
group of people coming together for a workshop or an
informal small group of people.
NHS Improving Quality has produced some useful resources
on helping you with facilitation skills. They provide the
following summary:
Facilitation requires:
• an environment of mutual trust
• the ability to generate a sharing environment
• a willingness to listen
• a desire to seek understanding
• the ability to be diverse and flexible
• the ability to challenge yet stay supportive
• the ability to work with people from a wide range of
backgrounds and
• a toolkit of styles, approaches and techniques.
To be effective as a facilitator, you should help the group you
are working with get further, faster and in a more focused
way than they would alone – and help them have some fun
along the way! For more information see http://www.nhsiq.
nhs.uk/media/2757715/2010_handy_guide_to_facilitation_
final__low-res_.pdf
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