Impact of lay partners on co-production of integrated care policy

Setting: North West London (NWL), an urban area composed of 8 boroughs with a highly diverse population of 2.2m. In October 2013, NWL was selected as one of 14 NHS Integration Pioneers. Background: NWL have been integrating physical, mental and social care provision for elderly and diabetic patients since 2011, with citizen engagement through a Patients, Carers, Users Group. From September 2013 we have been planning to widen the scope and scale of the initiative to a ‘Whole System’ approach, to be implemented in 2014. We intended to co-design the new system from the start with patients/users/carers and other citizens. Method: The design structure included five workstreams (Populations and Outcomes, GP Networks, Provider Networks, Commissioning and Finance, Informatics) plus a cross-cutting Lay Partners Advisory Group of 20, which was recruited from among patients/carers/users who already had experience of acting in a representative role and had the capability, capacity and commitment to take on an active role. Some were drawn from the existing Group, others were nominated via each borough’s Clinical Commissioning Group, Healthwatch, Adult Social Services, primary care patient participation groups and patient charities. A full day of training for potential Lay Partners was commissioned from the Centre for Patient Leadership, a patient-led organisation. Expenses incurred by Lay Partners were remunerated. Outcome: All the design workstreams and the overarching programme board have had 1-3 Lay Partners as full members from the first meeting. Lay Partners attended on average eight hours of meetings per month, plus reading and commenting on discussion papers. They developed a ‘CoProduction Touchstone’ setting out principles and best practice, which was accepted by the Board. Some have been asked to co-chair their workstream. Their major impact has been to keep the focus on designing patient-centred accessible, pro-active and high quality care. They act as ‘guardians of the vision.’