Publications

Public Involvement

27/06/2001

1. INTRODUCTION

There is a clear expectation for Health and Social Care organisations to develop a partnership approach with the public when making decisions that affect their populations. It is only through striving to achieve partnership that an organisation can realise the full benefits of involving the public and can develop services that are responsive to the needs of the people who use that service.

The Board is committed to developing genuine partnerships with its public when decision-making. This includes decisions relating to planning, priority setting, developing standards, evaluation, monitoring, service development and related policy and strategy formulation. Engaging the public can take a variety of forms from members sitting on multidisciplinary committees and project teams, to being part of specific panels, to members giving their views at one-off events such as focus groups. This Policy will cover the full remit of such involvement and sets out the Board's commitment to public involvement.

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2. DEFINITION OF THE BOARD'S PUBLIC

The term public for the purposes of this policy refers to service users (past and present), carers, patient representatives, service user groups, voluntary organisations as well as the local community, public representatives such as Council and Assembly members and the wider public as potential patients/clients and tax payers.

Public involvement will also involve the following specific categories:

(i) people who feel or are excluded from services. This includes for example people from different geographical location and categories for which the Board will promote equality of opportunity including between persons of different religious belief, political opinion, racial group, sexual orientation, age, gender and marital status and between persons with a disability and persons without and beween persons with dependants and persons without.

(ii) people who choose alternative services which are not generally available within the HPSS;

(iii) people who choose private care because for example, the wait is too long in the NHS or the quality of the service is perceived as better.

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3. EXAMPLES OF PUBLIC INVOLVEMENT

The Board has continually worked towards developing the role of the public in the Board's decision-making over the years and has to date been successful in doing this. Below is a selection of projects initiated in 1999/2000 which gives an indication of the levels and ways in which the public can be involved in the Board's decision-making.

Mental Illness Hospital Services Consumer Advisory Panel

An Advisory Panel was set up to obtain a service user and carer perspective at key decision stages of the project to refine and quantify the future of mental illness hospital services in the Board's area. The panel is made up of 11 members, both users and carers, who between them have had experience of a range of services provided by mental illness hospitals in the Board's area and two members are currently inpatients in a continuing care ward. An officer from the Northern Health and Social Services Council is also a member of the group and the users are supported by the co-ordinator of the User Initiative at Holywell Hospital.

A survey of the use of Dental services for people with a Learning Disability

The Learning Disability Programme of Care Team led a study, part of which was to determine the factors which influence continued use of Muckamore Abbey hospital dental services by former residents of Muckamore Abbey (now residing in the community). Postal questionnaires were sent to the patients/carers requesting information about their dental attendance since living in the community. Questions focused on levels of satisfaction with previous and current service provision. It is accepted that this may not have been an ideal method of determining satisfaction and in future the Team will look at more innovative ways of obtaining such information, with the help of representative organisations.

Locally Sensitive Commissioning

The health and well-being of local communities and their involvement in Board decisions and policies in the Causeway area was the theme of a series of workshops hosted in June 1999 by the Coleraine, Moyle and Ballymoney Councils. Community and voluntary groups, local politicians, the Northern Health and Social Services Council, Causeway Trust and the Board took part in the launch of a three year project aimed at giving local people a say in how the Board's resources are used. During the year this was followed up by focus groups and meetings with groups to develop ways of helping them address local issues.

Primary Care Commissioning Pilots

To date both pilots within the Northern Board area, have been very successful in forging genuine links with local people, public representatives and local organisations. The public have been and continue to be involved at all levels of the pilots' work . This has ranged from membership on steering committees and task groups of local councillors, Northern Health and Social Services Council members and members of the general public, to participation in focus groups by local people with particular specialist knowledge. For example:

the abc Pilot Diabetic Task Group has a number of people with diabetes from the Diabetes UK organisation sitting on their task group and together they have developed a patient held Shared Care Record Book for people with diabetes which is also used by all the relevant professional people who have an input into the care for that person.
The Mid-Ulster Commissioning Pilot have worked in partnership with the local community development and voluntary organisations to undertake a needs assessment of people over the age of 65 in the Mid-Ulster area. Numerous focus groups have been carried out with the over 65's, carers, home helps and district nurses throughout the area. The participants were free to discuss aspects of any services provided/not provided that made it easier or more difficult to be an elderly person in their area.

Children's Services Planning

Consultation with users of services has and will continue to be a crucial and core activity of the children's services planning process. Sound networks have been established in the form of reference groups to enable consultation to occur at various levels, with a variety of interest groups including local politicians and most importantly, with children and young people, their families and communities.

Review of Mental Health Day Care

The above project was initiated to ensure that the best model of day care is available to support the Board's vision for mental health services. Two members of the public, who have used Mental Health Day Care services participate in the reference group as advisers, in carrying the Review forward. Extensive focus groups in Day Centres have also been carried out to gather a wider user perspective.

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4. STATEMENTS OF PRINCIPLE

4.1 Securing Commitment

Top level commitment is essential to promote a culture of partnership, and should ensure that every opportunity to maximise involvement is taken, embedding public participation in the everyday work of Board Officers. Clear lines of accountability will be established with a senior member of staff responsible for taking the policy forward. One person will be designated on a project basis as the point of contact for issues relating to public involvement. The Consumer Services Manager will be the general point of contact for issues relating to public involvement.

Public involvement will become embedded in the planning timetable of all projects, including time needed to research best practice for that initiative, to ensure consistency of approach. For example organisations will be given a minimum period of 2 months to prepare their response to consultation documents, with a longer period allocated where possible. Adequate time will be included for training /capacity building of both staff and those external to the organisation to meet the specific requirements of a project.

It is also important that the Board, as a commissioner of services, encourages the mainstreaming of public involvement in the everyday decision-making of Provider organisations.

It is recognised that the appropriate timing for public involvement is essential and this should be at the earliest possible opportunity in the decision-making process for all types of decisions.

4.2 Development of Enduring Partnerships

Key people and organisations will continue to be identified with a view to developing genuine partnerships with them at all possible levels of operation. The mechanism developed for this will enable people/organisations to make themselves known to the Board in addition to the Board working with local people and organisations to identify key people for particular projects.

Members of the public may not always be aware or informed of health and social care agency boundaries. Their issues and concerns may go beyond these boundaries and this does and will continue to necessitate extensive interagency working with organisations such as housing and education bodies and local community development organisations. The Board will continue to maximise opportunities for supporting community development work to encourage the development of services which are responsive to community needs.

Experience has shown that communities /populations are not homogenous - there are different needs and views in a community and therefore wide-ranging participation will continue to be sought where possible.

While the Board wishes to continue to work very closely with voluntary organisations, it also recognises that the voluntary sector is not necessarily the same as communities /people. Efforts will be made to include organisations that are user-led as well as organisations that are simply representative of users. Innovative ways to involve people not in the organised voluntary sector, not already accessing services and from local communities will continue to be developed.

The involvement of marginalised groups presents a particular challenge and this will be fully supported and encouraged . The Board's Equality Scheme sets out its commitment to promotion of equality of opportunity and good relations with particular reference to marginalised groups. The Board's Action Plan for New TSN also sets out the Board's commitment to marginalised groups.

Consultation with many communities of interest works best and is more credible when conducted by someone from that community and this will be encouraged wherever possible and appropriate. The Board will work with representatives of the nine categories of people identified in equality legislation (Section 75 Northern Ireland Act 1998) to develop consultation means for decisions that affect the people covered by this legislation.

4.3 Expectations

The concept of 'adding value' is very important and the public should never be involved for the sake of involvement. Provided that they have been meaningfully facilitated to be involved, the public's contribution should add a new dimension to that of the present decision- making.

Responsibilities /expectations, accountability and processes at each and every interface with Board Officers and its public will be made clear.

Members of the public will be considered as equal partners to Board/ professional staff on committees and project teams. Specifically the views of the public will be given the same degree of consideration and importance as those of the managerial or professional disciplines. Where there is a voting system then the public representation will have one vote while on a team.

It is important to try to avoid raising expectations unrealistically and therefore openness about limitations, after ensuring these limitations are valid, is needed. Honesty will be required about constraints over finance, decision-making, agendas, etc.

When choosing members of the public for involvement, efforts will be made to be as representative as possible, using available research/statistics on population profiles. External organisations that are willing, will be encouraged to play a key part in this process . The Board recognises research/statistics available from marginalised groups can also be valid and will encourage the use of this in the decision-making process whenever possible. When time, staff and financial resources permit, additional research may be commissioned as part of a project, which will give a greater understanding of the population profile.

4.4 Facilitating Involvement

It is understood that resources will be needed to enable participation and a protocol will be developed to ensure fairness and consistency. With an increasing involvement of public agencies and the public in general in the work of the Board, a remuneration policy will have to be developed that sets out the Board's policy on this issue. At this time the Board undertakes to reimburse travel expenses, provide refreshments and pay appropriate dependent expenses. When there is a need, expenses will be paid upfront.

The Board will encourage and enable those least likely to participate to do so. People and groups of people will have the process of capacity- building and enablement to participate tailored according to their needs and the needs of the particular project.

An honest and open approach is needed when involving the public. Participating members of the public will receive all the information and support they need to enable involvement on an equal basis with professionals, with safeguards embedded in the process to protect confidentiality. This may include supporting documents with context/ background histories. Consideration will also be given to the needs of special groups, who do not for various reasons have access to mainstream media (e.g. National newspapers, television/ radio programmes) and therefore may not have the same volume of inherent contextual history as other people.

An important part of facilitating involvement is the availability of information in an accessible format and this needs to be the case in all initiatives where the public are participating in decision-making. Information will be made available in line with the Board's Policy for Communicating Information Well. Where possible the Board will work with representative organisations in determining the nature of 'accessible information'.

Efforts will be made to ensure that members of the public, who are not part of an ongoing Board decision-making team, but have been involved in putting forward their views and supporting decision-making, will receive feedback. Where decisions made are at odds with the public's opinion this will be made explicit and an explanation for how the decision was reached given.

Information, education and training will be given to staff to equip them with the skills necessary to involve the public in decision-making. The Board will also endeavour to ensure that the public are equipped with the skills necessary to become a partner in health and social care management and decision-making.

Appropriate external organisations will be encouraged to assist with identifying training needs, identifying good practice for particular groups of people and delivering training.

4.5 Monitoring and Evaluation

The public will be given the opportunity to be involved in drafting the policy on public involvement and implementing and reviewing the policy. The policy will be annually reviewed by the public and staff, to ensure it is meeting its aims and to assess the need for revision in light of good practice elsewhere.

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