Department of Health Sciences, University of Leicester, Leicester, UK.
Int J Health Policy Manag. 2016 Jan 21;5(4):259-63. doi: 10.15171/ijhpm.2016.07.
This article engages with debates about the conceptualisation and practical challenges of patient and public involvement (PPI) in health and social care services. Policy in this area in England has shifted numerous times but increasingly a consumerist discourse seems to override more democratic ideas concerning the relationship between citizens and public services. Recent policy change in England has seen the creation of new consumer champion bodies in the form of local Healthwatch. The article describes these new organisational structures for PPI and shows how those who seek to influence planning and delivery of services or comment or complain about aspects of their care face considerable complexity. This is due, in part, to the ambiguous remit set out for newly instigated Healthwatch organisations by government. Drawing on governance theory, we show that it can also be understood as a function of an increasingly polycentric governance arena. Challenges that flow from this include problems of specifying jurisdictional responsibility, accountability, and legitimacy. We review Healthwatch progress to date, then we set out four challenges facing local Healthwatch organisations before discussing the implications of these for patients and the public. The first challenge relates to non-coterminous boundaries and jurisdictional integrity. Secondly, establishing the unique features of Healthwatch is problematic in the crowded PPI arena. The third challenge arises from limited resources as well as the fact that resources flow to Healthwatch from the local authorities that Healthwatch are expected to hold to account. The fourth challenge we identify is how local Healthwatch organisations negotiate the complexity of being a partner to statutory and other organisations, while at the same time being expected to champion local people's views.
本文探讨了在健康和社会保健服务中患者和公众参与（PPI）的概念化和实际挑战。该领域的政策在英国已经多次发生变化，但越来越多的消费主义话语似乎压倒了关于公民和公共服务之间关系的更民主的想法。最近英格兰的政策变化见证了以当地健康观察家的形式创建新的消费者拥护者机构。本文描述了这些新的 PPI 组织结构，并展示了那些试图影响服务规划和提供或对其护理方面发表意见或投诉的人面临的相当大的复杂性。这部分是由于政府为新成立的健康观察家组织规定的模糊职权范围。借鉴治理理论，我们表明，这也可以理解为日益多中心治理领域的一个功能。由此产生的挑战包括指定管辖权、问责制和合法性方面的问题。我们回顾了迄今为止健康观察家的进展，然后提出了当地健康观察家组织面临的四个挑战，然后讨论了这些对患者和公众的影响。第一个挑战涉及非交叠的边界和管辖完整性。其次，在拥挤的 PPI 领域中，确定健康观察家的独特特征是有问题的。第三个挑战源于有限的资源以及资源从健康观察家期望追究责任的地方当局流向健康观察家的事实。我们确定的第四个挑战是当地健康观察家组织如何在作为法定和其他组织的合作伙伴的同时，同时又期望拥护当地人民的观点，从而应对这种复杂性。
