Exploring commissioners, service providers and treatment service users' views about involvement in public health commissioning :a case study of local alcohol services

Abstract

This research investigates stakeholders’ knowledge of, and experience in, public health commissioning of alcohol services in North East England. Public health commissioning has undergone significant transformation during the course of this research. However, health policies and legislation have consistently supported the concept of stakeholder involvement in all stages of the commissioning process. Alcohol is an issue that spans health and wider public health services. On a global level alcohol is the fifth leading cause of morbidity and premature death and is causally linked to over 60 diseases. The growing recognition of both the harmful effects of excessive alcohol consumption, and the rising associated costs have made it a major public health priority in recent years, both internationally and within the UK. The North East has one of the highest prevalence rates for excessive drinking and alcohol related health inequalities. A qualitative case study approach was adopted, focussing on the commissioning of alcohol services in a specific local area. Semi structured interviews and focus groups were used to obtain the perspectives of commissioners, alcohol service providers, general practitioners and alcohol service users. Collectively, all study participants were stakeholders in the commissioning process. However, understanding about what constituted stakeholder involvement was not consistent among participants and often definitions were limited to public and patient consultation. Stakeholder participation was often viewed as an end point rather than a process, the implication being that ‘any involvement was good involvement’. Furthermore, participatory approaches did little to ensure that stakeholder involvement actually influenced planning and decision making. Arnstein’s Ladder of participation was used to examine the extent of stakeholder involvement and a revised ladder is proposed. For many stakeholders, contribution to commissioning decisions seemed to occur at a tokenistic level, resulting in minimal motivation for at least some stakeholders to become involved in the commissioning process.