One of the drivers for increased patient involvement in medical education is the increasing acknowledgement of the ‘patient voice’ in healthcare. This in turn reflects a wider involvement of service users and carers, and the ‘personalisation’ of care at all levels in public services (Carr and Dittrich, 2008, p. 4). This shift towards a partnership and personalised care agenda, enshrining choice and located around local services, is set out in the NHS Next Stage Review (DH, 2008, p. 14), which emphasises the role of clinicians, not only as practitioners and leaders, but also as partners in care.

Two streams of lay involvement in healthcare services have emerged. Patient involvement as the contribution of individuals to clinical decisions about their own healthcare and that of others in similar circumstances, and public involvement via the participation of individuals or groups in the development, planning and provision of services. Clinical and non-clinical decision making are different; however, areas of overlap exist in clinical governance, medical education and research.

Patient involvement can be seen as a product of particular interpersonal relations typified within the doctor–patient relationship and the importance of appropriate communication training has long been recognised. However, as the BMA Patient Liaison Group (2007) stated: ‘PPI is not about people wanting to make the clinical decisions. It is, in part, about facilitating patient autonomy.’ They suggest that patients want to be treated as partners by health professionals, and would like to be offered a choice of treatment and to be informed to enable choice. Involvement in care improves outcomes through greater compliance with medication and treatment. 

There has been little research into the effectiveness of user involvement in the evaluation and development of services, although a positive effect on the patient experience has been reported. For example, the Macmillan/DH Cancer Partnership Project Evaluation report (2004) summarises:

• partnership groups show effective achievements including improvements in information, communication of bad news, transportation, parking, waiting times and the design of new buildings
• strong leadership is crucial to the effectiveness of groups
• the commitment of health professionals, cancer networks and cancer service users is key to sustainability of patient involvement in cancer services
• health professionals may experience emotional and interpersonal challenges when working with patient/carer members in the groups.