From guidance to governance: A perspective review of embedding public and patient involvement within an institutional research ethics committee.

<ns3:p>Background Public and Patient Involvement (PPI) is now a central component of health and social care research. Despite widespread endorsement, the governance structures overseeing research such as institutional research ethics committees (RECs) have been slower to incorporate PPI in meaningful ways. The Irish PPI Ignite Network has undertaken a programme of work to clarify ethical considerations around PPI and to support inclusion of public contributors in REC governance. This paper reflects on the implementation of PPI membership within a university REC and examines whether expectations established by national guidance aligned with lived experience. Methods This perspective review draws on three linked initiatives undertaken by the PPI Ignite Network: (1) development of a national statement clarifying when REC approval is required for PPI, (2) co-produced guidance for sustaining PPI membership on RECs, and (3) real-world implementation of PPI membership on a university institutional REC. Reflexive narrative accounts from a PPI coordinator and a PPI contributor after more than one year of REC membership were analysed using interpretive thematic analysis. Results Three overarching themes were shared: (1) legitimacy without clarity of impact, (2) learning and cultural translation, and (3) structural readiness versus relational readiness. The REC was welcoming and operationally accessible, but influence on decisions was difficult to perceive. Membership required extended acclimatisation, and ethical deliberation often depended on tacit institutional knowledge. Guidance accurately predicted barriers around training, confidence, and language but underestimated the time needed for integration and the complexity of institutional governance cultures. Conclusions Embedding PPI within RECs is feasible and beneficial, but implementation is developmental rather than procedural. Guidance documents help institutions prepare structurally, yet successful integration depends on relational and cultural change. PPI membership should be considered a long-term governance intervention rather than a discrete inclusion initiative. Evaluation frameworks should shift from measuring decision impact to assessing deliberative quality and ethical reflexivity.</ns3:p>