Patient and Public Involvement (PPI) is an essential business requirement and without deep roots in the community and a responsive commissioning process, plans are more likely to unravel and difficult decisions will become more difficult to take. Listening and responding Commissioners and providers need to be good at both listening and responding. In general, the NHS is good at listening to both patients and the public. But, in general, the NHS remains poor at responding to the needs and wants of individuals and communities. The basis for effective PPI is in being a responsive organisation: having systems and a culture that reach out to the populations served and allowing for the alteration of commissioning plans to meet their expressed needs.