PPI Current and Future Challenges Graham English, Executive Director

2 Its not one thing or process Information Giving InvolvementEmpowerment Consultation Collaboration

3 Retrospective Vs Real time & Prospective Customer Vs Collective Direct Vs Indirect Individual Vs Collective Proactive Vs Reactive

4 So, the meaning, even the purpose of Involvement, varies according to the perspective taken

5 Understanding Involvement Policy context  Foundations Trusts  Section 242 NHS Act 2006  A duty to involve  World Class Commissioning  Competency 3 – first among equals Involvement as a transformative force. Central to the reform agenda

6 And the challenge is?  It’s new  It’s huge  It’s intended to be all pervasive

7  It takes time  This is about relationship building as well as data gathering  There is ‘Implementation Lag’ and a need to ‘justify the effort’

8  It’s challenging  It has the potential to put people, senior people on the defensive, in vulnerable places, on vulnerable issues, at vulnerable times  It changes the way we do all our business  It’s not in our DNA

9 The challenges in the process itself  How can we know it is being done well?  How can we measure it?  How should we performance manage it?  How do you compare involvement in one place or on one issue with another?

10  It requires resources to be used differently – up-front investment not post-hoc justification  Resources in PCTs are being focussed in Commissioning, not provision

11  The data is difficult to gather and to interpret  Opportunity from new technology if used well  Much (but not all) of the data is ‘soft’, what can be done to make this useable data?  The NHS does not routinely ask for this type of data from its clients  Issues for Public, Patients and Professionals alike  Skewed data  Seldom heard voices  Mistaking hearing and listening  Loud voices  The over-compensation problem So what are the issues here for users of Urgent Care?

12  Involvement is seen as a PCT / Commissioning issue, not a General Practice issue  Generates issues for Practice-based Commissioners

13 What’s in it for the staff?  Lack of formally-recognised role and skills definition?  Lack of career structure  Lack of skills???  Lack of training???  Lack of status and recognition – at Board level

14 Membership  FT models  Initial emphasis is on attracting members  Are the models working?  Should they apply to PCTs and/or to ‘Health Communities’?  Can we avoid ‘Involvement Drain’ i.e. the ‘best’ at involvement migrate to the FT, and ‘Involvement Fatigue’?

15 Tackling the Mystique of Involvement  What is Involvement if it is not delivered through good communication and relationship skills?  Ensuring the new technology adds value not process

16  Buy in from staff  Limited financial resource  Uncertainty about PPI direction (despite widespread existence of strategies and action plans), need for continuously evolving approaches  Project-based, not embedded  Clarity about and understanding of the differing roles of the various elements of PPI processes  Lack of clarity on benefits of PPI

17 Urgent Care Challenges in Involvement  No ready-made client group  Those that use your services are often transitory, ‘belonging’ to other client groups  All the ‘standard’ issues and expectations still apply  Evidence what the state of PPI is  Be clear about your purpose, aims and goals  Recognise the costs and potential benefits (don’t fail for lack of resources)  Identify who needs to be involved (& segment)  Match the activity to those involved and the purpose  Evaluate, Learn and Feedback

18 Myth Busters  PPI is difficult to do  We might open a Pandora’s box and not be able to please the public because there are too many differing views Yes it can be, but if you think of involvement as a lot of varied small and simple activities on their own, it need not be difficult You are never going to please everyone, but, on the whole, people respond reasonably when they are given sufficient information to enable them to understand the realities within which the service functions

19 Myth Busters  It will all just be tokenistic Good involvement means asking people for their views early, so they can genuinely influence your plans, and making sure that people have really good information and evidence about available choices

20 Myth Busters  PPI is expensive  We might have to change our plans if we ask the public It certainly can be expensive if you do not do it. Some organisations have been involved in lengthy acrimonious consultations and legal challenges when they got it wrong. PPI does not cost the earth and it can save resources if you get your service improvements right Correct