Transformation Directorate

Representation in decision making and governance

Whether they are being involved as users, beneficiaries or active citizens, people and communities will have a view on the strategic issues for your product or service. You will therefore benefit from ensuring that people and communities are represented in your governance structures.

Examples of strategic issues people and communities can help with include:

  • identifying benefits and disbenefits (these may be different for different communities)
  • setting relative priorities
  • determining whether the delivery approach is sound
  • setting the product or service’s proposed aims

Planning for decision-making and governance

It is important to plan for how you will include people and communities in your decision-making structures. For example, will you:

  • require someone for a specific period (it is usually best to start with some time commitment, which can always be reviewed as the programme develops)?
  • need someone with expertise or lived experience?
  • invite people to join your existing governance structure or take issues to outside groups to discuss?

Think of the power dynamics within your governance structure and aim for people to participate (at a minimum) in pairs.

Prepare training, inductions and resources for people before they attend events or meetings, to ensure they are prepared and comfortable for what they will undertake.

Who to involve

Follow the principles for working with people and communities and think about who you are involving in your governance and decision-making structures. For example, you may look to involve people with lived experience of the issue you are exploring, or you may want to involve people with a specific experience of the healthcare system. Make this clear in your planning.

How to involve people

You will also want to consider how people can get involved, and what the application process might look like. You could choose to approach groups directly, and there are many voluntary, community and social enterprise (VCSE) groups that can help with this. Or you may choose to open applications and ask people to proactively reach out. Think about how formal or informal these processes are, as this will impact who you will reach.

People can be involved in decision making in a number of ways, such as responding to surveys, attending one-off events, and participating in regular boards or committees. It can also be important to go to where people are, for example piggybacking community events and entering community spaces, rather than expecting people to come to you. NHS England has developed a patient and public voice partners policy, which outlines how this approach can work. We’d also advise that you review the policy on reimbursing expenses and paying involvement payments.

NHS England also has specific guidance on how to recruit patient voice representatives (this is only accessible to those with an NHS England login), including considerations for remuneration, induction and support, and terms of office on boards.

Please note that if you intend to involve a level 4 PPV partner, you will need to follow this recruitment process.

Example: People and community representation in governance structures - electronic referral service

The electronic referral service optimisation and transformation programme is the national programme to:

  • digitise the patient referral pathways
  • ensure the facilitation of advice and guidance
  • enable services to refer, book, and manage appointments efficiently and effectively

As part of the programme’s governance structure, a steering committee and clinical council meets monthly. Three patient, public voice partners sit on the steering committee and clinical council, supporting the programme by ensuring that the voice of people and communities are considered in the decision-making process.


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