Using the 4Pi National Involvement Standards

Last year I wrote a blog about anxiety in relation to Patient and Public Engagement and Involvement (PPEI). This resonates with many people I speak with. It’s a common emotion that can be difficult to name as the root of behaviour. It’s a natural response to uncertainty and the unknown and in this blog I’ll bring in an aspect of our PPEI work which I think can help begin address this underlying emotion and offer a way out of the tokenistic conversations.

About 3 years ago we became aware of the 4Pi National Involvement Standards developed through the National Involvement Partnership (NIP) led by the National Survivor User Network, funded by the Department of Health and Social Care and published in January 2015. The standards set out a framework which draws on the experience of service users in mental health services, published research, policy documents and legal frameworks to address inequality and discrimination. The standards are written in plain English, are attractively designed and combine practical ideas with explanations of why each of the standards are important and connected. Here they are:


This addresses how people want to work together. Do they share the same values? What’s important in this relationship?


Why do we want to work together? What do we want to achieve? This includes the purpose of the activity and the purpose of the roles of each individual who will be involved.


This focuses on who needs to be involved. Who will be directly impacted by the activity and how can they be involved in decision – making at all levels.


This attends to how to co-design and develop the process of involvement that is appropriate and proportionate to the task and which reflects what is meaningful and acceptable to those who will be actively involved. When and where will we carry out this activity?


Importantly, how do we understand the difference involvement makes? This can include the impact of the process itself, how people change through being involved and the impact of any outputs which are produced. What have we learned? The ‘so what’?

These standards appealed to us precisely because they offer a framework within which to have conversations about involvement that start to uncover where people may be more or less confident about what they are doing. This can be applied to service users, patients and carers who want to make a difference but who are unsure where to start and how they want to play an active role. It can help health professionals, clinicians, managers and researchers to tease out what they want to achieve working with service users, patients and carers.

It doesn’t matter which standard you start with.  In my experience initiating a conversation using 4Pi helps people understand more clearly what they want to do and in doing so provides permission to ask questions and test out ideas.  PPEI is a process of mutual learning for improvement, not an end in itself. 4Pi offers a way, not necessarily the only way to begin a more meaningful and less anxiety provoking experience.


To read more about how we have used 4Pi in practice, read the Service user engagement in quality improvement: applying the national involvement standards paper.

For more information, contact Rachel Matthews, ,telephone 020 331 53047.