PPI (patient and public involvement) is imperative for successful commissioning for several reasons: it saves money and ensures pathways are used; it increases the moral and democratic legitimacy of the NHS; and it leads to safer and better designed services. Effective PPI requires democratic and participatory involvement from both individuals and community groups to influence priorities, service development, and quality standards. This can be achieved through structures like Healthwatch, consortium governance models, and community development approaches that view community members as assets and work to improve health through co-production.

1. PPI IS IMPERATIVE FOR SUCCESSFUL
COMMISSIONING BECAUSE:
• It’s a financial imperative
– Save money
– Get pathways used
• It’s a moral imperative
– Who’s NHS is it anyway?
• It’s a political imperative
– No democratic legitimacy
• It’s a practical imperative
– Safer
– Better design
• It’s a legal imperative

2. COMMUNITY INVOLVEMENT
AND COMMISSIONING
Dr Brian Fisher MBE
Chair of the Socialist Health
Association

3. WHAT KIND OF INVOLVEMENT?
• Democratic
• Participatory
–Influence through engaging with
–Individuals
–Groups
• Listening Responding

4. CONSORTIUM GOVERNANCE
OPTIONS
• DEMOCRATIC
– Democratic elections to the Board
– Councillors/LA on the Board (?)
• PARTICIPATORY
– HealthWatch on the Board
– Other lay people on the Board
– Foundation Trust consortium
– Lay reps on every key committee
– A super patient participation group
– Community development

5. HEALTHWATCH
• Son of LINKs, grandson of Fora, great-
grandson of CHCs
• A network of networks and groups
• To influence commissioning of health and
SC by understanding key issues for local
people.
• Future responsibilities?
– Complaints
– Shared decision-making

6. HEALTH AND WELL-BEING
BOARD
• Consortium, HW, LA, NHS CB if relevant
• Chaired by LA
• Joint decision-making on commissioning
• Start with Joint Strategic Needs
Assessment
• Has the semblance of democratic
legitimacy, but no substance

7. WHAT TO BECOME INVOLVED IN
• The consortium’s agenda
– Priorities
– Service development
– Setting standards – quality in SLAs
– Service monitoring
– How to spend savings
• The community’s agenda

8. PROACTIVE DIALOGUE,
DEEP AND WIDE
• Experience based design
• Database
• Community development

9. HEATH AND WELL-BEING BOARD
CONSORTIUM
HEALTHWATCH
HW
LOCAL VOLUNTARY GROUPS

10. COMMUNITY
DEVELOPMENT/ORGANISING
• Improves PPI
• Improves health protection
• Tackles health inequalities
• Supports behaviour
change

11. ASSET-BASED COMMUNITY
DEVELOPMENT
• People as assets, not problems
• Individuals, organisations and statutory services
working together to improve civil life
• Both local people and statutory services have
skills that need to be combined for maximum
effectiveness – co-production
• Enhancing health promoting/protecting
mechanisms
• Strengthening the capacity of
indiv and communities

12. CD Stronger and
deeper SNs
RESILIENCE ENHANCED CONTROL
Health protection Can negotiate with services
Resilience to economic More strength for self-care
adversity Health inequalities reduce
Better mental health

13. 7 STEP MODEL
• Listening event
• Brings together local agencies (health,
police, education, SC) and residents
• Partnership
• Forms ‘organizing hub’ for activities
and initiatives
• Leaders appear
• Rapid changes in commissioning

14. HELP - COMMISSIONING @ 9
MONTHS
• Company formed
• Playpark
• GP surgery
• Dental surgery
• Benefits advice
• Tai Chi
• Plans for radical change

15. HELP – OUTCOMES @ 5Y
• Life expectancy + 6 yrs
• Increased Breast Feeding 50%
• Postnatal depression rates down 60%
• Child accident rate down 50%
• 78% reduced fear of crime
• Other benefits .. escalated impact of other
Public Health programmes, and changes to
services and commissioning
• Estimated savings based on 5% reduction
across a basket of conditions = £70k per year
for 5000 population.

16. BIG SOCIETY?
• REDUCED STATE PROVISION
• SOCIAL JUSTICE
• INCREASED ACCOUNTABILITY
• TRANSPARENCY
• ENHANCE PUBLIC SECTOR MARKETS
• LEADERSHIP BY FRONTLINE PROVIDERS
• FUNDING
• IMPROVED LOCAL COMMISSIONING
• NEIGHBOURHOOD GROUPS MUTUALS AND
COOPERATIVES
• CHARITABLE GIVING
• VOLUNTEERISM