1. PPI IS IMPERATIVE FOR SUCCESSFUL
COMMISSIONING BECAUSE:
• It’s a financial imperative
– Save money
– Get pathways used
• It’s a moral imperative
– Who’s NHS is it anyway?
• It’s a political imperative
– No democratic legitimacy
• It’s a practical imperative
– Safer
– Better design
• It’s a legal imperative

2. COMMUNITY INVOLVEMENT
AND COMMISSIONING
Dr Brian Fisher MBE
Chair of the Socialist Health
Association

3. WHAT KIND OF INVOLVEMENT?
• Democratic
• Participatory
–Influence through engaging with
–Individuals
–Groups
• Listening Responding

4. CONSORTIUM GOVERNANCE
OPTIONS
• DEMOCRATIC
– Democratic elections to the Board
– Councillors/LA on the Board (?)
• PARTICIPATORY
– HealthWatch on the Board
– Other lay people on the Board
– Foundation Trust consortium
– Lay reps on every key committee
– A super patient participation group
– Community development

5. HEALTHWATCH
• Son of LINKs, grandson of Fora, great-
grandson of CHCs
• A network of networks and groups
• To influence commissioning of health and
SC by understanding key issues for local
people.
• Future responsibilities?
– Complaints
– Shared decision-making

6. HEALTH AND WELL-BEING
BOARD
• Consortium, HW, LA, NHS CB if relevant
• Chaired by LA
• Joint decision-making on commissioning
• Start with Joint Strategic Needs
Assessment
• Has the semblance of democratic
legitimacy, but no substance

7. WHAT TO BECOME INVOLVED IN
• The consortium’s agenda
– Priorities
– Service development
– Setting standards – quality in SLAs
– Service monitoring
– How to spend savings
• The community’s agenda

8. PROACTIVE DIALOGUE,
DEEP AND WIDE
• Experience based design
• Database
• Community development

9. HEATH AND WELL-BEING BOARD
CONSORTIUM
HEALTHWATCH
HW
LOCAL VOLUNTARY GROUPS

10. COMMUNITY
DEVELOPMENT/ORGANISING
• Improves PPI
• Improves health protection
• Tackles health inequalities
• Supports behaviour
change

11. ASSET-BASED COMMUNITY
DEVELOPMENT
• People as assets, not problems
• Individuals, organisations and statutory services
working together to improve civil life
• Both local people and statutory services have
skills that need to be combined for maximum
effectiveness – co-production
• Enhancing health promoting/protecting
mechanisms
• Strengthening the capacity of
indiv and communities

12. CD Stronger and
deeper SNs
RESILIENCE ENHANCED CONTROL
Health protection Can negotiate with services
Resilience to economic More strength for self-care
adversity Health inequalities reduce
Better mental health

13. 7 STEP MODEL
• Listening event
• Brings together local agencies (health,
police, education, SC) and residents
• Partnership
• Forms ‘organizing hub’ for activities
and initiatives
• Leaders appear
• Rapid changes in commissioning

14. HELP - COMMISSIONING @ 9
MONTHS
• Company formed
• Playpark
• GP surgery
• Dental surgery
• Benefits advice
• Tai Chi
• Plans for radical change

15. HELP – OUTCOMES @ 5Y
• Life expectancy + 6 yrs
• Increased Breast Feeding 50%
• Postnatal depression rates down 60%
• Child accident rate down 50%
• 78% reduced fear of crime
• Other benefits .. escalated impact of other
Public Health programmes, and changes to
services and commissioning
• Estimated savings based on 5% reduction
across a basket of conditions = £70k per year
for 5000 population.

16. BIG SOCIETY?
• REDUCED STATE PROVISION
• SOCIAL JUSTICE
• INCREASED ACCOUNTABILITY
• TRANSPARENCY
• ENHANCE PUBLIC SECTOR MARKETS
• LEADERSHIP BY FRONTLINE PROVIDERS
• FUNDING
• IMPROVED LOCAL COMMISSIONING
• NEIGHBOURHOOD GROUPS MUTUALS AND
COOPERATIVES
• CHARITABLE GIVING
• VOLUNTEERISM