Consumers and users have very little power to be able to affect services, the most extreme and probably the only level of influence they have is to refuse to use public services and to go private. This is something which a low income family would be unable to do (Naidoo & Wills, 2005). The term Citizen increases the level of power because the World health organisation (1978) in their Alma Ata declaration decreed that each citizen has a right and a duty to participate in their health care. This idea is backed by the government who label the public as stakeholders: accountable for their health (Naidoo & Wills, 2005). There is also an increasing appreciation of the lay perspective which is where an individual can give insight into their own subjective experiences regarding ill health. It fills the missing gaps which professionals are unable to do alone. The lay perspective creates a partnership between the professional and the patient which is effective in providing a holistic approach in care planning, rather than just a medical one (Naidoo & Wills 2005).
Why the public should be involved
Now we understand the levels of involvement and control the public have, it is necessary to appreciate why it is important to involve the public in healthcare.
One of the major advantages of public involvement is the financial benefits associated with reducing the costs of healthcare services. Public participation increases service delivery by measuring levels of satisfaction, ensuring the services provided are what the people want (Naidoo & Wills, 2005). It identifies unmet needs, and prevents inappropriate services that do not deliver (Scottish Executive 2002). Resources can then distributed effectively ensuring future spending is prioritised accordingly (Naidoo & Wills 2005).
One significant reason why the public should be involved is simply because people have a right to be. In 2003 the department of health launched research to investigate what the public wanted from the healthcare system. The responses included “services to be shaped around our needs, instead of being expected to fit the system” and “listening to what the patients are saying then act” (DoH 2004 p.6). Unless the public has a say by being involved this cannot happen.
Better working relationships and increased understanding are two other benefits which can also be attributed to public participation, and justifies why the public should be involved. Involvement restores confidence in services and builds strong open relationships between health workers and the community (Scottish Executive, 2002). New initiatives can be monitored by local communities to ensure agreed standards are met, creating trust between the professional and the public; and encouraging people to show greater commitment and ownership to services provided (Naidoo & Wills 2005).
Public involvement also has a significant impact on the mental well-being of the patient. It produces greater confidence, reduced anxiety, greater understanding, and positive health effects (DoH 2004). It brings together the strengths and weaknesses of all parties; creating a better comprehension of treatments and services (Naidoo & Wills 2000).
As well as the financial benefits, mental well-being and the strong relationships; participation creates; public involvement is now also a legal requirement. The Department of Health (2004) states that:
“Section 11 of the health and social care act 2001 places a legal duty on the NHS to involve and consult patients and the public in the planning and development of health services...”
How the public can be involved
The importance of public involvement has now been established and there are various ways of getting the public involved. The most minimalist form of involvement is that of receiving information. Many health promotion campaigns or health initiatives are publicised by the media on behalf of local governments. Although there is no need for the public to take an active role, they are provided with information from which they can either decide to go along with or lobby against (Naidoo & Wills, 2005).
As previously mentioned public involvement can also require active participation which is usually at an individual or collective level. On an individual level, the introduction of many internet sites dedicated to specific illnesses has made it increasingly easier to educate oneself on a particular condition. This has led to the expert patient. An initiative in which the patients with chronic illnesses work alongside the health professional, who recognise them as partners in their own treatment in disease management (Naidoo & Wills, 2005)
Additionally, individual public views can also be expressed via local radio phone-ins’, self-assessment questionnaires, one-to-one interviews, or citizens panels (Naidoo & Wills, 2005).
However, no individual has the power to make decisions for the community; this is done at a collective level. One of the highest forms of collective involvement is that of community development and regeneration. It starts with a participatory needs assessment (PNA), where members of the community are selected to review current services, and give their opinion on what services are required for the area. An agenda is set, and the community meets with local officials to identify a plan of action. Development and regeneration projects are hard to implement. They require time and commitment to be successful; however the benefits to the community upon completion are invaluable (Naidoo & Wills 2005).
Professional Awareness of Public Involvement
So now we know why the public should be involved and how they can be involved in healthcare services; it should be easy to engage people to participate in local initiatives. Unfortunately this is not the case, and all too often the public are forgotten and professionals revert back to the consultation process. In 2002 the Scottish health executive (p.1) issued guidance insisting “it is no longer good enough to simply do things to people; a modern healthcare service must do things with the people it serves.
Therefore as nurses we need to be aware of public involvement. We act as the patients’ advocate and have an important role in facilitating the publics’ involvement in healthcare decisions (McIver & Brocklehurst 1999). We are in the best position to help patients assess any unmet needs and assist with community development (Scottish Executive 2002). The world health organisations’ Ottawa charter also agrees that nurses serve as facilitators and states that: “health personnel have a responsibility to mediate between differing interests in society for the pursuit of health” (WHO 1986).
As previously mentioned public involvement is now a legal right via section 11 of the Health and social care act 2001 (DoH, 2004). Because of this, nurses have a legal responsibility to vigorously promote public involvement. The department of health (2004) has targets in place via the Public Service Agreement (PSA) to enhance patient accountability, and improve the patient experience by 2006. To ensure this happens nurses must constantly be ware of the need for public involvement.
Challenges Regarding Public Involvement
Although public involvement is the obvious way forward, often there are barriers to prevent this. The idea of a partnership between the health professional and patient requires both parties to respect each others views and to have equal input into future care planning. However, often professionals see the questions posed by educated patients as an attack against their expertise and become defensive which inhibits the open relationship require for patients to fully participate (Naidoo & Wills 2005).
Initially patients may also be hesitant to become involved in the treatment of their own illness, preferring the expert opinion of others in addition to having the desire to be looked after rather than having the responsibility of treating themselves (Naidoo & Wills 2005).
When working with the community in regeneration and improvement plans it is sometimes difficult to get the people involved to agree. This is because different people hold different perspectives on the correct course of action. For projects to be successful the parties involved must have an agreed agenda, and set priorities (Jones, Sidell & Douglas 2002). Until an agreement within the community is reached development and regeneration is impossible (Naidoo & Wills 2005). It is also known that some projects and initiative become nothing but ‘talking shops’ (Jones, Sidell & Douglas, 2002. p.51), where parties are unable to come to a decision and achieve nothing.
Funding can also be a key issue. Fixed-term financial support provided by local authorities can expect results within a short period of time. However this view can be unrealistic as the period required to build trust with local communities can be lengthy. Development can be slow, especially if considerable time is taken for the community to reach an agreement on priorities and goal setting (Ewles & Simnett 2003).
This essay started by looking back on an era where professionals dominated the healthcare system and where their decisions were rarely questioned. However due to a shift in government policies the public are now asked to take an active role in their own healthcare services. The public can be involved in various ways in health care decisions, individually or collectively, from treatment planning to priority setting.
Public involvement is invaluable in many ways and provides benefits such as financial rewards in reducing the costs associated with the healthcare service; and providing better working relationships between the lay person and professional.
Nurses and other healthcare workers have a legal duty to involve the public in their healthcare and services, Nurses need to be constantly aware of actively encouraging the public in involvement as they are in the best position to act as the patients advocate in assessing any unmet needs.
However although it has been made clear that involvement plays an important role in the UK’s healthcare system, still major barriers exist and prevent the public from becoming involved. One major barrier is it that of the healthcare professionals themselves who see public involvement as nothing but an attack against their level of experience.
Brocklehurst N, 2004. Public health and it’s implications for practice. Nursing Standard. 18, 49, p.48-54.
Department of health (DoH) 1999. Saving Lives: our healthier nation (online). Available on the World Wide Web URL:
Department of health (DoH), 2004. Getting over the wall: how the NHS is improving the patient’s experience (online). Available on the World Wide Web URL: http://www.dh.gov.uk/assetRoot/04/09/08/66/04090866.pdf
Ewles L & Simnett I, 2003. Promoting health: a practical guide. 5th Ed. Edinburgh: Bailliere Tindall.
Jones L, Siddel M, & Douglas J, 2002. The challenge of promoting health: exploration & action. 2nd Ed. Basingstoke: Open University in association with Palgrave
McIver S & Brocklehurst N, (1999). Public involvement: working for better health Nursing Standard. 14, 1, p46-52.
Naidoo J & Wills J, 2000. Health promotion: foundations for practice. 2nd Ed. Edinburgh: Bailliere Tindall.
Naidoo J & Wills J, 2005. Public health and health promotion: developing practice. 2nd Ed. Edinburgh: Bailliere Tindall.
Oxford English Dictionary 2006 (online). Available on the World Wide Web URL:
Scottish Executive, 2002. Consultation and public involvement in service change (online). Available on the World Wide Web URL:
World Health Organisation, 1978. Ata Alma primary healthcare declaration (online). Available on the World Wide Web URL: http://www.who.int/hpr/NPH/docs/declaration_almaata.pdf
World Health Organisation, 1986. Ottawa charter for health promotion (online). Available on the World Wide Web URL: http://www.paho.org/English/AD/SDE/HS/OttawaCharterEng.pdf
