- The document discusses different levels of involvement from information to consultation to participation. More complex decisions that require trade-offs may be better suited to participation methods like citizens' juries. - Factors that can enhance involvement include clear communication, selecting appropriate methods, building trust and relationships, and providing feedback on how views influenced decisions. - While the public wants their needs met, they prefer participating at a system level rather than decisions affecting individual patients.

1. Health Services Management Centre and the
Nuffield Trust

2. Jo Ellins

3. Which elements/aspects of priority setting:
 Do you currently involve patients and the public in?
 Could you involve patients and the public in?
 Might patients and public want to be involved in?

4. Strategic
planning
Monitoring and Patients Priority setting
evaluation and the decisions
public
Implementation
phase

5. 1. Instrumental benefits: better, fairer, more
legitimate decisions
2. Political benefits: fostering accountability,
transparency, citizenship
3. Educative benefits: promoting more
realistic public expectations
(Williams, Robinson & Dickinson, forthcoming)

6.  Willingness to participate in decision making varies
 Key motivation is to ensure that services better
meet people’s needs
 More comfortable participating in system and
programme level decisions, than those affecting
individual patients
 Little desire to share responsibility for decisions,
especially as these increase in complexity
 But do want to have a voice in the process and for
decisions to be more open and transparent
Litva and colleagues, 2002

7. Information Consultation Participation
Flow of information One way One way Two way
Agency public Agency public Agency public
Purpose Letting people Getting a snapshot Engaging in
know and raising of patient and dialogue or
awareness public views negotiation
Individual (patients)
Collective (public)
Adapted from Rowe and Frewer, 2005

8.  Can you map the framework onto the
activities you have identified
 What is their purpose?
 Who are you involving/would you involve?
 Does the framework suggest any other points
of involvement you hadn’t initially
considered?

9. Information Consultation Participation
Flow of information One way One way Two way
Agency public Agency public Agency public
Purpose Letting people Getting a snapshot Engaging in
know and raising of patient and dialogue or
awareness public views negotiation
Individual (patients)
Collective (public)
How? Leaflets, websites, Surveys, focus Citizens juries,
local media, groups, public deliberative polling,
roadshows, meetings, discrete choice
noticeboards, complaints, opinion exercises, Delphi
newsletters polls methods

10. Information Consultation Participation
Flow of information One way One way Two way
Agency public Agency public Agency public
Purpose Letting people Getting a snapshot Engaging in
Opportunities for
know and raising of patient and dialogue or
information,
awareness public views negotiation
reflection and
Individual (patients) deliberation
Collective (public)
How? Leaflets, websites, Surveys, focus Citizens juries,
local media, groups, public deliberative polling,
roadshows, meetings, discrete choice
noticeboards, complaints, opinion exercises, Delphi
newsletters polls methods

11. Information Consultation Participation
Flow of information One way One way Two way
Agency public Agency public Agency public
Purpose Letting people
Informing Getting a snapshot Engaging in
Opportunities for
know and raising asof patient and
preferences, well dialogue or
information,
awareness capturing them; views
as public negotiation
reflection and
participants can, and deliberation
Individual (patients) often do, change
their views
Collective (public)
How? Leaflets, websites, Surveys, focus Citizens juries,
local media, groups, public deliberative polling,
roadshows, meetings, discrete choice
noticeboards, complaints, opinion exercises, Delphi
newsletters polls methods

12. Information Consultation Participation
Flow of information One way One way Two way
Agency public Agency public Agency public
Purpose Letting people
Informing Getting a snapshot Engaging in
Opportunities for
know and raising asof patient and
preferences, well dialogue or
information,
awareness capturing them; views
as public negotiation
reflection and
participants can, and deliberation
Individual (patients) often do, change
their views
Collective (public)
How? More suitable for
Leaflets, websites, Surveys, focus Citizens juries,
decisions which are public
local media, groups, deliberative polling,
complex, contested
roadshows, meetings, discrete choice
and require trade-
noticeboards, offs complaints, opinion exercises, Delphi
newsletters polls methods

13.  Set out with a clear idea about what the public is
being asked to do
 The ‘right’ method is the one that suits the aims,
target group and circumstances
 Make use of local networks and expertise
 Have a clear rationale for inviting/selecting
participants (and for exclusions)
 Clarity with participants about other
inputs/influences in the decision-making process
 Communicate how decisions have been made and
where public views have been considered

14. Can do Have the resources and Capacity building, training
knowledge to participate and support
Like to Have a sense of Building visibility, trust,
attachment that reinforces relationships
participation
Enabled to Provided with the Investing in infrastructures,
opportunity for groups and networks
participation
Asked to Mobilised by official bodies Opportunities that are
or voluntary groups appealing, engaging and
appropriate; getting the
‘ask’ right
Responded to See evidence that their Feedback on how decisions
views have been were made and views were
considered considered
Adapted from Lowndes, Pratchett and Stoker, 2006

16.  Take one of the activities identified:
 How would you involve patients and the public in
this activity?
 What factors would enhance (or reduce) the
effectiveness of your approach?

17.  Litva, A and colleagues (2002) ‘The public is too
subjective: public involvement at different levels of
health care decision making’, Social Science and
Medicine, 54: 1825-37.
 Lowndes V, Pratchett L and Stoker G (2006)
‘Diagnosing and remedying the failing of official
participation schemes: The CLEAR framework’, Social
Policy & Society, vol 5, 281–291
 Rowe, G. and Frewer, L. (2005) ‘A typology of public
engagement mechanisms’, Science, Technology and
Human Values, vol 30, pp 251-290.
 Williams I, Robinson S and Dickinson H (forthcoming)
Rationing in Health Care, Bristol: Policy Press