Service User Involvement in Commissioning

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Service User Involvement in Commissioning

• Daniel Madge
• Manchester PCT

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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

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

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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

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A Brief History Cont

• Speaking Our Minds 1996
• Collective voice
• Survivor pride
• Wider social links
• Plea for self determination

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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

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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.

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The voice of protest

• Anti Psychiatry Movement 1960s
• Campaign Against Psychiatric Oppression 1980s
• Critical Psychiatry - current
• www.critpsynet.freeuk.com

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Traditional Approaches To Service User Involvement

• Co-option
• Patient Forums
• Service User Representatives
• Consultation exercises

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The Evidence(Miller and Ahmed 2000)

• Professional organisational hierarchies exclude
  service users
• Service Users have no statutory authority
• Legitimacy comes from being official

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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

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Supporting The Modernisation Agenda

• Choice
• Payment by Results
• Cost and Volume Contracts
• Direct Payments
• Individualized Budgets
• Contestable Commissioning
• .All offer opportunities for greater involvement

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Supporting The Modernisation Agenda Cont..

• Recovery
• Social Inclusion

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Ways of Getting Involved
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Options for Involvement in Commissioning

• Needs Assessment
• Service Design
• Tender process
• Service Delivery
• Service Monitoring
• Customer satisfaction
• Choice

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Involvement in CommissioningSome
examplesco-option

• User Set Standards
• User Focused Monitoring
• Self Help
• Service User Employment
• User Led Provision
• Community Engagement PPI
• Service User Consultants / Critical Friends

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Involvement in CommissioningSome examples
Conflict

• VCS Campaigning
• Alternative provision

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Thankyou

• Daniel Madge
• daniel.madge_at_manchester.nhs.uk