Clinical commissioning group (CCG) lay member David Taylor-Gooby provides an insight into one of the two main lay member roles – patient and public involvement – and the difference it makes to the workings of a CCG.
Lay members bring tremendous skill and value to clinical commissioning groups (CCGs). They offer an impartial voice to all discussions and help CCGs forge a direct link to the public and communities they serve, which is crucial to delivering a patient-centred service – the heart of what CCGs do.
Last month NHS Clinical Commissioners’ (NHSCC) Lay Members’ Network
launched a new guide, Maximising the lay member role in CCGs
, which provides a series of top tips and key messages to help CCG leaders, and the broader system, make the most of the skills lay members bring.
Lay members can feel isolated in their role – this guide offers us a collective voice and provides insight into our views. It lays out what we feel CCG leaders can do to foster shared learning and development, and create opportunities to learn from our peers.
What always impresses me when I meet other lay members – and what the NHSCC guide makes clear – is that we are a very able bunch, from a variety of backgrounds. There is considerable talent there, which is of great benefit to the NHS.
The basic minimum number of lay members is two and many CCGs operate with this: one for involvement and one for audit and governance. I am aware that some CCGs have more than that, and we could have a very useful discussion about the value of having more, and what they actually do.
My official title is ‘lay member, patient and public engagement’. Sometimes we use the word ‘involvement’ or event ‘participation’. I prefer the term ‘involvement’, as I think it is important we use the right words. Engagement could simply mean finding ways of telling people about what you are doing without necessarily expecting them to have an influence. Participation means them actually taking part, and could be used to describe situations where patients are taking an active role in their own treatment.
To me, ‘patient and public involvement’ means finding ways so that both patients and the public have a constructive and effective influence on what the NHS does. It only works well if it can avoid conflict situations and work collaboratively. It is something I am proud to do, but actually carrying out what it says is not always easy.
So what does a lay member for engagement do? The recent NHSCC report offers guidance, but it is often up to lay members’ creativity, imagination and drive.
I have noticed that most CCGs have some form of network of groups representing patients. A common model is that focus groups, or patient groups, are set up in each GP practice. These then send representatives to a group covering the CCG area, or part of it. In our patch, South Durham, we have three. For those who do not know, Durham is very diverse and has health inequalities equal to the national figures. The Dales are very different to the old coalfield areas. One big group wouldn’t work, partly because of the distances involved.
These groups work well and give the CCG useful feedback and contributions to policy. Members often sit on groups looking at particular conditions or issues. But they are essentially ‘patient groups’. They don’t really include the ‘public’ bit I referred to at the beginning. I find that engaging the wider public is an issue most CCGs grapple with.
All of us have an Overview and Scrutiny Committee (OSC). I used to sit on one before becoming a lay member. These work best when they cooperate with the NHS. Something I heard referred to as ‘consensual scrutiny’ is a situation where the OSC and NHS work together to tackle common problems. Councillors represent the public of course, but they would be the first to admit that we are not reaching many people.
Finally there is Healthwatch. They often conduct surveys, and it would be silly not to share their work with CCGs so that the NHS doesn’t do the same thing again. Healthwatch, however, is supposed to scrutinise the NHS, so it has to keep its distance.
All these avenues are important, but there need to be other ways of reaching a wide range of people too. In Durham, we have things called ‘area action partnerships’ (AAPs), which aim to draw on the energy and resources of local communities and help preserve separate identities in what I have already described as a large and diverse county.
Each AAP consists of councillors, community representatives and stakeholders, of which the NHS is one. They have core budgets, but aim to draw down additional funds from elsewhere. My CCG has given them funding which they have used, along with public health, to develop projects which develop health.
Many are schemes to try to improve mental health through activities aimed at combating loneliness and isolation. Others help encourage exercise and healthy living. The important thing is that the CCG reaches a large number of people who otherwise would not be involved with us.
The lay member role is distinct and looks quite different across CCGs, given the varying local contexts in which they operate. It’s supremely valuable to be able to learn from the experience of other lay members and discuss common challenges and solutions, which is a large part of why the NHSCC Lay Members’ Network exists. The network will continue to work with lay members, CCGs leaders and national decision-makers to develop the role and learn from the lessons set out in the guide.
David Taylor-Gooby is a lay member for public and patient engagement at Durham Dales, Easington and Sedgefield Clinical Commissioning Group. He writes in a personal capacity.
**NHS Clinical Commissioners published Maximising the lay member role in January 2016 – access the guide from the organisation's website. NHSCC is the voice of clinical commissioning groups, and is part of the NHS Confederation. Follow NHSCC on Twitter @NHSCCPress
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