For years there has been the expectation that people will give their time for free to help health organisations to make decisions about how to improve, what services to offer and whether they are offering a high quality service.

We are now starting to have a split, with some organisations offering payment for certain activities, others deciding that they will not offer payments at all, and a raft of organisations in-between wondering what on earth to do.

The systems needed to offer payments for involvement activities are starting to formalise involvement activity and have the potential to create a more business-like approach, and this, for me, is the outcome that I am most excited about. You need a budget to pay people, an audit trail and a very clear sense of purpose. Paying people requires the service to seriously consider why they are doing a particular activity and what they hope to get out of it. The quality of insight, listening to a wider range of voices and being as inclusive as possible becomes all the more important.

Imagine you are an organisation who would like to support a local voluntary sector organisation to deliver service-user-led involvement activities, or you might be hosting a co-design event and offering payment to people taking part – both will require some kind of procurement or payment system. Perhaps by having real money attached to this kind of activity ensures that it won’t be a tick-box exercise. You are not going to spend hundreds of pounds on getting insight that you then won’t use are you?

There is much debate about the power differential that exists between those outside and those inside the system and the impact of paying people on this relationship. For instance, when you have members of the public, who use services, working alongside people who work in the system, making key decisions and co-developing services, can a payment offer start to balance out this difference? Offering payment has implications for the relationship an organisation has with the people it involves, when there is money involved the relationship changes. From what I have observed so far, it does not appear, as some would have expected, that views are compromised, as far as I can tell, it’s more that there is a change in expectation on both sides. We don’t yet know the full impact of this change in dynamic and it will be interesting to explore the implications of this over the next few years.

This is a tricky area to navigate. There will always be people who are more comfortable volunteering their time and there is evidence that this is, if managed well, a fulfilling activity that can lead to all kinds of benefits for the person involved, as well as the organisation they volunteer for. Offering payments and other kinds of support such as reimbursement for travel, or carers, as well as other development opportunities can be a real incentive and there is evidence that it widens out the kinds of people that might want to get involved both in terms of background, lifestyle and age. There is a great deal of evidence that overcoming financial barriers can make a real difference when trying to be more inclusive.

More than anything, I hope that the introduction of payment will ensure that we end up with well-planned and focused activities that are properly evaluated and the differences that participants’ insights and ideas have made documented and shared.

Top Tips

Deciding to offer payments and reimbursements must be well planned and executed and I would recommend:

Service user led involvement – there are organisations out there that can help, so why not commission them to support/deliver your activities? We have made the assumption that involvement is easy and that anyone can do it, but this is not the case. Involving people from different walks of life who have had health experiences good and bad is a complex and highly skilled endeavour.

Copy – find examples of how others are doing this rather than trying to start from scratch (National Institute Health Research, Health Education England and NHS England have useful policies which we followed in the development of the Imperial College Health Partners principles).

Involve your administrative and procurement teams very early on – they bear the brunt of this change and need to be part of the planning. They are also very useful in terms of what is and isn’t possible in your organisation.

Be mindful of creating competition – there will be organisations that just can’t afford to pay and I have already heard of people choosing to help one organisation over another because of the payment offer. If you can do this in partnership across a geographical area and across health and social care, all the better.

Be transparent – once your policy is in place it needs to be shared far and wide and people who work in your organisation need to understand how to use it.

Plan, plan, plan – everything needs to be clear between the service and the people being involved before an event or activity takes place. Systems and processed need to be carefully thought through.

Learn as you go – this is new territory for us all and we will make mistakes, so build in regular reviews and flexibility to change what isn’t working.