Personal and Public Involvement (PPI) is a term used to describe the active and meaningful involvement of service users, carers and the public in the commissioning, design, delivery and evaluation of Health and Social Care (HSC) services, in ways that are relevant to them.
• service users;
• families, and;
The values for PPI are:
• Dignity and respect;
• Inclusivity, equity and diversity;
• Collaboration and partnership;
• Transparency and openness.
The principles for involvement are recognised as:
• Leadership and accountability;
• Part of the job;
• Supporting involvement;
• Valuing expertise;
• Creating opportunity;
• Clarity of purpose;
• Doing it the right way;
• Information and communication;
• Accessible and responsive;
• Developing understanding and accountability;
• Building capacity;
• Improving safety and quality.
These are explained in more detail in the Department of Health, Social Services and Public Safety (DHSSPS) policy circular on PPI issued in 2007 .
Check out PPI Case studies section to hear how involving people, has made a difference to Health and Social Care.
Recent research has also been undertaken to look at the impact of involvement which clearly shows that Northern Ireland is making good progress in relation to embedding Personal and Public Involvement. Read the research report here.
There are many reasons why it is important to consult and involve service users, carers and the public.
People’s lives can be transformed when they have the knowledge, skills and confidence to manage their own health, and when they are able to help shape their care and treatment to fit with what is important to them. Service users and carers bring ‘expertise by experience’, which can be critical to areas such as accurate diagnosis and development of appropriate care plans.
When health outcomes are agreed, needs are better met and people can be supported to manage their own care. There is a growing body of literature to show that good quality involvement can lead to improved health outcomes, a more effective and efficient system and improved quality of life for patients, their families and carers, the community and the whole of Health and Social Care.
Involvement is also recognised as a key component of quality. It has been shown to improve quality and safety and to have reduced complaints and serious adverse incidents (SAIs).
Involvement and consultation is a statutory requirement. From 1 April 2009, the Health and Social Care (HSC) (Reform) Act (NI) 2009 placed a statutory duty of involvement and consultation on HSC organisations. The legislation requires that service users and carers are involved in and consulted on:
1. the planning and provision of care;
2. the development and consideration of proposals for change in the way that care is provided;
3. decisions that affect the provision of care.
Stakeholders are any person, group or organisation who has an interest or concern in the particular area.
The target group you wish to involve might be as wide as the general public, or as narrow as an individual user of an existing service. You will need to think about any ‘hard to reach/easy to ignore’ or ‘seldom heard’ communities within your target group or groups and service or disease-specific patient groups.
Building a demographic profile of the target group will support you to tailor your involvement exercise consider their age, sex, gender, ethnicity, and any other key characteristics. This will help you to identify appropriate ways to facilitate their involvement.
Stakeholders you may wish to involve may include:
• patients, service users (current, past or potential) and, where appropriate, their advocates;
• carers and their representatives;
• staff and their representatives;
• representative advocacy, voluntary and community organisations;
• individuals, including ‘silent voices’ who are not represented by any group;
• leaders of opinion, such as councillors and MLAs;
• the Patient and Client Council, other HSC organisations and/or statutory organisations;
• the wider public, as potential users of HSC services;
• HSC Trust volunteers.
Yes, there are a number of levels of involvement and many different ways in which people might be involved in commissioning, service development, delivery and/or evaluation, depending upon their personal circumstances and interest.
Personal and Public Involvement (PPI) ranges from one-to-one direct care to collective involvement in the development or co-production of policies and strategies where priorities and objectives are set.
The ‘ladder of involvement’ is a widely recognised model for understanding different forms and degrees of participation, (based on the work of Sherry Arnstein). Check out the different levels of involvement here.
PPI on every step of the ladder is valuable, although participation becomes more meaningful with activity towards co-production at the top of the ladder.
 Sherry R. Arnstein, ‘A ladder of citizen participation’, Journal of American Planning Association, Vol. 35, No 4, July 1969, pp. 216 – 224.
Involvement is not an objective in itself. It is important to have clarity on the purpose of the involvement, ie what is the central issue or key question(s) that you are seeking to engage people in?
It is also important to be clear about the parameters of the involvement, what is open for engagement and what level of influence will the process have. For example:
- the findings will inform future plans;
- the findings will inform the production of options;
- the people engaged can influence the prioritisation of resources;
- the outcome of the engagement process will directly impact on a final decision, plan or investment.
Careful consideration needs to be given as to who is to be involved to ensure that the patients, service users, carers and the public are truly represented.
There are ways of reaching most groups in the community, but some may require additional support to engage. The first step is to talk to the particular group or individuals about the best way to consult and involve them. This could be done on a small scale, or as part of a larger involvement exercise including all potential audiences.
Another suggestion is to make use of those people who have existing expertise of working with particular groups and /or individuals. In some cases, trusted parties can act effectively as intermediaries.
The principle of ‘go to where they are’ is a useful approach which helps to promote and facilitate involvement.
Have a look at the guide on working with vulnerable or isolated people and communities here.
Yes, for effective involvement to take place people need to feel supported and that their contribution is valued.
Service users, carers and stakeholders who have agreed to become involved and participate in service development and improvement activity, such as meetings, discussion fora, focus groups, training events, interview panels or a defined task or work programme, can be reimbursed for out-of-pocket expenses.
Check out the PPI Standards here
A Personal and Public Involvement (PPI) monitoring and performance management process has been established by the Public Health Agency (PHA) and the Regional PPI Forum. This requires all Health and Socical Care Trusts (HSCTs) to undertake the monitoring process, which involves:
- self-assessment is undertaken by HSCTs, completed in partnership with the HSCT’s PPI panel on an annual basis and signed off by the HSCT social and clinical care governance committees or equivalent;
- the PHA review the self-assessment returns and undertake a verification visit with service users/carers;
- an assessment report developed by PHA and submitted to Department of Health for consideration.
Patient and client experience (PCE) is about people’s perception of the quality of the care they received. It relates directly to the experience the patient receives when they are interacting with the HSC system and focuses on:
- privacy and dignity.
Personal and Public Involvement includes concepts and practices such as health literacy, shared decision making, and supported self-management. Meaningful Involvement not only helps inform the direction and priorities of health and social care, whether that is at an individual level or collective level, but it also sustains peoples’ participation in and ownership of their own health and social wellbeing.
While the two concepts are linked, sharing a similar value base, they are distinct. A patient can conceivably have an experience that meets the standards above and have minimal levels of involvement. Likewise, it is possible for one to be meaningfully involved, but for their experience of health and social care to have fallen short of the five PCE standards. The goal is to ensure that people have a good experience and also that they are meaningfully involved.
Quality Improvement (QI) is about making Health and Social Care (HSC) services safe, effective, patient-centred, timely, efficient and equitable. Involving service users and carers is a key principle of quality improvement. GREAT checklists have been developed to support staff undertaking HSC Quality Improvement work and may be found here