Patient and public advocates in health and social care would make bloody good pilots.

Year after year we ask them to help successfully land projects and initiatives in ‘fuel critical’ situations. They are having to carry more, and further. But for how much longer before someone has to declare a real fuel emergency? And a serious one at that.

When did we begin to run public involvement in health on principles and values more suited to Ryanair?

Funding has been a perennial problem in public involvement and continues to be so. It is the proverbial elephant in the room – or should I say jumbo in the control tower – and we need to talk about it. In an adult way.

Looking at public involvement in research we have a rather curious state of affairs occurring. On the one hand there are institutions and projects allocating around 10% of their budget to public involvement activities. That would seem a good benchmark. On the other, researchers are generally under-estimating and therefore undervaluing costs. Generally, because public involvement is not appearing as a budget line in people’s business plans it is extremely vulnerable. Sometimes it is hidden in the communications budget and we all knows what that means.

Where discussion of these matters does occur I find that patients and the public have more common sense than anyone else around the table. After all, unlike the Prof or consultant who drove to the meeting in their Lexus, they had to think hard about how they would meet the costs of the bus fare. They know money is tight. They do not expect riches. But nor should they be asked to commit to projects running on vapour.

So what to do? I think there are a number of ways in which we might tackle it together. In research at least.

It would be good to know what is being spent, where and how. I suspect it’s possibly more than we think, probably less than is needed and likely not in the right places. Knowing this is helpful if we want to be more strategic about how we fund public involvement in the future.

All researchers submitting research applications should be using the new INVOLVE costing template for public involvement. And reviewers should be looking to see that they have.

Leaders have a responsibility to find and allocate resources appropriately. Good leaders recognise that the patient voice is strategically important. So we must constantly challenge the notions on which their approach to its funding is based. Does it hold water?

As lay members of projects we should be asking more questions about how the budget is being spent. And helping to find ways of spending money better.

And we must resist the temptation for organisations to dress up communications or marketing as public involvement. Public involvement is about design and effectiveness and quality. Not PR.

I don’t know about you but I’d quite like our health service to be the flag carrier for public involvement in society.