Intended for healthcare professionals

Education And Debate

Public involvement in health care

BMJ 2004; 328 doi: (Published 15 January 2004) Cite this as: BMJ 2004;328:159
  1. Dominique Florin (, fellow1,
  2. Jennifer Dixon, director1
  1. 1Health Policy, King's Fund, London W1G 0AN
  1. Correspondence to: D Florin
  • Accepted 8 December 2003

The NHS needs to be clear about the aims and how to achieve them

The government is promoting public involvement in health care as part of new NHS policy.1 2 Proposals include allowing the public to elect members of the governing boards of foundation trusts3 and primary care trusts' obligations to engage with the public.4 However, clarity and consensus are lacking about what public involvement means in health care, why it is desirable, and whether current policies will meet the desired objectives. We examine the latest polices and their potential effects.

What public involvement means

Public involvement and other allied terms are used to mean a variety of activities or objectives. In this article we use public involvement to refer to the involvement of members of the public in strategic decisions about health services and policy at local or national level—for instance, about the configuration of services or setting priorities. Public involvement is different from patient involvement, which refers to the involvement of individual patients, together with health professionals, in making decisions about their own health care. Clearly, a spectrum of possible involvement of patients and the public exists between these two extremes. For example, user involvement may refer to a group of patients helping to shape a particular service. Arnstein defined another spectrum of public involvement, ranging from professionals giving information to the public to a genuine hand over of power and decision making to the public.5

Why is public involvement desirable?

Advocates of increased public involvement argue that public services are paid for by the people and therefore should be shaped more extensively by them, preferably by a fully representative sample.6 One assumption made is that greater public involvement will lead to more democratic decision making and, in turn, better accountability, but, as we discuss below, neither is necessarily the case. A …

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