The Patient and Client Council (PCC), has an independent statutory remit to represent the interests of the public in Health and Social Care (HSC). Our vision is for a HSC service actively shaped by the needs and experience of the public.
The Northern Ireland Executive’s Draft Programme for Government 2024–2027 sets out an ambitious agenda of change for Northern Ireland, which the Executive seeks to achieve by working in partnership; ‘Working in partnership means listening to you throughout the consultation period, responding to your feedback and then delivering the final Programme for Government in collaboration with everyone in our society. It is about doing what matters most today and shaping a better tomorrow, together’.
At the PCC we welcome this commitment to a partnership approach, which reflects a developing conversation across the public policy landscape. There is a growing recognition of the need to more effectively involve the public in policy development, public sector reform and in delivering effective and safe services. This is underpinned by the need to change the nature of the relationship between the public and services, from one of passive recipients to active partnership.
A number of benefits would result from taking a more strategic cross–governmental approach to public participation, including maximising the assets at our disposal, building and maintaining trust in government, and solidifying a sense of public ownership of public services. But ultimately, meaningful public participation throughout the policy–making process and during service design and delivery we believe will result in better services and outcomes for us all.
Embracing the public as assets
In the context of an HSC system under unprecedented pressure, with a limited budget, and a society facing significant health inequalities, it is vital that we maximise and mobilise all the resources at our disposal to improve health outcomes for all. At the PCC we have held a series of conversations with decision–makers and the public examining how the HSC system might better embrace the public as assets. But what do we mean by this?
We can all agree that the skills, knowledge and experience of our health care professionals are key assets to our health service. Likewise, we can agree that the budget, buildings, equipment and medicines are vital to delivering good quality care. The public, however, are experts, by experience, in the care they or someone they care for has received. This experience and expertise should not be lost to the system, and if appropriately utilised, the public can add significant value to the commissioning and design of services, and their safety, across the region. Through their lived experience, the public know what their needs and those of their communities are, what has worked and what has not. In this sense, people, and the communities in which they live, should be seen as a core asset to the Health and Social Care system and should be appropriately involved in policy development and quality assurance, as well as being consulted, once policies have been drafted.
Building Trust
Many people lack the confidence that Governments understand the reality of their daily challenges, and that public services are able to meet their diverse needs. Giving people a greater voice in helping to articulate issues, set priorities and develop solutions should help build trust in our democratic institutions and public services. Listening to and learning from the public as part of the policy development process, does not reduce the authority or accountability of public servants or elected representatives – they are rightly the decision–makers. We should all, however, be interested in enhancing the basis and evidence upon which their decisions are made.
It is clear that public sector reform and reforming the Health and Social Care System has not proceeded at the pace and depth required to meet growing demand and maximise our confined budgets. It is PCC’s belief that transforming the Health and Social Care System, and improving the health and wellbeing of the population, can only be achieved through genuine partnership with the public. The same applies for all public sector reform.
In the context of health inequalities, there can be numerous barriers for individuals in accessing services. There are also significant barriers for many people in participating, to inform decision–makers of the access issues they face. Being able to hear, understand, appropriately assess and strategically address these issues will be vital to shaping services which meet the diverse range of people’s needs and start to tackle some of our persistent health inequalities.
What could be done?
It is important to recognise the meaningful work that is already taking place. Within HSC, we have key components that support public participation in place right across the system, through service user feedback, public consultation, patient experience and Personal and Public Involvement initiatives. With the statutory duty of Involvement that exists across HSC, there is the potential for HSC to lead in this area. Enhancing this through a strategic and cross–governmental approach to public participation, which embraces the public as assets and has the ethos of partnership at its core, has the potential to strategically align, fully embed and build on, the different elements of engagement and involvement that currently exist. This would be for the betterment of the HSC, Government and ultimately the public – now and into the future. Given our statutory role and remit, PCC will continue to be a key advocate for a strategic approach to public participation.
Meadhbha Monaghan, Chief Executive, PCC.
Meadhbha joined the PCC in 2020 as Head of Operations and was appointed as Chief Executive in March 2023. Meadhbha has over ten years’ experience in the homelessness, harm reduction and refugee sectors in the UK, Republic of Ireland and in the US. Her interests lie in addressing issues at the interface where social injustice, structural violence and the social determinants of health impact most profoundly.
