How we set up a ‘Fairness Commission’
Dr Ian Wilkinson explains how Oldham CCG used a one-off patient participation process to discuss with patients how commissioning might affect local healthcare services.
Since the very beginning, Oldham Clinical Commissioning Group (CCG) has been committed to involving local people in all that we do and the decisions we make. We know we are going to have to bring local public opinion along with us in the years ahead as we make some challenging decisions about the services we commission. Last year, we discussed how we could launch conversations with local people about our work and settled on focusing on the issue of ‘fairness in the NHS', as everyone has different ideas about what fairness means when finite resources have to be allocated.
The other advantage of selecting fairness as a discussion point is that it enabled us to concentrate on a cross-cutting issue and not get into the specifics of clinical priorities when we were not ready at that time for such detailed conversations.
We worked with our engagement team and Local Involvement Network (LINk), to bring together clinical commissioners and local people to explore how commissioning decisions could be made in a fair way.
We decided that, as the issues were complex, we needed a deliberative approach where members of the public could be immersed in the information so their views were well informed and we could immediately make use of them.
What we did
We decided to run a citizens' jury – something none of us had done before.
We called this the Oldham Health Commission into Fairness. This was run over four days during which a panel of people, reflective of the local population, heard expert testimonies from clinicians and other health professionals, before making recommendations on the principles and practice of fair healthcare commissioning. The panel were members of the public who had never been involved with the NHS (other than as patients), so they came along with relatively open minds and no particular prior knowledge.
I was privileged to be an expert witness, alongside colleagues, and we presented and were cross-examined on subjects such as how commissioning works, finance, health inequalities, ethics and health economics. It was very clear that the participants began to gain confidence as they began to understand the difficult challenges that commissioners face and became able to question the ‘experts' on their own terms, challenge their thinking and bring their own patient experiences to bear on the discussion.
The findings of the commission were presented to the CCG Committee and then shared with the wider public, who were invited to share their thoughts. A final report was produced and we are now using this to inform our commissioning decisions.
What we learned
Reflecting back, the following key learning comes to mind. Firstly, we should trust the public to share decision-making about local service with clinicians and healthcare managers. After all we trust 12 random members of the public to sit on a jury in court, expose them to evidence, and allow them to potentially decide to send someone to prison.
Secondly, working alongside our local LINk (soon to be HealthWatch) and other patient networks was invaluable, so I would encourage other CCGs to get them on board.
I'm aware that enthusiasm for public involvement among clinicians is variable, so it is really important for the CCG Governing Board to lead by example. I would encourage them to start by talking to their patients.
Dr Ian Wilkinson is the accountable officer for Oldham Clinical Commissioning Group