Embed public and patient perspectives into all NHS healthcare decision-making structures

The Index has not yet recorded a verbatim government response to this recommendation.

NHS England, ICBs, NHS trusts and foundation trusts all have legal duties to make arrangements to involve the public in their decision-making about NHS services. The main duties for NHS bodies to make arrangements to involve the public are all set out in the National Health Services Act 2006, as amended by the Health and Care Act 2022:

• section 13Q for NHS England

• section 14Z45 for integrated care boards

• section 242(1B) for NHS trusts and NHS foundation trusts.

A duty for commissioners to promote involvement of each patient is required under s.14Z36.

A requirement to involve the public is also included as a service condition in the NHS Standard Contract for providers.

In line with these legal duties, NHS commissioning organisations are required to publish an annual assessment of how well they are meeting this duty as part of statutory annual reporting.

NHS England is required to carry out an annual assessment setting out how well the ICB has performed on its statutory duties, including how the ICB has promoted patient and public involvement and choice. Assessments can be viewed via individual ICB websites.

NHS England provides statutory guidance for Integrated Care Boards (ICBs), NHS trusts and foundation trusts to support them to meet their public involvement legal duties. It is relevant to other health and care organisations, including local government, to ensure collaborative working to involve people and communities.

The NHS Constitution is clear that the NHS belongs to the people. Patient and public participation is currently being supported through a variety of ways including through:

Public participation

• Service Condition 12 of the NHS Standard Contract, which sets out how Providers must communicate and involve service Users, Public and Staff.

• Statutory guidance, produced jointly with DHSC, exists for ICBs, NHS Trusts and NHS Foundation Trusts on how they should work in partnership with people and communities including supporting them to meet their public involvement legal duties. The guidance can be used by primary care providers to achieve best practice.

• the NHS Assembly, a body of some 50 members who include people with lived experience of healthcare and leaders of patient representative organisations, as well as professional leaders in healthcare.

• the NHS Citizen Advisory Group, which brings together a diverse range of patient and public partners that are involved in work programmes’ involvement networks and fora, with patient and public members of relevant committees, programme boards and working groups.

• For general practice, the National Health Service (Personal Medical Services Agreements) Regulations 2015 state that providers must establish and maintain a group to obtain the views of patients about the services they deliver and enable them to obtain feedback.

Patient feedback

• CQC and NHS England publish patient experience surveys in primary and secondary care under their National Patient Survey Programme. Examples include the Cancer Patient Experience survey and the GP Patient Survey.

• The Friends and Family Test (FFT) is an important feedback tool that Provider Trusts and primary care providers use that supports the fundamental principle that people who use NHS services should have the opportunity to provide feedback on their experience.

• Patients and their carers should also have access to a Patient Advice and Liaison Service operated within the provider organisation. This is intended to offer confidential advice, support and information on health-related matters and should be available as a point of contact.

• The Patient Safety Incident Response Framework includes as its first priority the compassionate and effective engagement of those affected by patient safety incidents in the learning response to those incidents. Those affected by incidents must be fully involved in patient safety incident investigations from the start and throughout as long as they wish to be involved.

• Under the NHS Patient Safety Strategy, all NHS organisations are required to appoint a minimum of two ‘patient safety partners’ (lay people) to their patient safety oversight committees (or equivalent).

• The Patient Safety Commissioner, since her appointment in September 2022, has had a key function to amplify the voice of patients at the heart of clinical care.

Complaints

All providers and commissioners of NHS services are subject to a statutory duty to handle complaints in accordance with the requirements of the 2009 Complaints Regulations. This includes primary care providers and independent sector providers.

• In December 2022, the Parliamentary and Health Service Ombudsman issued Complaints Standards which include expectations on how providers and commissioners will handle complaints, together with a model complaint handling procedure and detailed guidance on how the Complaint Standards can be applied in practice.

The Government agreed with this recommendation.

The National Health Service Reform and Health Care Professions Act 2002 established Patients’ Forums and the Commission for Patient and Public Involvement in Health.