Service User Involvement in
Commissioning
Daniel Madge
Manchester PCT
What Is Commissioning?
 “Commissioning is the means by which we
secure best value for patients and taxpayers
– Best possible health outcomes
– Best possible healthcare
– Within the resources made available by the
taxpayer
DH Commissioning Framework
What do commissioners do?
National
Targets
Review
Service
Provision
Decide
Priorities
Assess
needs
Design
Services
Seek public and
patient’s views
Shape structure of
supply
Performance
Mgt
Referrals, Ind
needs
assessment,
treatment
Manage
demand
Commissioning
 Effective commissioning means effective
engagement of patients and local
communities. Patients, through greater
choice, will drive improvements in many
services. For services where wide choice
may not always be possible, the views of
patients and carers and families, groups of
service users and their communities should
still substantially influence service provision.
DH Commissioning Framework
A Brief History of Service User
Involvement
 The Plea for The Silent 1957
– Individualistic
– Imprisonment
– De-personalisation
– Objectification
– Plea that they did not belong
– Confinement = an error
– Plea for someone to talk to
A Brief History Cont…
 Speaking Our Minds 1996
– Collective voice
– Survivor pride
– Wider social links
– Plea for self determination
Impact of a collective voice
Individual
 Disassociation from
MH
 An error in the
system
Collective
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Added confidence
Pride in association
Pride in surviving
Implied system fault
Challenge to
biological construct
How does this challenge the
biological construct?
“…my experience is not valid and I cannot be
whole. It limits the scope of our lives and
creates victims. The ethos within which we
tackle our problems… is damaging to our
chance of becoming partners in the
community.”
The voice of protest
 Anti Psychiatry Movement – 1960’s
 Campaign Against Psychiatric Oppression
1980’s
 Critical Psychiatry - current
www.critpsynet.freeuk.com
Traditional Approaches To
Service User Involvement
Co-option:
– Patient Forums
– Service User Representatives
– Consultation exercises
The Evidence
(Miller and Ahmed 2000)
 Professional & organisational hierarchies
exclude service users
 Service Users have no statutory authority
 Legitimacy comes from being official
The Evidence
(Bowling 1996)
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Involvement = tokenistic
Influence is difficult to achieve
SU Reps are not representative
SU groups are riven by splits
SU are fearful of retribution
Involvement engages too small numbers
Engagement is designed for
professionals
Supporting The Modernisation
Agenda

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Choice
Payment by Results
Cost and Volume Contracts
Direct Payments
Individualized Budgets
Contestable Commissioning
….All offer opportunities for greater
involvement
Supporting The Modernisation
Agenda Cont..
 Recovery
 Social Inclusion
Ways of Getting Involved
Self care
 Direct payments
 Self Help
 Engagement in care plan
Carers
 Support for carers to care
 Carers involvement in CPA
Service Provision
 User led services
 Employment in services
Commissioning
 Commissioners promote involvement
 Support commissioning agenda
Campaigning
 Independent critical friend
 Independent service user groups
Options for Involvement in
Commissioning
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Needs Assessment
Service Design
Tender process
Service Delivery
Service Monitoring
‘Customer satisfaction’
Choice
Involvement in Commissioning
Some examples…co-option
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User Set Standards
User Focused Monitoring
Self Help
Service User Employment
User Led Provision
Community Engagement – PPI
Service User Consultants / Critical
Friends
Involvement in Commissioning
Some examples… Conflict
 VCS Campaigning
 Alternative provision
Thankyou
Daniel Madge
daniel.madge@manchester.nhs.uk