Introduction
Over the past few decades, governments across the world have stressed the need for increased service user involvement in the provision of health and social care services, right from the planning stage, up to the delivery of the same (Omeni et al., 2014). Health and social care providers in the UK have always been committed to meeting the needs of people in need of their services. Nonetheless, the only way to transform service provision in health care is for health and social care providers to focus on what is important to service users (Crawford et al., 2014). The NHS Constitution hinges on seven principles, one of which states that 'patients must be the heart of everything that we do.' One way of achieving this is through the use of PPE (public and patient experience and engagement). In this case, PPE entails understanding the experiences of service users and, more importantly, empowering them to partake in decision-making (Nicholls et al., 2003). The focus of this essay is to delineate the legal basis of service user involvement within NHS institutions and to examine its role in ensuring quality in healthcare provision.
NHS Constitution
The NHS Constitution sets up the values and principles of the NHS. More importantly, identifies the pledges made by the NHS to service users, its goal in ensuring they are achieved, as well as the rights of patients, staff, and the public. What this appears to suggest is that the people own the NHS (Public Health Action Support Team, 2017). Therefore, it must be seen to improve people's health and well-being. As a treasured national institution, the NHS operations are guided by its founding principle, which encompasses the provision of free healthcare to all in need, irrespective of the circumstances surrounding them. Principle 4 of the NHS Constitution recognizes patients as the central focus of its operations. In other words, the kind of services that the NHS offers ought to reflect the preferences and needs of patients, along with their carers and families. Seeing as this is enshrined in the NHS Constitution, patients and other service users have a right to be involved or consulted in making and planning decisions regarding their care and health by service providers. This includes, but is not limited to, caring for mentally ill patients and patients in need of end-of-life care.
Furthermore, service users also have a right to support and information in making decisions about their health. What this means is that if at all the NHS hopes to improve its service provision to users, it needs to consult and involve these service users in making decisions regarding their treatment and care (NHS Constitution, 2009). The NHS must, of necessity, support patients to manage and promote their health. The NHS should also encourage patients, staff, and the public to constantly give feedback and use such information to enhance service provision.
Relevant legislation that mandates service user involvement
Participation of patients, carers, and the public in NHS activities is now a legal requirement that justifies "everything that the NHS in England does. “The NHS and Community Care Act forms the legal basis for the formal recognition of the inclusion of users in service planning. Community Care Plans were developed by local authorities following consultations with service user representatives (Department of Health, 2013).
NHS Trusts are mandated by relevant laws to involve patients in decision-making. The Department of Health has, over the years, published various legislation and guidance whose goal is to promote the engagement agenda as a valuable strategy in enhancing quality in the planning and delivery of services within the NHS (Department of Health, 2015). Such legislation and guidance are intended to ensure that NHS institutions incorporate patient involvement in their varied decision-making processes and in improving service delivery. One such document is the 1999 Patient and Public Involvement policy, which advises health organisations to collaborate with service users, carers, patients, and local communities in an attempt to develop health and care services that meet the needs of individuals and local communities (UHBristol Clinical Audit Team, 2009).
NHS Trusts, along with Primary Care Trusts and Strategic Health Authorities, are obliged by Section 11 of the 2001 Health and Social Care Act to consult and involve patients, carers, and the public in planning activities involving health care provision. Accordingly, there is a need to consult everybody affected by it in the planning of service delivery, formulation and consideration of proposals aimed at changing the way services are delivered, and on decisions that could be made and which will impact the operation of services in question (NHS England, 2015).
The 2003 PPIF (Patient and Public Involvement Forums) was established to improve the NHS in terms of the quality of service offered to users. This was based on experiences and views of patients, families, and their carers following assessment of monitoring of NHS service delivery to them. Once the views of NHS services had been collected from the public, the PPIF then made recommendations to the NHS on areas it needed to act on (NHS England, 2015). The 2004 Health and Social Care Act was instrumental in evolving decision-making to local NHS Trusts, further improving service delivery in health care.
Section 242 of the 2006 NHS Act spells out the duties of all NHS institutions by way of involving service users in their planning and decision-making. In this case, a 'user' has been defined as someone likely to use the services of the NHS, or one who is already using them. The NHS can meet the requirement of 'involvement' via the provision of relevant information to service users and consulting them (NHS England, 2015). Service users could be involved directly in such arrangements, or the NHS could involve their representatives in the planning of service delivery, along with provision of recommendations on how the NHS undertakes its various operations that affect service users.
Service User Participation
Participation and transparency are fundamental values in "transforming customer service in health and care" (NHS England, 2015). Weinstein (2010) has identified user involvement and public participation as an area of growing interest in social and health care practices and services. Users should be able to freely and readily access information and offer feedback on services. Conversely, health providers should be in a position to act fast on users' feedback to improve service delivery. According to NHS England (2015), service providers should utilise the latest digital technologies in a bid to increase the outcome, experience, and safety of care. NHS England has, over the years, demonstrated a commitment to changing how the public accesses health care information. This has been made possible by adopting the latest digital technologies to improve data and information availability to better support public and patient participation (NHS England, 2015, p. 32).
The WHO describes service user involvement as a process that empowers individuals to actively and authentically participate in identifying their concerns, making decisions impacting their lives, shaping policies, and contributing to the planning, development, and delivery of services to drive meaningful change (2002, p. 10).
According to NHS England (2015), the service user ought to take an active role in the planning and delivery of their care. Health care providers who are in a position to facilitate such a process end up delivering higher-quality services, thereby leading to enhanced service user satisfaction and compliance.
Snow et al. have identified a gap between real-world needs and healthcare research as evidenced by the incompatibility between the perceived needs of carers and patients and the research agendas. Snow et al further argue for the need to close this gap by inviting carers and patients on board to assist with developing health priorities. This is important, seeing as the delivery of patient-centred care hinges on the ability to match the evidence base with the needs and concerns of service users (Fereday & Rezel, 2016).
Benefits of service user involvement
Involving carers and users in the planning and delivery of health services constitutes a desirable initiative whose objective is to facilitate in transfer of power from the medical profession and policy makers to the public (Public Health Action Support Team, 2017). Leading health organisations such as the World Health Organisation (WHO) have been at the forefront in campaigns to promote user involvement. Towards this end, a number of countries have so far developed laws that augment the influence of service users, in addition to affording them control over health and social care services provided to them (Crawford et al., 2003).
Benefits emanating from involving carers and users in service planning and delivery may be categorised into two groups: service improvement and democratic principles. In terms of democratic principles, inclusion of carers and users in a rationed and prioritised health care provider like the NHS has been shown to promote public accountability, participatory democracy, and transparency (Nilsen et al., 2006). Moreover, user involvement is a clear indication of the health care provider's recognition of people's capacity for self-determination, as evidenced by listening to their voices in regards to their care planning (Public Health Action Support Team, 2017). This is in keeping with the principle of autonomy, which recognises individuals as being capable of acting with understanding and intentionally, devoid of any controlling influences (Varelius, 2006).
The WHO has also recognised people's capacity for self-determination in its Alma-Ata declaration, which notes that “people have a right and duty to participate individually and collectively in the planning and implementation of their health care” (WHO, n.d., p. 1). Elsewhere, Entwistle and Hanley (2006) are of the view that when health care providers like the NHS involve users in their service planning, this helps to enhance their commitment to not only comprehending such service planning, but also to influence issues that have an impact on them.
Conversely, the service improvement benefit of involving users hinges on the argument that doing so aids in increasing the quality of activities that public health organisations engage in. For instance, patients suffering from such long-term illnesses as diabetes or hypertension will often have important insights regarding their care that policymakers and health care providers lack. Accordingly, their involvement in decision-making about their care will aid in the improvement of service delivery. In addition, policy makers and medical professionals may have similar conflicts of interest in planning for care delivery, such as a financial interest, something that carers and users lack (Public Health Action Support Team, 2017). Their inclusion, therefore, would go a long way in bringing a neutral voice on board, thereby ensuring that such planning takes into account the health and care needs of patients, and not what policymakers and health professionals think patients need. Furthermore, when service users are involved in service planning, this is likely to result in more acceptable and accessible health services and enhanced adoption of relevant clinical findings (Nilsen et al, 2006).
Crawford et al. (2002) credit service user involvement for helping to enhance user access to services and information. May, Montori, and Mair (2009) opine that improvements aid in the coordination of health and social care planning and delivery, in addition to improving the patient-clinician relationships. There is also a link between user involvement and positive clinical outcomes as reported by Nicholls et al. (2003), including enhanced confidence and self-esteem, in addition to therapeutic benefits to patients owing to improved social interaction.
Patient, carers, and involvement in service planning and delivery aids in making informed choices. This is because the patients and carers have access to more knowledge and information regarding the quality of care in a given healthcare setting. Consequently, they are better able to make informed choices (Fereday & Rezel, 2016). Furthermore, strong social support networks in the form of friends, family, and peers have long been known to be beneficial to the health of individuals, while there is a link between improved self-esteem and confidence and health and well-being (Fereday & Rezel, 2016). Accordingly, when patients and their families play an active role in the planning of health care, the ensuing satisfaction of having influenced health and care delivery is beneficial to them and their families.
A report published by the King's Fund (2011) indicates that patients who are involved or engaged in health services report a high level of confidence in such services. However, carers and patients are poorly engaged in as far as making decisions regarding their health is concerned. This calls for more attention and effort by health care providers in terms of supporting patients to engage in decision making.
According to Drennan and Alred (2013), service user involvement acts as a source of empowerment to patients, carers, families, and their carers. This is indicative of the belief that meaningful and genuine involvement leads to improvement and positive change for service users and the service providers as well. Nonetheless, service user involvement is faced with several barriers. For instance, several professionals may be hesitant to adopt service user involvement for a number of reasons. Some professionals may be of the view that it might be too costly and time-consuming to realise meaningful involvement, while others are blind to the benefits of service user involvement (Drennan & Alred, 2013).
It is important that NHS institutions get service user involvement right since the inclusion of service users in planning and decision making brings on board their individual experiences regarding the kind of health problems they could be facing, and the problems facing the health system from their point of view (Drennan & Alred, 2013). Besides, doing so provides policymakers and healthcare professionals with an alternative perspective on models, approaches, and services. This goes a long way in complementing the current system.
While patient participation and involvement in health care have mainly been articulated in the form of rights, it is important to note that such rights also contain responsibility. The NHS Constitution acknowledges these responsibilities (Department of Health, 2009). Moreover, Healthwatch England has been involved in the development of the responsibilities and rights for social and health care to ensure that the type of health and care that patients receive from the NHS matches their needs. This is important in order to enable the NHS to use its limited resources fairly to improve efficiency in service delivery (Department of Health, 2013).
Conclusion
Service user involvement is a central concept in terms of how the NHS operates, as enshrined in its constitution. Principle 4 of the NHS Constitution acknowledges that service users ought to be a key focus of NHS planning and decision-making. The formal recognition of service users in service planning is also well documented in various legislation, including the Community Care Act, the 2001 Health and Care Act, and the 2006 NHS Act, among others. Service user involvement is associated with numerous benefits insofar as service improvement is concerned, including increased access to information and services and increased user confidence with service provision. To overcome barriers to service user involvement, it is important to create awareness of its benefits among health care professionals and to emphasize the existing legal framework on the issue.
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