Promoting collaboration between users and health professionals : the experience of Maternity Services Liaison Committees
The inclusion of user representatives in committees and groups alongside health professionals is one of several ways of involving users in the planning and monitoring of health services. However, there have been reports of barriers to the involvement of users in such groups and very little is understood about the processes that take place and the factors which promote effectiveness. This study addresses this shortfall in relation to a specific type of user involvement forum in maternity services - the Maternity Services Liaison Committee (MSLC). MSLCs are attached to hospital trusts or health authorities and bring together health professionals and local users to plan and monitor local maternity services. The study is a qualitative assessment of a sample of eight MSLCs using a combination of observation and interview methods. It investigates the structure and work of MSLCs, the way members participate, and the meaning and value of MSLCs to members, in order to establish the effectiveness of MSLCs and potential for improvement. The committees were found to have a limited direct impact on maternity services. Arguably their greatest influence was in promoting collaboration between constituent groups and the accountability of health professionals. The impact of MSLCs and the extent to which users were involved were limited by factors to do with the structure and processes of the committees. MSLCs could be improved to some extent through changes to these, but improvement beyond a certain point would be difficult to achieve because the problems reflect fundamental issues to do with the structure of the health service and the way MSLCs were set up, the high degree of professional control over MSLC activity and health care in general, and characteristics of users. These findings have implications for the effectiveness of other forums for user involvement presently being implemented in the health service.