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Is fear of public engagement holding the NHS back?

By Our Chair: Jane Mordue on 26/10/16

Sustainability and Transformation Plans could fundamentally change the way the NHS works. With the first plans now being published our Interim Chair calls on the NHS to work hand-in-hand with communities to get these reforms right

This week sees the first local Sustainability and Transformation Plans (STPs) being published across England.

What are STPs?

Sustainability and Transformation Plans are a new approach to help ensure that health and care services are planned around the needs of local people rather than around individual organisations.

NHS England identified 44 areas across the country and asked them to develop a plan, that will run until 2020/21, showing how local services will work together to improve the quality of care, their population’s health and wellbeing and NHS finances. The plans and are key to delivering the Five Year Forward View.

Birmingham, and North Central London have already published their plans and others will soon follow.

Opportunity to involve people in the big decisions ahead

It’s no secret that our hospitals, GP surgeries and care homes face big challenges.

More of us are living longer, many of us coping with multiple health issues, and the cost of care is rising rapidly. 

Yet when professionals and policy makers sit down to talk about how things might be done differently there is often a strong sense of fear that whatever they propose they will face an army of activists campaigning to stop them.

This fear can then translate into people being brought in only at the very end of the process to simply ‘rubber stamp’ over-simplified plans. 

Those affected are left with little understanding of the reasons for change, unclear as to how the plans have been put together and feeling ignored.

Understandably this fuels the fires of opposition, but it also means the NHS misses out on a golden opportunity to use feedback to make the right decisions first time.  

Ultimately it creates a vicious circle where change is often a slow and needlessly painful process that leaves communities feeling betrayed and creating unnecessary barriers to further change in the future.   


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Public engagement is nothing to fear

Our annual report to Parliament, published last week, sets out what the Healthwatch network has heard from more than half a million patients and members of the public over the last year.

One of the strongest themes that comes through is that people both recognise the current strain on the system and want to do their bit to help.

Patients tell us they are willing to try doing things differently, offering up very practical and pragmatic suggestions on how things can be improved without breaking the bank.

Speaking with patients can also question a whole range of preconceptions in a way that is helpful to health and care professionals, giving valuable evidence and insight into how people really see and use services.  

Take for example, the comments we have gathered from older people which challenge the idea that they might be reluctant to make use of new technology such as skype appointments and online booking. If anything they are often the eager early adopters as the ones with the most to benefit from the increased flexibility in care.

Breaking the cycle

It is true to say that the health and social care sector has been slow to learn some of the valuable lessons of other sectors when it comes to managing change. 

However, we are now seeing the publication of the first local plans that could fundamentally change the way the NHS works across England.  

Some argue that the NHS is already on the back foot with regards public involvement in this latest round of reforms.

But this attitude will not help break the cycle or ensure the NHS makes the right decisions.

It is crucial that early criticism doesn’t result in local decision makers retreating from their duty to talk with the public and missing out on the chance to make the proposals actually fit both the wants and needs of consumers.

NHS England has recognised this and has issued strong new guidance reiterating how important it is that local areas work with their communities to help make the big decisions ahead. 


What should communities expect?

It is important to note that consultations are not the only point at which communities should be involved. Gathering people’s experiences and views is a vital part of understanding the context for change, however when formal consultation on NHS changes starts it is important that:

  1. The case for change is clearly set out so that people can understand both the current situation and the reasons things might need to be done differently.
  2. Work is undertaken with patients and the wider public to jointly design and discuss possible solutions.
  3. The impact on different groups of people must is fully assessed and specific engagement undertaken with them
  4. The community is given adequate time to consider the proposals on the table and provide feedback.    
  5. When the final plans are agreed and published that those in charge of the changes show how they have considered the feedback they have received and the difference this has made to their plans.

These tips are based on guidance from Healthwatch Kent.


Time to get involved

Local Healthwatch across the country are doing their bit, working alongside the voluntary sector to provide the NHS with advice on how to effectively involve communities and to help cut through some of the impenetrable language often used in public consultations.

We are also sharing what we have heard from the hundreds of thousands of conversations we have had with people, providing a foundation of current patient experience and aspirations for the future.

However, this is a conversation that needs as many of us as possible to get involved. People often talk about the NHS as a national treasure, so when health leaders offer an opportunity to have our say in the process of deciding its future we need people to seize it.

Whilst the focus for now will undoubtedly be on the plans being published throughout the autumn, we also need to start thinking more long term and treating the STPs for what they really are - the latest instalment in a change process that is likely to last many years.

The real prize here is to capitalise on the system’s need for public input to reset the relationship between services and those who use them and show that when the NHS works together with local people the result is better care and support.


Healthwatch can help

If you are a health or social care professional, your local Healthwatch can help you find out what people think of services in your area. If you are a member of the public and want to share your experience to help shape health and care services of the future, get in touch with your local Healthwatch.  

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