Participation, Involvement and Engagement – More Than a Question of Semantics

Internationally, the distinctions between the state, the market and civil society are becoming increasingly blurred. Governance theories show the complexity and interdependency of relationships between actors and institutions working across these fields. We are currently conducting a qualitative case study incorporating ethnographic methods to research the process and effects of patient and public involvement in one region of the English NHS. To date we have conducted in-depth interviews with a sample of members of the public / patients who get involved, Healthwatch Chief Executive Officers and Chairs of Health and Wellbeing Boards. In the next few months we will be interviewing NHS staff and observing involvement processes.

Our focus of inquiry is on a relatively new body Healthwatch, described as a ‘consumer champion’. Healthwatch is mandated to involve volunteers in its work of amplifying the voice of local people who use statutory health and social care services. Commissioned by local authorities, Healthwatch organisations are entitled to a seat on the local Health and Wellbeing Board. They have powers to ‘enter and view’ NHS and social care establishments and report their findings to these providers and to commissioners.

Preliminary findings suggest that statutory bodies are actively engaging local public(s) as they plan for service transformation. Recognisable tensions surface around how public(s) are constituted, how deliberative or not methods of engagement are, as well as the usual problematic issue of representation. Unexpected and novel findings are emerging around legal definitions and requirements for statutory consultation in the context of major service changes. It appears that patient and public engagement is being carried out in an attempt to pre-empt objection to proposed service changes when these are formally presented for legal consultation. This raises interesting theoretical questions about governance and governmentality and empirical questions concerning agenda setting and manipulation versus empowerment and co-production.