Hogg Christine N L
London Metropolitan University, London, UK.
Health Expect. 2007 Jun;10(2):129-38. doi: 10.1111/j.1369-7625.2006.00427.x.
Patient and public involvement is the cornerstone of the 'patient-led' National Health Service (NHS). Though the UK has had state sponsored arrangements for patient and public involvement since 1974, they have become fragmented and unstable. Patients' forums and the Commission for Patient and Public Involvement in Health replaced community health councils (CHCs) and their national association in England in 2003, but now will be replaced by local involvement networks (LINks) and the Commission will be abolished in 2007.
This study provides an overview of research on the effectiveness of arrangements for patient and public involvement and reviews the debates about accountability, independence, ensuring consistency of performance, representation and how arrangements for the NHS fit within the wider agenda of citizenship and renewal of democracy. It explores key themes and areas for learning to inform the debate about how LINks might work effectively to improve the health of local people, in particular addressing issues of equity, representation and citizen engagement.
The proposed LINks provide the opportunity to integrate patient and public involvement into wider initiatives for local democracy and citizen engagement. But debates and key issues about user and public involvement in the 1970s remain current and unresolved. If the new LINks are to succeed where forums and CHCs are considered to have failed, the strengths and weakness of both need to be understood and addressed.
患者及公众参与是“患者主导”的国民医疗服务体系（NHS）的基石。自1974年以来，英国就有政府资助的患者及公众参与安排，但这些安排已变得零散且不稳定。患者论坛以及患者与公众健康参与委员会于2003年取代了英格兰的社区健康委员会（CHCs）及其全国性协会，但现在它们将被地方参与网络（LINks）取代，该委员会将于2007年被废除。
本研究概述了关于患者及公众参与安排有效性的研究，并回顾了有关问责制、独立性、确保绩效一致性、代表性以及NHS的安排如何适应更广泛的公民身份和民主更新议程的辩论。它探讨了关键主题和可供借鉴的领域，以为关于LINks如何有效运作以改善当地居民健康的辩论提供信息，特别是解决公平、代表性和公民参与等问题。
提议的LINks提供了将患者及公众参与纳入更广泛的地方民主和公民参与倡议的机会。但20世纪70年代关于用户及公众参与的辩论和关键问题仍然存在且未得到解决。如果新的LINks要在被认为论坛和CHCs已失败的方面取得成功，就需要理解并解决两者的优势与劣势。
