Witten by Department PPI Manager, Polly Kerr, and Dr Stan Papoulias, Research fellow at Kings College London.

In 2022, one of us (Polly) brought a team of people together to develop a ‘competencies framework’ – a structured outline of the skills, knowledge and behaviours needed for a role – that we hoped would answer a need: over the years we have seen the PPIE (Patient and Public Involvement and Engagement) workforce grow and expand, yet we felt that much of what we do is still not well understood and our roles do not fit within a recognised career pathway.

We produced this framework by gathering together what our colleagues told us about their skills, experience and challenges, and especially by listening to their shared concerns about the lack of career progression in the role. Our hope was that this framework might lay the foundations for a better understanding of involvement and engagement work as complex and skilled, with an integral role to play in the impact and success of research.

What our colleagues told us

In November 2024, the then NIHR Centre for Engagement and Dissemination hosted a workshop for PPIE staff so that our colleagues could tell us what they thought of the framework. This included whether changes were needed, whether it would work in their setting and, importantly, whether it could have any unintended consequences.

Our colleagues voted with their (virtual) feet and filled nine breakout rooms to share their views. Their numerous responses were thoughtful and involved, so, to honour their integrity, we subsequently commissioned independent survivor researcher (a researcher with lived experience of mental health services) Alison Faulkner to produce a summary and analysis, an edited version of which is published here (see separate document). This is what we learned.

Our colleagues broadly shared an appreciation for this framework in that its very existence could raise the profile of PPIE staff and potentially improve their status, by clearly laying out the extensive skills and responsibilities required for the role. They told us that the framework could:

• help inform job descriptions for PPIE posts
• facilitate the planning and resourcing for such roles within organisations and in applications for funding
• help identify training and support needs of the PPIE workforce
• provide a useful set of pointers for appraisals and career development.

Our colleagues also helpfully pointed out that some dimensions of the job were missing or not emphasised enough: research skills, though present, languished under a ‘technical’ heading; community engagement only made occasional appearances; expertise in Equity, Diversity, and Inclusion (EDI) featured as a distinct, itemised skill rather than being woven into all aspects of the framework; facilitation, relationship building and all the relational work which is such a large part of the role needed more weight.

Beyond the framework

What struck us repeatedly as we read through these suggestions was that our colleagues, in telling us how we could improve the framework, were also saying that their needs extended beyond what such a framework could provide:

• Could a framework which listed all the competencies that contribute to relationship building and skilful facilitation combat the routine devaluation of these aptitudes as ‘soft skills’?
• Could a more holistic emphasis on EDI make it easier to enable inclusive research?
• Could a single framework, no matter how flexible, fit the hiring regulations and requirements of institutions as varied as universities, NHS Trusts and charities?
• Could it fit the needs of people with both professional services and academic contracts?

The wide range and richness of the feedback we received shows us that the framework responds to a real need and could be helpful in improving the status of the workforce. However, our colleagues were also telling us that the framework alone cannot raise the profile of PPIE staff. For that to happen it would need to be embedded within a broader institutional recognition of PPIE work and those who undertake it.

Spelling out the complexity, richness and multiplicity of skills required for the role may not be enough to persuade budget holders to provide adequate funding and resources. Even if no single individual could reasonably be expected to have all the skills articulated in the framework, it may still be the case that only one person is hired for the job. And, without broader institutional buy-in, the framework might in fact make it easier to undervalue PPIE, with people being employed at the lowest level and then not supported to develop.

Our colleagues’ input can indeed help us revise and strengthen the framework. However, their comments also give us pause. For sure, we can refine, tinker, rephrase, add missing competencies. But to do this we need to know: would improving the framework lead to proper recognition and security of the role, career development opportunities and consistency in job roles? Where this work goes next is dependent on a number of factors, not least support from funders who are making increasing demands of PPIE and the staff supporting these activities.

A call to funders

We are fully supportive of the NIHR Strategic Commitments for Public Partnerships, in particular the ambition to ‘strengthen capacity and capability’ for which a motivated and supported PPIE workforce is surely crucial. The Medical Research Council published its public partnerships strategy in 2024 and the Health Research Authority’s Shared Commitment to Public Involvement celebrated its third anniversary earlier this year – but these too cannot be delivered without a full recognition of the labour of PPIE and an integration of both public contributors and PPIE staff as equal partners in research.

We call on all funders of health and social care research to consider whether our framework can be adopted and recommended widely as a method of acknowledging and endorsing PPIE staff in all sectors. We also ask funders to acknowledge that a full integration of PPIE in research settings requires a decisive transformation of such environments, a process for which the recognition of PPIE work is only the beginning.

Background to the project and relevant links

Managing difficult situations in PPI

PPI workforce career recognition and training and addendum

The hidden costs of patient and public involvement: a necessary conversation

The value of PPIE labour – a webcomic