Review

Whose NHS is it anyway?

MANAGING PUBLIC INVOLVEMENT IN HEALTHCARE PURCHASING
Carol Lupton, Stephen Peckham and Pat Taylor
Open University Press, 1998, £16.99

Public involvement in purchasing health care services has become increasingly important over the past 15 years as the role of the public within the NHS has changed from that of ‘passive patient’ to ‘active consumer’ of services. This book aims to examine some of the ways in which HAs have attempted to make sense of public involvement and to encourage the development of more effective strategies to include the public in decision making.

The first six chapters give a good overview of the history of public involvement in the NHS. They contain clear explanations of different levels of possible involvement and include an interesting discussion on the need for local representation in the provision of public services. The tensions between the democratic and consumerist approaches to public involvement are outlined and the difficulty in defining who can be truly representative of the ‘public view’ highlighted.

The second half of the book examines, from the very different perspectives of the public and health care commissioners, the meaning and value of public involvement. It concludes with a debate about possible future structures and roles for the public, including the nature and responsibilities of CHCs, the use of market research techniques and the future of the HA as a ‘champion of the people’. Concerns about the ability of primary care groups to manage this vexed issue are also raised.

The book provides a great deal of background information and raises a range of important issues. But if you are looking for a ‘how to’ manual of public involvement you will be disappointed. There are few examples of good practice and little in the way of direction to help you. By way of compensation, the reference section is very thorough and will be useful for finding practical advice.