Background remarks

Community engagement is as important for values-based practice as the process of agreeing or dissenting about the values themselves. Only by understanding values will it be possible to engage in a proper discussion about values and get to a point of dissensus. Knowing the values and aspirations of patients and service users is a critical feature of the process. Unfortunately, in the past, commissioners have not often acted responsibly to truly understand values in a way that enables a genuine debate. This is made more difficult by the requirements of the ‘strong’ or ‘thick’ system of values-based understanding.

Learning the values of one individual or a small group of defined service users is relatively easy; obtaining a composite set of values from sets of users across an area, supplemented by the values of groups of professional commissioning staff, Health and Well-being Boards, and the public, will be immensely more difficult. Many GPs involved in commissioning are likely to be impatient to get some results, especially because of the delays in legislation, but also because of the financial situation that requires a ‘decent minimum’ set of service responses. However, in its way, this offers scope for a wider process that can provide a set of values to ensure all opportunities for values-based commissioning are taken.