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Health Services Management Centre and the Nuffield Trust
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Jo Ellins
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Which elements/aspects of priority setting:
Do you currently involve patients and the public in?
Could you involve patients and the public in?
Might patients and public want to be involved in?
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Patients and the public
Strategic planning
Priority setting decisions
Implementation phase
Monitoring and evaluation
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1. Instrumental benefits: better, fairer, more legitimate decisions
2. Political benefits: fostering accountability, transparency, citizenship
3. Educative benefits: promoting more realistic public expectations
(Williams, Robinson & Dickinson, forthcoming)
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Willingness to participate in decision making varies Key motivation is to ensure that services better
meet people’s needs More comfortable participating in system and
programme level decisions, than those affecting individual patients
Little desire to share responsibility for decisions, especially as these increase in complexity
But do want to have a voice in the process and for decisions to be more open and transparent
Litva and colleagues, 2002
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Information Consultation Participation
Flow of information One way Agency public
One way Agency public
Two way Agency public
Purpose Letting people know and raising awareness
Getting a snapshot of patient and public views
Engaging in dialogue or negotiation
Individual (patients)
Collective (public)
Adapted from Rowe and Frewer, 2005
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Can you map the framework onto the activities you have identified
What is their purpose?
Who are you involving/would you involve?
Does the framework suggest any other points of involvement you hadn’t initially considered?
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Information Consultation Participation
Flow of information One way Agency public
One way Agency public
Two way Agency public
Purpose Letting people know and raising awareness
Getting a snapshot of patient and public views
Engaging in dialogue or negotiation
Individual (patients)
Collective (public)
How? Leaflets, websites, local media, roadshows, noticeboards, newsletters
Surveys, focus groups, public meetings, complaints, opinion polls
Citizens juries, deliberative polling, discrete choice exercises, Delphi methods
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Information Consultation Participation
Flow of information One way Agency public
One way Agency public
Two way Agency public
Purpose Letting people know and raising awareness
Getting a snapshot of patient and public views
Engaging in dialogue or negotiation
Individual (patients)
Collective (public)
How? Leaflets, websites, local media, roadshows, noticeboards, newsletters
Surveys, focus groups, public meetings, complaints, opinion polls
Citizens juries, deliberative polling, discrete choice exercises, Delphi methods
Opportunities for information,
reflection and deliberation
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Information Consultation Participation
Flow of information One way Agency public
One way Agency public
Two way Agency public
Purpose Letting people know and raising awareness
Getting a snapshot of patient and public views
Engaging in dialogue or negotiation
Individual (patients)
Collective (public)
How? Leaflets, websites, local media, roadshows, noticeboards, newsletters
Surveys, focus groups, public meetings, complaints, opinion polls
Citizens juries, deliberative polling, discrete choice exercises, Delphi methods
Opportunities for information,
reflection and deliberation
Informing preferences, as well as capturing them;
participants can, and often do, change
their views
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Information Consultation Participation
Flow of information One way Agency public
One way Agency public
Two way Agency public
Purpose Letting people know and raising awareness
Getting a snapshot of patient and public views
Engaging in dialogue or negotiation
Individual (patients)
Collective (public)
How? Leaflets, websites, local media, roadshows, noticeboards, newsletters
Surveys, focus groups, public meetings, complaints, opinion polls
Citizens juries, deliberative polling, discrete choice exercises, Delphi methods
More suitable for decisions which are complex, contested and require trade-
offs
Informing preferences, as well as capturing them;
participants can, and often do, change
their views
Opportunities for information,
reflection and deliberation
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Set out with a clear idea about what the public is being asked to do
The ‘right’ method is the one that suits the aims, target group and circumstances
Make use of local networks and expertise Have a clear rationale for inviting/selecting
participants (and for exclusions) Clarity with participants about other
inputs/influences in the decision-making process Communicate how decisions have been made and
where public views have been considered
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Can do Have the resources and knowledge to participate
Capacity building, training and support
Like to Have a sense of attachment that reinforces participation
Building visibility, trust, relationships
Enabled to Provided with the opportunity for participation
Investing in infrastructures, groups and networks
Asked to Mobilised by official bodies or voluntary groups
Opportunities that are appealing, engaging and appropriate; getting the ‘ask’ right
Responded to See evidence that their views have been considered
Feedback on how decisions were made and views were considered
Adapted from Lowndes, Pratchett and Stoker, 2006
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Take one of the activities identified:
How would you involve patients and the public in this activity?
What factors would enhance (or reduce) the effectiveness of your approach?
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Litva, A and colleagues (2002) ‘The public is too subjective: public involvement at different levels of health care decision making’, Social Science and Medicine, 54: 1825-37.
Lowndes V, Pratchett L and Stoker G (2006) ‘Diagnosing and remedying the failing of official participation schemes: The CLEAR framework’, Social Policy & Society, vol 5, 281–291
Rowe, G. and Frewer, L. (2005) ‘A typology of public engagement mechanisms’, Science, Technology and Human Values, vol 30, pp 251-290.
Williams I, Robinson S and Dickinson H (forthcoming) Rationing in Health Care, Bristol: Policy Press