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Large scale change

With the advent of Sustainability and Transformation Partnerships, Integrated Care Systems and the NHS Long Term Plan, we are getting used to the idea of large scale change in healthcare.  However as this paper points out, large scale change tends to be associated by the public with making cuts and downgrading services, and can be met by strong opposition.

The response is public involvement - to increase the legitimacy of decision-making, tailor publicly-funded services to local needs and resolve tensions.  But what actually is public involvement?

A plethora of terms are used to refer to who should be involved: patients, service users, citizens, public, lay people, communities or consumers.  And the term involvement is often used interchangeably with participation, consultation or engagement.  Little is known about how involvement is understood, or operationalised in practice.  It remains unclear which methods are most appropriate under different circumstances, and evidence about the impact of involvement is sparse.

This study found that in large scale change, public involvement often takes the form of a consultation model in which information flows one-way.  Any public opposition is attributed to a lack of understanding of the technical arguments, implying a need to improve communication rather than offer more deliberative methods of involvement.

But sometimes the public both understand and question the technical arguments, seeking alternative routes to voice their views.  As a result, two models of involvement co-exist: invited and uninvited participation.  

Uninvited (oppositional) participation is often framed as an obstacle to implementation of large scale change.  But, say the authors of this paper, "Political conflict is an inherent, and potentially beneficial, part of healthcare planning. Thought should be given to reframing the conflict in large scale change as positive, and how it can be incorporated into meaningful methods of public involvement".

You can download the report via our website.
Involvement evidence on tap

There is plenty of evidence and guidance on patient and public involvement in healthcare.

This paper reflects on involvement as a two-way process, and looks at how professional roles are shaped by that process.

NHS England's bite-size series offers lots of practical guidance.  Here is one example.

This paper, described as a "provocation" challenges some basic assumptions about the purpose and value of patient and public involvement.  

For more evidence and guidance on patient and public involvement, search "involvement", "participation", "PPI" etc here:  
This just in…
New evidence on all aspects of patient experience and involvement is being published all the time.  Check out our top picks from recent reports:
Beyond the NHS.  Addressing the root causes of poor health.
Hidden no more: Dementia and disability.
Mental Health Act Code of Practice 2015. An evaluation of how the Code is being used.
Free resources

Not a subscriber to the Patient Experience Library?  Don't worry - you can still get lots of free stuff from our website!  

Our quarterly Patient Experience magazine carries insightful comment from a range of contributors, as well as our top picks of recent reports on patient experience and patient/public involvement. 

Patient Experience in England is our annual overview of the evidence base, drawing on surveys and research from government bodies, health charities and academic institutions.  The evidence is broken down into manageable chunks, and research findings are grouped under key themes for ease of understanding. 

You can browse our Knowledge Maps to see how patient experience is being reported in your area.  

And if you want to wear your patient experience heart on your sleeve, you can download and print our posters and stick them on your wall.  Better still, post them to the Chief Executive of your local NHS Trust!
Do you know of a stand-out report on patient experience that people in CCG's, PALS teams and local Healthwatch should be reading?  If you do, and you'd like to see it featured in this newsletter, let us know! 
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