1. Introduction

People and communities are at the heart of everything NHS England does. The NHS Constitution states that people have a right to be involved in the NHS. By properly listening to people who use and care about services, the NHS can understand their diverse health needs better and focus on what matters. This helps to improve the quality of services, tackle health inequalities and make better use of public resources. 

The policy sets out how NHS England meets its commitment to working in partnership with people and communities, including through roles such as patient and public voice (PPV) partners. All those who get involved in NHS England’s work form an integral part of the organisation and play a vital and unique role by providing valuable insight from a lived experience perspective.

The policy supports NHS England to meet its ‘public involvement’ legal duty and to use this as a platform for building genuine and meaningful partnerships with the people and communities we serve. It sets out how the statutory guidance on Working in partnership with people and communities should be applied throughout NHS England.

By implementing this policy, NHS England will:

• meet our public involvement legal duty and involve people in decisions about the services we commission
• work with people and communities to ensure the views of those we serve are integral to our policy, planning and decision-making processes

2. Scope

This policy is for NHS England employees to follow. It applies to all NHS England’s directorates and regions. It is not a policy for integrated care boards (ICBs), providers or other NHS organisations to follow.

By implementing this policy, we should:

• consider how the benefits of partnership can be realised in our work areas
• ensure we can evidence the difference that involving people has made
• identify sufficient resources to support people to take part and remove barriers to their participation
• be aware of our legal duty to involve the public, how it may apply to our area of work and action needed to meet it
• contribute to an organisational culture in which working with people and communities is everyone’s business

This policy also describes how we will work with Patient and Public Voice (PPV) Partners. PPV Partners are one of the main ways we work with people and communities as an organisation. They are patients, carers, and members of the public who help NHS England in a personal capacity by bringing their own lived experience to our work. They can take part in a range of activities including advisory roles, engagement, co-design and co-production (see Appendix 1). 

3. Policy statement

3.1 The importance of partnership working

NHS England has a legal duty under section 13Q of the National Health Service Act 2006 (as amended by the Health and Care Act 2022) to properly involve patients and the public in our commissioning processes and decisions. For further information about our legal duties see: NHS England » Working in partnership with people and communities: Statutory guidance. The guidance also explains how working with people and communities is essential to meeting other statutory duties, including on health inequalities and the ‘triple aim’ in the Health and Care Act 2022.

While involvement is a legal requirement, working with people and communities also informs and provides valuable insight for wider NHS England objectives, including:

• population health management and the personalisation of care
• delivering the ‘3 shifts’ of the 10 Year Health Plan for England
• addressing health inequalities, improving quality and improving the experience of care
• ensuring our services and digital products are accessible and meet people’s needs

The legal duties provide a platform to build collaborative and meaningful partnerships that start with people and focus on what really matters to our communities. The statutory guidance sets ambitions for wider health and care systems to involve people and communities in their work, and we hold ourselves to the same standard. This means building positive, trusted and enduring relationships with communities to improve services, support and outcomes for people.

3.2 Principles for working effectively with people and communities

The statutory guidance sets the ambition for health and care systems to build positive, trusted and enduring relationships with communities to improve services, support and outcomes for people. This is also the agreed ambition for NHS England, and this policy affirms our commitment to follow the 10 principles set out in the statutory guidance.

These principles will help NHS England meet our legal duty and develop our ways of working with people and communities. Applying the principles means taking a variety of approaches, depending on context and objectives.

3.3 Putting the policy into practice

Section A1 of the statutory guidance describes a variety of approaches working with people and communities. There is no ‘one size fits all’ model.

While there can sometimes be a perceived hierarchy in roles and contributions, all forms of involvement – when used appropriately – can add value. It is important that the appropriate approach is built into project planning at an early stage so that people’s views and contributions meaningfully influence the decisions we make.

At its heart is an ethos which ‘starts with people’ and focuses on what matters to people in the context of their lives and the communities. Work with people and communities must be embedded through:

• our governance structures
• our directly commissioned services
• our public voice networks and forums
• ‘open engagement’ (for example, public consultation events and online surveys)
• working with our PPV partners (for example, through advisory groups, workshops or programme boards)
• employing people with lived experience

More information on how we work with people and communities is available in Appendix 1.

3.4 Addressing equality and health inequalities

This policy is part of NHS England’s commitment to fostering a positive culture of dignity and respect for all and to minimising the risk of discriminatory practice particularly in relation to the characteristics protected under the Equality Act 2010.

Our work with people and communities helps us meet both the public sector equality duty and our duty to reduce health inequalities. It involves actively reaching out to a diverse range of people and enabling participation by groups that experience barriers to access or poorer health outcomes. The statutory guidance on working with people and communities highlights specific considerations when promoting diversity and inclusion in engagement activities.

Actively seeking, listening to and understanding the views of individuals with lived experience will help us to address health inequalities. Our practice should be focused on hearing from people who experience the worst health inequalities. In practical terms, this means:

• designing engagement approaches in ways that encourage and support their participation
• recognising the barriers to taking part that people can face and working to address them
• keeping people who get involved safe and working in trauma informed ways to support them

Further information about trauma informed approaches to engagement is available in the statutory guidance. 

3.5 Payments and expenses

Reimbursing expenses and offering involvement payments to PPV Partners can help remove barriers to involvement. Payment rates are:

• £150 per day (more than 4 hours) or
• £75 per half day (4 hours or less)

Under this policy, the rates are reviewed annually.

Individuals should not be out-of-pocket because of their involvement with NHS England, so all reasonable out-of-pocket expenses are reimbursed. This includes directly covering costs which would otherwise be incurred, for example pre-booking train tickets on behalf of an individual and reimbursing expenses incurred by them.

3.6 Accessible information and communication support

To support people to take part, NHS England will provide information in alternative languages and formats and professional communication support at meetings and events. This includes the provision of information in alternative formats such as easy read or Braille, in community languages, and professional communication support (for example British Sign Language (BSL) interpreters and speech-to-text-reporters).

Where individuals have specific or complex needs and prefer to arrange their own support, NHS England will reimburse these costs when agreed in advance with the hiring manager and with evidence of expenditure such as receipts.

3.7 Safeguarding

NHS England employees are responsible for keeping people who get involved safe. They should only share what they feel comfortable sharing. They must never be asked to talk about traumatic experiences unless this has been carefully planned, with trauma-informed practices in place to ensure their safety and wellbeing. Not putting appropriate safeguards in place can cause distress and reduce trust. Depending on the context, it may be necessary to arrange therapeutic support at activities and afterwards. The statutory guidance explains how trauma-informed approaches should be used.

NHS England has statutory safeguarding arrangements in place to protect children and adults from neglect, harm, abuse or violence. NHS England employees who work with people and communities should understand and implement NHS England’s safeguarding policy and guidance, which covers: 

• safely involving children and young people
• safely involving vulnerable adults
• safeguarding considerations at events (both in-person and online)
• the handling of any allegation of abuse, either at work or in someone’s personal life

Information about the policies and actions to follow in the event of a disclosure or concern about an individual’s safety can be obtained from the Safeguarding team. This includes guidance on immediate actions as well as how to record and report the concern or incident appropriately. If there is a concern that someone is at immediate risk of significant harm, emergency services should be notified without delay.

Any concerns should be referred to the NHS England Safeguarding Team: england.safeguarding@nhs.net.

4. Roles and responsibilities

NHS England directorates and regions are responsible for implementing this policy. They should determine how best to apply it within their programmes and ensure they have appropriate and effective ways to involve the public to meet the legal duty. NHS England national and regional engagement leads will help teams design meaningful approaches to public involvement and to assess whether the legal duty to involve applies to their work. This support includes tailored advice, guidance and access to our learning and support offer.

In addition, NHS England delegated budget holders are responsible for ensuring that programme budgets make sufficient provision for work with people and communities.

5. Equality impact assessment (EQIA)

As part of the development of this policy, its impact on equality has been analysed and no detriment identified.

6. Associated documentation

Resources are available on the NHS England intranet to help colleagues apply this policy, including:

• an implementation guide, which includes the processes to follow when working with people and communities, and answers to common queries
• a step-by-step guide to planning engagement
• PPV partner recruitment guidance and templates

NHS England employees should consult these resources before starting work with people and communities.

Appendix 1: How NHS England works with people and communities

A1.1 As part of our commitment to working with people and communities – and in line with our legal duties – NHS England has a range of ways to support meaningful involvement. These include, but are not limited to, the following examples.

Board meetings

Meetings of the Board of NHS England are held in public, which means that members of the public may attend to observe. They are broadcast live on NHS England’s website and recorded for future viewing. Where there are confidential issues for discussion (for example, discussions involving personal identifiable, commercially sensitive or legally privileged information), the Board will go into closed session.

Copies of the agenda and other papers are published in advance of the Board meeting and the meeting minutes published afterwards.

Non-executive directors (NEDs) of the Board seek to ensure, through constructive challenge and in other ways, that the interests of patients, taxpayers and the public are represented at Board meetings. The skills, experience, and knowledge to represent these interests are an explicit requirement of the NED role at NHS England.

Two-way communication between NEDs and PPV partners is facilitated through governance arrangements. For example, the NED chair of the Workforce Training and Education Committee is also co-chair of the People’s Advisory Forum.

Committees, working groups and programme boards

NHS England has PPV partners who make a regular contribution to its work through various boards, committees and working groups. These roles are openly recruited to, with agreed responsibilities, lengths of term and support to do the role effectively.

Directly commissioned services

Every element of our commissioning system must be informed by listening to and acting on the views of those who use health and care services. Their views should inform service development; this helps us get services right for people and their families and supports continuous improvement. The participation frameworks for commissioning areas within NHS England set out the key partnerships and approaches to engagement and approaches to demonstrating that the legal duty to involve has been met.

Networks and forums

NHS England hosts a range of networks, advisory groups and sounding boards that have membership from people and communities. These forums help us to involve people from different communities and with health interests in our decision-making. Working with a wide range of groups helps in bringing fresh and diverse perspectives and ensures our work meets different communities’ needs. These roles are openly recruited to and have specified terms of service. Some of these groups are linked to programmes and others are formed around specific communities.

Members are brought together at the NHS Citizen Advisory Group which includes a diverse range of members, including young people, older people, inclusion health groups, carers, LGBTQI+ people, people with learning disabilities, and autistic people. The group champions appropriate, effective and meaningful participation, including identifying opportunities for improved practice. It also provides opportunities for peer support and the sharing of learning and good practice.  

NHS England staff can bring early ideas and proposals to the forums for discussion. For more information and to contact the forums please email england.peopleandcommunities@nhs.net.

Inviting views from the public

Some of the ways we work with people are open to anyone wanting to share their views. These ‘open access’ opportunities include:

• attending a public meeting
• completing a survey
• taking part in a consultation

These activities do not require specific skills or knowledge, and there is no recruitment or selection process. They involve no formal commitment or expectations on either side and are typically one-off opportunities. People may be contacted afterward to give feedback or receive an update on the work, but there is no expectation of ongoing involvement or a continuing relationship.

User research and one-off engagement

There may be occasions when individuals are invited to take part in discrete, time-bound engagement opportunities within NHS England. For example:

• attending events, workshops or focus groups on a one-off basis
• taking part in a specific piece of research or an engagement activity
• taking part in a user research session

Under this policy, people who take part are reimbursed for their expenses. In certain circumstances voucher payments can be made (for example, where this will encourage participation and help us gather a broader range of views).

Where voucher payments are offered, 1 voucher should be issued per person or 2 in exceptional circumstances. Voucher payments cannot be paid for on-going engagement activity or and cannot replace involvement payments to PPV partners.

Patient and public voice (PPV) partners

One of the main ways NHS England works with people and communities is through the Patient and Public Voice (PPV) Partner role. PPV Partners are integral to our work and support us by sharing their expertise and lived experience through ongoing involvement in workshops and engagement sessions, through membership of advisory groups, and through networks and programme boards. They are recruited based on specific skills and experiences; and are offered an involvement payment in recognition of their contribution. There are some exclusions on who can become a PPV Partner and limits to the number and duration of roles they can do. Further information about PPV Partners and how NHS England supports them is provided in Appendix 2.

Employing people with lived experience

NHS England employs people with lived experience where there is a substantial, ongoing requirement for their input. For example, where the level of time commitment or specialist input is over and above that would be deemed fair or appropriate from a PPV partner relevant lived experience is included in the person specification for these positions and the recruit has a contract of employment with NHS England.

Working with other organisations

NHS England often commissions voluntary, community and social enterprise (VCSE) organisations and others to assist with engagement work (for example, because the organisation has essential knowledge, skills or relationships that support the engagement).

This helps NHS England reach marginalised or excluded communities (for example, people experiencing homelessness; Gypsy, Roma, or Traveller communities, asylum seekers and refugees, or those in contact with the justice system). This can be a more effective way of involving people from marginalised groups than, for example, recruiting PPV partners. Section A3 of the statutory guidance provides more information about the benefits of working with VCSE organisations.

External partner organisations should be chosen for their reach, experience and expertise in engaging with the people we need to work with. They must have appropriate policies and processes for recruiting and supporting individuals, especially those from marginalised or excluded groups, and these arrangements should be in line with the principles set out in this policy. NHS England staff should consider the suitability of an external organisation to deliver engagement activity as part of the commissioning process. In these instances, the external organisation’s policies should be followed, including those relating to expenses and involvement payments.

NHS England procurement procedures or grant procedures should be followed when commissioning this type of support. The VCSE Health and Wellbeing Alliance may also be able to offer support as part of existing grant arrangements. For further information about the alliance, contact england.peopleandcommunities@nhs.net. 

Appendix 2: Patient and public voice partners

A2.1 Introduction

The patient and public voice (PPV) partner role allows people with lived experience to contribute to our work on an ongoing basis. PPV partners bring objectivity and challenge, enabling us to make more informed decisions with and for the people and communities we work with. They are offered an honorarium and are reimbursed for expenses.

PPV partners are recruited for roles that involve a sustained level of involvement or significant responsibility, based on their specific skills and lived experience. They typically work with NHS England over a sustained period of time (although they may sometimes be involved in one-off commitments) and the roles carry a significant level of responsibility or direct involvement in decision-making. A formal recruitment and selection process is required and there are clear expectations around PPV Ppartner contributions, conduct and the support needed to allow them to do their role effectively.

While ‘PPV partners’ is the name used in this policy for the role, they may also be referred to as:

• lived experience partners
• lay representatives
• public voice members
• service users

The previous PPV partner policy (2017) outlined 4 distinct levels of PPV partner roles. Following engagement with NHS England staff and PPV partners, we have streamlined this approach and introduced a single PPV partner role.

NHS England is committed to ensuring that PPV partners:

• are valued and supported to maximise their contribution
• have a positive experience
• come from a wide range of backgrounds and experiences
• feel their contribution to NHS England is appreciated

NHS England has a responsibility to monitor and maximise the diversity of the PPV partners we work with. It is also important that we recognise that PPV partners have other commitments (for example, caring responsibilities and work). All PPV partner opportunities should make clear the expectations and commitment required, and individual conversations should take place about the contributions and support needed.

A2.2 Involvement payments

NHS England is committed to reducing barriers to involvement and taking positive action to ensure we hear from people who experience inequalities and poor health outcomes. PPV partners may face barriers to involvement. An individual may, for example, have a long-term condition, caring responsibilities or be part of a community that experiences marginalisation. Education, family or work commitments can affect people’s ability to participate.

Lead contacts or hiring managers should ask PPV partners about any support needs or accessibility requirements. PPV partners should be encouraged to share any such needs with their NHS England contact as soon as possible after recruitment or after registering for an event. In response, NHS England staff should reduce barriers to participation (for example, pre-booking travel on their behalf) so that they are not out-of-pocket.

Reimbursing expenses and involvement payments can remove barriers to involvement. At the policy’s publication, payment rates are:

• £150 per day (more than four hours) or
• £75 per half day (four hours or less)

Involvement payments – and even the acceptance of an unpaid PPV partner role – can affect individuals’ benefit payments, and we have a responsibility to direct people who are interested in working with us to appropriate sources of advice.

We should also recognise and appreciate the time and input of PPV partners in a variety of ways. This includes both formal and informal expressions of thanks, as well as offering opportunities for personal development, skill-building, and gaining experience.

Meals and refreshments can be provided for PPV partners at face-to-face meetings or events under the Standards of business conduct policy because they are not NHS England employees. Approval is needed from the budget-holder.

Supporting everyone to take part ensures NHS England meets its commitment to include people from a diverse range of backgrounds. For PPV partners with a disability, NHS England is required by law to make reasonable adjustments where they are deemed appropriate. Further information is detailed in the recruitment guidance.

A2.3 Limits and exclusions

To encourage a range of people to become PPV partners and to minimise conflicts of interest, there are limits to the number of roles that PPV partners can have and some exclusions.  The limits are:

• PPV partners can only hold up to 3 roles at any one time
• The length of term for a PPV partner role is 4 years

As stated above, PPV Partners are not employees of NHS England and the limit to the number of roles also ensure that earning levels cannot be construed as implying employment.

While there is no fixed monthly limit on the number of hours a PPV partner can contribute, a general guideline is that that each role should average no more than 2 full days per month including all preparation and travel time. This also reduces the likelihood that the PPV partner role could be construed as employment.

There may be times when a PPV partner is involved in an intensive piece of work for a short period of time (for example, 3 days per week for 2 weeks). However, this would typically be balanced by periods of lower involvement in other months, resulting in an approximate average of 2 days per month over a year.

To minimise conflicts of interest and to ensure that PPV partners bring a public perspective the following people cannot be NHS England PPV partners:

• a chair or board member of an NHS body – including an NHS trust, NHS foundation trust and/or an integrated care board
• an NHS England employee (including all staff, honorary or unpaid medical or dental posts). This applies even where their employed role is in a different area of the business. This exclusion does not prohibit NHS England staff from undertaking PPV partner roles in other NHS organisations, subject to NHS England’s Standards of business conduct policy
• a practising clinician – including practising GPs or general dental practitioners
• a serving MP or local councillor or a candidate for election to such a post

Some roles may have additional exclusions. Staff should ensure PPV partners meet the criteria during recruitment.

A2.4 Disclosure and barring (DBS) checks

Most PPV partner roles do not require a DBS check. A DBS check should only be a requirement of PPV partner roles where it is specifically justified by the nature of the work and if all other members of a committee or group have undertaken a DBS check. Where this is the case, the requirement should be made clear in recruitment information.

A2.5 NHS England responsibilities

All NHS England managers are responsible for engaging PPV partners in line with this policy, where it is relevant to their team’s work. They must ensure that PPV partners reflect the diversity of the communities served and be able to demonstrate the impact of working with PPV partners.

NHS England managers working with PPV partners should:

• oversee the support for the PPV partner’s involvement with NHS England from start to finish. This includes a recruitment phase, an induction, and ongoing support when they are in their role. 
• identify any resource requirements associated with working with PPV partners. This will usually include funding for PPV partners’ expenses and involvement payments. It also includes reasonable adjustments and accessibility support
• identify a named person (a ‘hiring manager’) to support PPV partners in their roles, whom PPV partners can contact with questions or concerns.
• ensure that PPV partners’ personal information is kept securely and that this data is registered on the NHS England Information Asset Register, in line with our information governance requirements and data protection law.

There is a welcome pack for PPV partners and this should be used by all staff to ensure a consistent approach that meets our commitments and legal duties (including in training and development, equity, diversity and inclusion, transparency and governance). 

NHS England staff, and especially named hiring managers, must be open and transparent about involvement payments and expenses when advertising PPV partner opportunities and roles.

The hiring manager is responsible for ensuring that:

• PPV partners have a copy of this policy and information about expenses and involvement payment claims in advance of their first meeting or event
• support and guidance is provided to any PPV partner who needs help or further information to complete claims
• PPV partners are advised to liaise with relevant agencies if they are receiving state benefits
• claims are checked and in line with NHS England requirements and this policy
• claims are approved using the correct corporate finance approvals process

A2.6 PPV partner responsibilities

PPV partners seeking reimbursement or payments should submit their claims through the appropriate system and in a timely manner (not more than 3 months after the event and/or activity that their claim relates to). When receipts are difficult to obtain (for example, travel cards or calls made on mobile phones), copies of bills or computer printouts and/or screenshots with the relevant section highlighted can be accepted. If receipts are lost, the PPV partner should discuss this with the named hiring manager.

Individuals can only claim their own expenses and those of a support worker or personal assistant. They cannot claim for expenses on behalf of other PPV partners or colleagues.

PPV partners who find it difficult to complete the payment process should contact their hiring manager to request additional support in the first instance. Where appropriate, NHS England will reimburse the cost of a support worker required to assist an individual in submitting claims (for example if the PPV Partner has a learning disability or communication support needs).

PPV partners are advised to keep copies of their submitted expenses claims along with records of payments or reimbursements received, in case these are requested by HM Revenue and Customs or other agencies.

A2.7 Standards of business conduct

NHS England‘s Standards of business conduct policy sets out requirements around declaring and managing actual and potential conflicts of interest, offers of gifts and hospitality, and commercial sponsorship. PPV partners are expected to comply with its requirements, including declaring any gifts or financial interests that may be regarded as a conflict of interest with the programme of work the PPV partner is involved in. The hiring manager should ensure that PPV partners are clear about the standards of business conduct and should maintain a record of conflicts of interest and any mitigations that were implemented. For further information contact england.governance@nhs.net

A2.8 Information governance

Sending sensitive information to PPV partners

During their involvement with NHS England, PPV partners may have access to confidential or sensitive information such as:

• commercially sensitive material (for example, if PPV partners are part of a procurement process)
• personal data (if PPV partners are part of a recruitment process)
• budget and resource information
• early drafts of programme documentation

NHS England staff sending sensitive information to PPV partners should ensure:

• the PPV partner has completed a confidentiality agreement
• the information is sent electronically via a password encrypted zip file or Egress secure file transfer. If sent as a hard copy, this should be by recorded delivery
• unless otherwise agreed, any information sent electronically to PPV partners as a group should be done using the ‘blind copy’ function

PPV partners should not, in general, be issued with NHS.net email addresses. Doing so poses risks around unauthorised access to NHS information and may lead to confusion about the status of PPV partners (as independent members of the public and not NHS employees). In exceptional circumstances, and for a limited number of roles, there may be a specific need for a PPV partner to be issued with an NHS.net email address. This should be determined on a case-by-case basis with a clear audit trail of the rationale for this and who has approved it.

If staff are in doubt about the management of sensitive information, they should contact the Information Governance team for advice. Contact england.ig-corporate@nhs.net.

Managing personal PPV Partner data

Management of information about PPV partners and prospective PPV partners (candidates for roles) should follow the requirements of NHS England’s Information governance policy.

Document information

Publication reference: PRN01954