NHS Boards across Scotland (in common with the situation across the UK) are currently witnessing a massive change in the demographics of their constituencies, rapid advances in medical technology and increased budgetary constraints. At the same time, however, they are being asked to undertake a ‘transformational’ approach to health and social care provision in their areas (something that will require the significant reorganisation and rationalisation of service) and also involve the public in this process.
It is no wonder, therefore, that many Boards are grappling with the question of when, where, and how to best engage the wider public in this process. Involve’s recent experience with two Scottish NHS Boards offers some important insights and solutions.
Involve was invited by the Scottish Government to support NHS Lanarkshire and NHS Tayside to engage the public in the development of their Integrated Clinical Strategies.
It was evident when we began to work with the Trusts that their obligation to involve the wider public in health and social care planning is creating a pressure to consult very widely. This seems to be the case whether or not what the public tells the trusts will be able to influence the decisions being made. The challenge for Boards and management is how to integrate public perspectives about service redesign with evidence about clinical best practice, organisational efficiency and patient safety, particularly in the context of local politics.
We determined that central to what the Trusts needed was an opportunity to develop their skills in recognising and articulating:
- At what stages of the strategic development process the contribution of the wider public is most valuable (to complement consultations with staff, existing service users and clinical experts)? And, how it could have an impact on the planning process?
- How can wider public engagement add new information that could inform decision making about service transformation?
- What is already known about public views? Where has substantive engagement already taken place with those most affected by the decisions e.g. direct service users and their families?
- When it is reasonable to communicate to the public that, while certain decisions have already been made (on the basis of substantive evidence), now is the right moment for the public to help shape the proposed service redesign?
Engagement is most effective when it is delivered by those who have to act on what the public say. In practice therefore, rather than delivering engagement for either of these NHS Trusts, we operated in a mentoring and advisory role. This included providing:
- Interactive workshops and presentations to board members and senior leaders to help inform their wider thinking on effective public engagement strategies;
- Support to senior leaders and public engagement leads to develop operational plans for delivering effective engagement strategies;
- Advice on how to choose the correct methodologies to deliver the engagement strategy;
- Support to design consultation questions able to deliver robust evidence useful for informing the development local strategies; and
- Training and mentoring for managers and frontline staff responsible for delivering workshops, meetings and engagement processes, including senior clinical staff who would be the public face of the consultations.
At the heart of all of our work was supporting decision makers to identify the points in the service redesign process when involving the public would contribute the most to the difficult decisions that have to be made to ensure our health and social care systems are fit for the 21st century. This is not an easy process, but doing it in a planned, considered and focused way should help build trust that decision makers in the health and social care system are serious about listening to the public and avoid unnecessary conflict.