Involvement sell-out gathers pace
Posted: 29 November, 2011 by Andrew Craig
Most patients will give a big yawn to the 2012-13 NHS Operating Framework for England. Unwise. Buried in an appendix is the game plan for completing the sell-out of genuine patient and public involvement. This started in the summer with the launch from NHS CEO David Nicholson of the innocuously named “shared operating model” for clustered PCTs which described how PPI/E at local level would be sacrificed on the altar of centrally directed messages delivered by communications teams. We said it amounted to “throttling” genuine involvement. And we are being proved right.
Lumped in with comms
The 2012-13 Operating Framework lumps communications and stakeholder engagement (which doesn’t seem to include patients and the public) as a support function for developing the CCG: “Communications and PPE - Communicating and engaging with all stakeholders, managing the reputation of the NHS, media/press and FOI handling, briefing, campaigns and consultations.”
Do these words matter? In the case of ”engagement” vs “involvement” the answer is “yes”, rather a lot. “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. Without involvement we can’t have any meaningful accountability. It isn’t that engagement is wrong, just that it is insufficient on its own for the purpose of influencing decisions. Sustained involvement is the key to this.
Framework can’t deliver involvement
The Operating Framework won’t deliver involvement, quite the opposite in fact. The “model” contained in Appendix B “Developing a communications and engagement commissioning support service” sets out a hard line centralist approach with “do once” messages devised centrally and then delivered locally.
This boils down to a bromide: 1) Tell your audience what you’re going to tell them. 2) Tell them. 3) Then tell them what you told them. 4) Job done. 5) Engagement box ticked. That’s what PPI in the new order will come down to, it appears, and clinical commissioning groups won’t even start doing that until mid 2012. What happens in the interim one wonders?
There is nothing here about bottom up involvement or community development or leadership from patients, carers and members of the public. And there are phrases about what the service will cost -“best price possible” etc, – which raises the real possibility that CCGs as “customers” are going to have to pay for this “support”.
If I was a GP with a stake in local commissioning I’d be pretty hacked off about being handcuffed like this. They need to communicate and involve now if they are going to make the kind of changes that QIPP savings demand, not a year from now.
This OF is supposed to get us well into 2013 when CCGs take over; I wonder if we will make it that far? As Harold Macmillan was wont to say “events, dear boy, events” are always the greatest challenge. And you can be certain that during 2012 that NHS will have its share of “events”.
Much more than Healthwatch
“Engagement” in the OF really comes down to what Healthwatch will do – assuming the pathfinders for Local Healthwatch survive and flourish. But even if so, that is far from enough. The OF skates over the 2nd domain in the authorisation pathway that is all about patients, carers and communities (and is quite robust on the evidence needed for involvement). Strange that. Persuading people of the need for change involving known and loved local services is hard enough when done well. Central policy locally delivered will not be up to the job.
No involvement, no legitimacy or support for change
Where will the local knowledge and sensitivities about interacting with diverse local communities come from? Not from this Operating Framework, that’s for sure. Co-production? Community development? Shared decision making? You may well ask. And there is a warning about what happens when “a new order of things” is introduced in the wrong way. It should be Mr Lansley’s bed time reading:
“And one should bear in mind that there is nothing more difficult to execute, nor more dubious of success, nor more dangerous to administer than to introduce a new order of things; for he who introduces it has all those who profit from the old order as his enemies, and he has only lukewarm allies in all those who might profit from the new.”
- Niccolò Machiavelli, The Prince (1532)
The Moore Adamson Craig Partnership supports user and public participation, trains lay representatives and develops responsive health, care and education organisations.
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We shall see. I think the CCGs will set the standard not the operating framework.
Firstly because they have to pass muster for domain 2, but also the smart ones are driven by enlightened self interest to pull the public as close to them as possible now for when they have to do nasty things later.
If the CCGs don’t think a comms dominated, under-resourced, mandatory shared service is fit for purpose they will hopefully throw their rattles out of the pram.
CCGs could yet save PPE!
Let us hope CCGs understand what is at stake around involvement/engagement and do exactly what the previous commenter suggests. They should have the power after all. Instead of the sound of bed pans clattering in a hospital ward in darkest Wales somewhere, I’d rather hear the sound of CCG leaders throwing their rattles out of the commissioning pram for just this reason!