You are here: HomeEducational ResourcesSupport GuideAppendices → Appendix A12

Educational Resources: Appendices

Appendix A12

Issues to consider when appointing lay members

Dr Paul Gerrish, Clinical Ethics Group, Sheffield Teaching Hospitals NHS Trust

Appointment of lay members to Clinical Ethics Group

Appointment of lay representatives is sometimes regarded as an important aspect of membership of a Clinical Ethics Group (CEG) and also in line with the current approach of the NHS for greater lay or patient involvement. Identifying and appointing lay appointments is not always easy and the following is aimed at giving some guidance to the process. There is no standard solution and each CEG will need to consider what is appropriate for the local situation; however it is important to identify a clear strategy at the outset.

Does the Trust already have a lay appointment process?

Most NHS Trusts now have started to have lay / patient involvement in the management structure e.g. of Directorates and there may well may a process that has been used locally before, although this may need to be significantly adapted as the needs of the CEG may vary from previous appointments.

What is meant by lay?

There should be clear agreement at the outset of what is meant by a lay member, what is his/her function and what he / she is expected to contribute. The expected contribution is certainly something prospective candidates will raise, as there will often be some concern as to what they can contribute. The definition of “lay” is not as simple as it may appear but needs early definition as this will need to be used in both job specification and short listing. One aspect that is easy to define is the person should not be an employee of the Trust but what about an ex-employee? Is a nurse who has not practiced for significant time “lay”? Is somebody who has been an LREC lay member for 10 years still a lay representative?

How many appointments?

In what may be considered a potentially intimidating environment there is much to be said for having at least two lay members to minimise any effects of isolation.

Routes for obtaining applicants?

The appropriate route for obtaining applicants will be very much dependant on what has been agreed as a “lay” representative. There may well be many people who already are involved within the local Trust in some format. The advantage of this route is that the members may well be a known quantity but the disadvantage is that they may already represent particular constituencies, it also may exclude excellent candidates to which ethics may be applicable but who are less interested in other aspects of voluntary involvement. In any approach adopted the Trust will need to be reassured it meets equal opportunity issues and formal advertisement and appointments in open competition for the posts has much to commend it. An advert in the public notice section of the appropriate local paper will often produce a number of good quality candidates, especially if this coincides with a small piece that papers are often happy to run about wider community involvement in difficult ethical decisions.

Advert example

As part of the Trust’s Patient and Public involvement strategy and action plan we are looking to appoint members of the public as lay representatives to the Clinical Ethics Group. This group is a recently formed group to advise ad support the Trust and it’s staff on ethical issues.

We are looking for somebody who has a broad interest in ethical issues and who will be able to provide a balanced view from a lay perspective. Clinical qualifications or experience re not required but good team working is important for this innovative and challenging appointment. Applicants would be required to attend monthly meetings, usually in the evenings. Training and support will be provided. Although the post is voluntary reasonable related travel expenses will be paid.

The advert should contain a clear contact point for interested individuals to make enquiries and the information pack sent to individuals should contain a detailed description of what the CEG is, who is on it and broadly what its functions are; this is best written by the CEG.

The practicalities of the applications

The appointment procedure should follow the standard approach for most NHS appointments; this will have the advantage of meeting equal opportunity requirements. A detailed job description along with a detailed personal specification will help ensure that short listed candidates are suitable; the personal specification can also form the basis for the assessment criteria at interview. Categories such as team working, communication, conceptual thought etc. may offer opportunities to explore the skills which a CEG may require.

The appointment process

It should be remembered through the whole process these are volunteers and everything should be done to make the process as stress free as possible.

Many Trusts will be happy for the CEG to handle the process, often with a personnel representative present to ensure that procedures are followed. Following short listing, which should involve as many of the CEG as possible it is useful to invite the short listed candidates to an informal meeting with perhaps two members of the CEG to find out more detail about what Clinical Ethics is and how this works. Most will not know how or what a CEG is. A short presentation of what a CEG is, how they are developing, who the members are, how it functions, the national picture etc. if useful, as this will provide a framework for questions and discussion. It is important to state any downside to the CEG at this time e.g. work may be spasmodic, it may be embryonic etc. and what it is not e.g. research ethics.
The interview process needs some thought and planning, a traditional interview panel is probably not appropriate as this may seem intimidating and may not offer an opportunity to easily explore important areas. An alternative model is of three “mini” interviews each perhaps of 20 minutes, with perhaps 2 CEG members for each interview and the candidates rotating around with relevant gaps. One interview may cover traditional areas such as experience, CV etc. and the other two each deal with an ethical discussion, the scenarios being given to the candidates on arrival.

Example Scenarios

1. Mr Z made a written advanced directive 5 years ago. He suffers from a chronic chest disease and the advanced statement provides that if he is admitted in respiratory failure he must not be ventilated. The advanced directive is placed in his notes.

Mr Z is brought into A&E in respiratory failure and is intermittently confused due to low oxygen levels in his blood. He says that he wants “everything done” in order to save him. The doctor in charge of his care decides to ventilate him.

Q1. What are the relevant ethical issues to consider?

Q2. Can the doctor justify treating the patient?

2. Mr J is a 55 year old man with advanced lung cancer. He has had chemotherapy to which he initially responded, but has relapsed. In discussions with his consultant Mr J expresses a belief that he may respond to further treatment. The consensus amongst the medical team is that Mr J has only a few weeks left to live and that should he suffer a cardiac arrest whilst on the ward any attempts to resuscitate him would be futile. Mr J says he wants everything done to him including resuscitation.

Q1. Should Mr J be resuscitated in the event of a cardiac arrest?

Q2. What are the ethical issues and what other things could the medical team do to help this patient?

After the decision is made it is important to feedback to unsuccessful candidates, again remembering these are volunteers.

Post appointment practicalities

References will need to be taken up and candidates will also need to be warned that many Trusts will require clearance by Criminal Records Bureau. The candidates will need to be offered some form of contract which should include an agreement in relation to confidentiality and this will also mean that they will usually have appropriate indemnity for Trust employees (even of a voluntary nature). Initially a contract of a year may be useful as this allows both sides to avoid long term unsuitable appointments. They may also need Occupational Health clearance and should be provided with the standard ID and access to library resources etc. It may be helpful to explain that the pace of NHS personnel departments in processing these practicalities may not be what is experienced in the private sector. It is important to make lay members feel part of the Trust, especially as many existing CEG members may well be senior experienced members of the organisation.

Travel and support expense should be offered and it is important to consider a budget to offer some training e.g. the Ethox workshop.

Involvement in meetings

A mentor for lay members may be useful initially to ensure that they settle in and the chair of the meeting has a responsibility to ensure that any technical medical terms are tactfully explained to ensure that the lay members have adequate factual knowledge to contribute to the discussion. During the first year it is useful to have some of review to assess how the appointments are progressing.

Lay appointments by open application may seem daunting but there are also significant rewards providing the process is handled carefully. There are many lay members who can make an important contribution, often offering a well thought challenging viewpoint on difficult subjects.

Copyright of Appendix A12 is held by Clinical Ethics Group Sheffield Teaching Hospitals

Dr Paul Gerrish
Chairman, Clinical Ethics Group Sheffield Teaching Hospitals