Do patients and members of the public who are involved in clinical commissioning groups make a difference to decision-making? Do the views of patients and the public influence the outcomes of debates about which health services to fund?
Observing patient involvement in the governance of CCGs in south London
In south London, there are 12 GP-led clinical commissioning groups (CCGs) - aligned with borough boundaries - and each one is responsible for spending NHS money on health services for residents living on their patch. Every CCG board has at least two lay members, or patient representatives. Many CCGs have also set up a patient advisory group.
A team of researchers from the Faculty of Health, Social Care and Education (Kingston University and St George’s, University of London), wants to find out more about the involvement of patients and members of the public in CCGs. In particular, they are keen to investigate what impact they have on commissioning decisions.
To do this, the team has observed board meetings of Wandsworth Clinical Commissioning Group, held in public once a month, since the beginning of 2014 through to the summer of 2015.
‘Wandsworth is very positive about the importance of the patient voice and want to find out how the patient perspective translates into decisions about where they put their money,’ says Professor Annette Boaz, a professor of health care research, who is leading the study with Professor Mary Chambers, a professor of mental health nursing and director of the Centre for Public Engagement in the Joint Faculty. The team also includes researcher Ali O’Shea.
Members of the team have also been observing meetings of Wandsworth CCG’s patient and public involvement (PPI) reference group. Wandsworth CCG’s website says this group’s purpose is to ‘deliver and develop patient involvement in all areas of the CCG.’(1)
‘We've been observing the contribution of members of the public and service users at meetings,’ says Professor Boaz. ‘They may be members of the patient and public involvement reference group, or members of the CCG Board, or they may have come to a meeting to present or make a contribution of some kind,’ says Professor Boaz.
‘We have also observed how CCG staff members respond to patient and public involvement.’
In addition, the research team has carried out interviews with Wandsworth CCG board and non-board staff members, and members of the public who are in the patient and public involvement reference group, or who have attended the CCG Board’s public meetings. The research team asked about their experiences of patient and public involvement in the CCG, how commissioning decisions are made, and about the contribution of patients and members of the public in this process.
The team found that Wandsworth CCG was committed to involving patients and the public in its work by running public events to get their feedback on personal experiences of healthcare services, and to inform the public of its plans to develop or change services.
In addition, the CCG allocated resources to support the involvement of patients and the public in formal meetings and PPI reference group meetings. They did this in a number of ways, including, for example, widely promoting meetings open to the public, providing members of the public with copies of meeting papers, and offering training, administrative and staff support to the patient and public involvement reference group.
Alongside this, members of the public who became involved in the work of the CCG also demonstrated a great deal of commitment, by giving up a significant amount of their time to attend meetings and events, and to read through meeting papers.