1. Service User Involvement in Commissioning Daniel Madge Manchester PCT

2. What Is Commissioning?  “Commissioning is the means by which we secure best value for patients and taxpayers –Best possible health outcomes –Best possible healthcare –Within the resources made available by the taxpayer DH Commissioning Framework

3. What do commissioners do? Review Service Provision Decide Priorities Design Services Shape structure of supply Manage demand Referrals, Ind needs assessment, treatment Performance Mgt Seek public and patient’s views Assess needs National Targets

4. Commissioning  Effective commissioning means effective engagement of patients and local communities. Patients, through greater choice, will drive improvements in many services. For services where wide choice may not always be possible, the views of patients and carers and families, groups of service users and their communities should still substantially influence service provision. DH Commissioning Framework

5. A Brief History of Service User Involvement  The Plea for The Silent 1957 –Individualistic –Imprisonment –De-personalisation –Objectification –Plea that they did not belong –Confinement = an error –Plea for someone to talk to

6. A Brief History Cont…  Speaking Our Minds 1996 –Collective voice –Survivor pride –Wider social links –Plea for self determination

7. Impact of a collective voice Individual  Disassociation from MH  An error in the system Collective  Added confidence  Pride in association  Pride in surviving  Implied system fault  Challenge to biological construct

8. How does this challenge the biological construct? “…my experience is not valid and I cannot be whole. It limits the scope of our lives and creates victims. The ethos within which we tackle our problems… is damaging to our chance of becoming partners in the community.”

9. The voice of protest  Anti Psychiatry Movement – 1960’s  Campaign Against Psychiatric Oppression 1980’s  Critical Psychiatry - current www.critpsynet.freeuk.com

10. Traditional Approaches To Service User Involvement Co-option: –Patient Forums –Service User Representatives –Consultation exercises

11. The Evidence ( Miller and Ahmed 2000)  Professional & organisational hierarchies exclude service users  Service Users have no statutory authority  Legitimacy comes from being official

12. The Evidence (Bowling 1996)  Involvement = tokenistic  Influence is difficult to achieve  SU Reps are not representative  SU groups are riven by splits  SU are fearful of retribution  Involvement engages too small numbers  Engagement is designed for professionals

13. Supporting The Modernisation Agenda  Choice  Payment by Results  Cost and Volume Contracts  Direct Payments  Individualized Budgets  Contestable Commissioning ….All offer opportunities for greater involvement

14. Supporting The Modernisation Agenda Cont..  Recovery  Social Inclusion

15. Ways of Getting Involved Self care  Direct payments  Self Help  Engagement in care plan Carers  Support for carers to care  Carers involvement in CPA Service Provision  User led services  Employment in services Commissioning  Commissioners promote involvement  Support commissioning agenda Campaigning  Independent critical friend  Independent service user groups

16. Options for Involvement in Commissioning  Needs Assessment  Service Design  Tender process  Service Delivery  Service Monitoring  ‘Customer satisfaction’  Choice

17. Involvement in Commissioning Some examples…co-option  User Set Standards  User Focused Monitoring  Self Help  Service User Employment  User Led Provision  Community Engagement – PPI  Service User Consultants / Critical Friends

18. Involvement in Commissioning Some examples… Conflict  VCS Campaigning  Alternative provision

19. Thankyou Daniel Madge daniel.madge@manchester.nhs.uk daniel.madge@manchester.nhs.uk