What do you get from in-depth interviews with clinical, management and lay leaders of six 2nd and 3rd wave CCGs about embedding patient and public involvement in their work and what they need to achieve this? Here’s the answer we came up with when we did just that in tandem with InHealth Associates. This work was supported by the Department of Health, undertaken on behalf of the NHS Commissioning Board and published this month.
Lay members role lacks clarity
We found a lack of clarity about the role of CCG lay members (and “lay representatives” generally) and some concern as to the degree they are ‘insiders’. They might support a Board’s decisions and thus risk external legitimacy amongst their “community constituency”.
Special support to lay members was identified by a number of interviewees, not just by lay members. What people wanted was support for lay members (and other patient representatives) to build the skills to be effective. There were some mentions of specific skills, such as analytical skills, insight and metrics, and also some calls for a network of lay members to be developed. We hope a support network will happen quickly.
Practical support (resources, logistical support, training) for lay input was hugely variable. Some lay members have contracts and are paid expenses, while others remain pure volunteers. One CCG lay member reported having been promised expenses and/or pay and had not received either. We heard that there was a need for guidelines about how to support lay people in these roles.
Locally in Wandsworth, our lay board members are paid £12,000 pa for a specific role, why isn’t everyone rewarded at least at this level?
Measurement of engagement effectiveness
Overall, these CCG leaders know that embedding engagement in everything they do is essential if they are to make commissioning decisions and service changes with broad user and carer understanding and community support. They are hungry for metrics to measure the impact of their engagement efforts. Let’s hope they get some measurement tools very soon and put them to good use.
Hope for the future
From what we heard, CCGs acknowledge a need to scale up communication with huge numbers of people. They are keen to focus on what’s important to the population and to ensure local perspectives feed in to commissioning decisions. Interviewees seemed ambitious, wanting to work with seldom heard groups, such as children and young people, people from diverse communities and those who don’t often access GP services.
No one pretends this will be easy, but with the right support and encouragement they should quickly become local organisations that listen and engage well.
The Moore Adamson Craig Partnership supports user and public participation, trains lay representatives and develops responsive health, care and education organisations. Feel free to contact us to discuss the opportunities. Follow MAC on Twitter @publicinvolve