Issue 45

20 May - 2 June 1997

Research insight - Going public with panel games

Costs are rising and demand is increasing, so how does a health authority decide what new treatments and equipment to spend money on and which budgets should be cut?

This is the question being asked by Dr Diana Winstanley, a lecturer in human resource management and a director on the health management programme at the Management School, who is publishing a book on stakeholder mangement for the public services later this year.

One solution is to try to involve the public as much as possible in decision making. "I'm looking at how health organisations involve the stakeholder groups, whether they be employees or the local population, to consult with them on health spending decisions," she said. "The question is whether you can satisfy the needs of all the different groups. In this book I am looking at the innovations and the new methods."

One chapter of the book, to be published by the Open University series, will look at health panels which were also the subject of a seven-minute item on Sky News in March, coverage initiated by Diana. "Due to public pressure and media interest, as in the Child B case, health authorities are trying to involve the local public more in decision making. Health panels are a more creative way to do this than some of the traditional and statutory forms of consultation."

The 'citizen's jury' is one form of health panel researched by Diana - a method used by the Kensington, Chelsea and Westminster Health Authority last autumn to tackle mental health issues in the area. "It was a one-off event," explained Diana. "Over four days the jury saw a range of expert witnesses and finally came up with a view that supported an increase in the provision of sheltered housing - confirming what the authority had anticipated doing anyway."

The authority took the view that the citizen's jury had been educational, but Diana considered it a somewhat expensive educational exercise.

Croydon Health Authority completed a different sort of health panel earlier this year. Two groups of twelve people from different localities met three times in one year then came to the decision that it was better to put money into diagnostic services, such as a MRI scanner, rather than giving patients a wider choice of where to be treated. "But had there been a pregnant mother on the panel, choice might have been incredibly important. She might have wanted a birth pool and not been able to use one at the local hospital," said Diana, pointing out that personal biases were inevitable.

A third method of consulting the public is to conduct a questionnaire which could involve as many as 1,000 people. The benefit of reaching a much wider range of people, however, would need to be set against the loss of depth of information provided. "There isn't a right answer at the moment," believes Diana. "I haven't made up my mind."

Her attention is also on plenty of other projects. "One of my last research contracts was the review of the Handynet, an information technology tool designed to provide a database of services for the disabled," said Diana, who first joined Imperial in 1986 as a research officer but then left temporarily to lecture at Kingston Business School. Other areas she researches include consensus building, appraisal methods and business ethics, and has just written a paper on stakeholder management. She also manages to find time to train for her coast-to-coast sponsored walk for asthma this July.