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Service User Involvement in Commissioning

Service User Involvement in Commissioning. Daniel Madge Manchester PCT. 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

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Service User Involvement in Commissioning

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

  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. 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 Impact of a collective voice

  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

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

  17. Involvement in CommissioningSome 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 CommissioningSome examples… Conflict • VCS Campaigning • Alternative provision

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

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