“Engagement” isn’t enough – only “Involvement” can influence commissioning

Have you noticed that PPI is being eased aside by many NHS bodies in favour of PPE?  The “patient and public” (PP) part is unchanged, but in the new rubric  “E is for engagement” and “I for involvement” is falling off the page.  We should be concerned if the “I-word” has been waylaid in the corridors of Whitehall in favour of “engaging people and communities” .   Engagement and Involvement aren’t interchangeable.

However it might be dressed up in the latest policy couture, “engagement” implies a process of enquiry initiated by the NHS when and how it chooses.  “Involvement”, in contrast, implies a sustained, continuous and co-created process.   Picture a gaggle of patients and members of the public hanging around until the NHS decides to engage with some of them for something specific in order to harvest their views for its own uses.  That is a relationship based on dependency, status and power and it won’t do for a user-led NHS.  It doesn’t encourage either health literacy or enthusiasm for doing it again.  You may ask what’s in a word: in the case of ”engagement” vs “involvement” the answer is rather a lot.  If PPE is now DH-approved will we see a rebranding for the NHS Centre for Involvement and the National Library of Health’s PPI specialist section and a host of other respected and established sources using the “I-word”?  I sincerely hope not.

It isn’t that engagement is wrong, just that it is insufficient on its own for the purpose of influencing commissioning decisions. Sustained involvement is the key to this. PCTs needs to develop processes to ensure they listen to patients and the public as they shape ideas for new service delivery models.  Can they be assured that service users, carers and the public are with them on the journey of service re-design as they develop service specifications, consider tenders, and monitor contracts?  If not, they are at risk and cannot demonstrate their accountability to the moral owners of the NHS – that’s you and me.

Here is an excerpt from a PCT policy that does understand the linkeage between involvement, engagement and communications:

Throughout this document we refer to involvement, engagement and communications for patient and public empowerment.  “Involvement for empowerment” is the overall objective; engagement is an aspect for specific purposes, including consultation on specific proposals; and communications is the range of techniques and tools used to interact with people, listen to their views, understand their feelings, communicate them appropriately and feed back to them what they said and what we are able to do with this intelligence.  The result of this is helping people feel that they are continually involved in our business.

Whatever you call it, If “involvement” doesn’t positively influence commissioning then it is a sham.  So why make it harder for ourselves by pretending that “engagement” will do it all?  Achieving sustained involvement is difficult, skilled and resource-intensive work, but it is an investment we cannot do without.   I am reminded of the comment attributed to ”Red” Adair the legendary oilfield firefighter: “If you think hiring an expert is expensive, just wait till you find out how expensive hiring an amateur is.”

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