Undermining patient and public engagement and limiting its impact: The consequences of the Health and Social Care Act 2012 on collective patient and public involvement

Abstract

Patient and public involvement has been at the heart of UK health policy for more than two decades. This commitment to putting patients at the heart of the British National Health Service (NHS) has become a central principle helping to ensure equity, patient safety and effectiveness in the health system. The recent Health and Social Care Act 2012 is the most significant reform of the NHS since its foundation in 1948. More radically, this legislation undermines the principle of patient and public involvement, public accountability and returns the power for prioritisation of health services to an unaccountable medical elite. This legislation marks a sea-change in the approach to patient and public involvement in the UK and signals a shift in the commitment of the UK government to patient-centred care.

Challenges Facing Healthwatch, a New Consumer Champion in England

“…Many theorists of governance as well as scholars of PPI highlight the agency of local actors and their ability to mediate constraints through exerting influence, brokering trust within networks and translating top down policy mandates in innovative ways. 6,12 Moreover, if there is one lesson to be learned from the recent history of rapid change in organisational arrangements for PPI in English healthcare, it is that new governance structures require time to 'bed in' and provide a basis for functional relationships. We suggest that collective work among Healthwatch organisations, perhaps orchestrated by Healthwatch England, may help to maximise their influence despite the constraints they face.…”

“…The Health and Social Care Act has led to further organisational complexity in England, abolishing some organisations and creating new ones, including new forums for strategic decision-making, notably local authority-hosted Health and Well-being Boards. 11,12 Clinical commissioning groups (CCGs) are now responsible for commissioning many of the services that their local population will use, while social care remains the responsibility of local government. Healthwatch is positioned as the principal body responsible for representing the public's views in this new system.…”

Building spaces for controversial public engagement – Exploring and challenging democratic deficits in NHS marketization

“…Until 2014 CCGs were under a duty to be financially solvent and were directly accountable to a range of potentially conflicting stakeholders, including the Secretary of State for Health, Healthwatch, the regulator (at the time Monitor), Local Authority Health and Wellbeing boards and the public. While CCGs had a requirement to engage with patients on commissioning, some suggested that the creation of Healthwatch represented a move from a form of patient involvement which sought to influence health and social care services to one which was intended to promote patient choice (Tritter & Koivusalo, 2013). This may be a contributing factor as to why, in terms of commissioning decisions made by CCGs, accountability appears to be focused upward toward the NHS commissioning board rather than to local residents (Tritter & Koivusalo, 2013).…”

“…While CCGs had a requirement to engage with patients on commissioning, some suggested that the creation of Healthwatch represented a move from a form of patient involvement which sought to influence health and social care services to one which was intended to promote patient choice (Tritter & Koivusalo, 2013). This may be a contributing factor as to why, in terms of commissioning decisions made by CCGs, accountability appears to be focused upward toward the NHS commissioning board rather than to local residents (Tritter & Koivusalo, 2013). Post-2014, the 5 Year Forward View has been endorsed by NHS England but with questionable legislative legitimacy (Madden & Speed, 2017) and the impacts of the developing sustainability and transformations plans on commissioning accountability remain to be seen.…”

The Big Society in an age of austerity: threats and opportunities for Health Consumer and Patients' Organizations in England

“…However, there is some scepticism about how and to what extent this will happen in practice. 21 It will take time to build trusting relationships. In addition, there are concerns that as larger HCPOs become directly involved in commissioning at local level, this may pit them against formal involvement structures, weakening the latter.…”