Review

Listen, learn and remember

EVERY VOICE COUNTS: primary care organisations and public involvement
Will Anderson, Dominique Florin, Steve Gillam and Lesley Mountford
King’s Fund, 2002, £7.99

How can more people become genuinely involved in the planning and delivery of their health care services?

One answer seems obvious: get some accountability into the NHS by linking it directly into the electoral system. Only when board directors, managers and clinicians have to explain their actions to voters on a regular basis will the NHS move towards being democratic. Sadly, this suggestion is not on even the most distant of political horizons.

In the meantime, the King’s Fund has come up with a thorough survey of how six London primary care organisations attempted to tackle the issue of public involvement in 2000 and 2001. The fund’s excellent booklet analyses the different ways in which each organisation approached the issue.

When their work began, each of the six were primary care groups with one statutory lay member. The latter tended to be viewed as the ‘expert’ on all matters public. The PCGs’ commitment to public involvement really depended on that person’s energy, strength of character and confidence in relating to seasoned health professionals. Surprisingly, perhaps, some achievements were made.

The survey stresses how a sustained public involvement programme must have a clear strategy and commitment from the whole organisation. It has to be on the agenda of managers all the time and not be seen as a luxury.

All six PCGs surveyed will now have become primary care trusts, whose boards must have statutorily a lay majority. Public involvement is now officially required by such initiatives as the NHS Plan and the national service frameworks.

The researchers believe that the endless reorganisations in the NHS have actually weakened public involvement. After each change, the issue has once again to compete with countless others in the new institutions. It seems self-evident that NHS organisations have never been designed to learn from public voices. The researchers hope that what has been learnt will not have to be re-learnt by the PCTs.

They give examples of how public views were sometimes not taken seriously and could be dismissed if they did not seem to meet the needs of the organisation.

The booklet leaves its readers with the message that the NHS will lose its fear of openness only if it dares to risk openness and welcomes the public’s views wholeheartedly. We can only guess at what follow-up research might find in two years’ time.

I hope this work will be read widely by leaders of PCTs. There is much they could use to promote public involvement.