Stage 2: Working with the public to plan and transform services

Much of this work will be about developing overall strategies and plans for transforming and/or integrating services and can involve

• formal consultation (under statutory duties)
• informal engagement about overall service reconfiguration in a local patch or about decommissioning particular services

The benefits include:

• decisions about services better reflecting local aspirations
• more robust and sustainable commissioning priorities
• more realistic operational plans.

Trust in leaders and public confidence will be able to develop more effectively when there is a shared understanding of expectations and limitations. In addition, an honesty about tensions and clarity about areas where there is consensus, will help to build the relationship between commissioners and those members of the public engaging with health services.

Building the capacity of local citizens and patient leaders to participate in decisions about resources is crucial.  Innovative approaches like participatory budgeting, where citizens have power to take decisions, rather than merely inform them, offer another way for the future.

Things to think about

Build trust and confidence in relationships and partnerships

• Provide clear information with local people and be honest with them about what can change and what cannot change as a result of engagement.
• During service improvement projects, some changes may involve difficult decisions, such as the trade-off between the location of care and the quality of that care, by engaging people in these tough decisions, commissioners are able to test scenarios and potential reactions to decisions.
• Work with the local authority, local councillors and Overview and Scrutiny Committee – all are critical in overseeing decisions that affect the way resources are spent.
• Work with those who may be affected by decisions on changes. This includes local providers, including hospitals and social care providers. It also includes potential providers (e.g. local social enterprises, the voluntary sector, private sector).

Consider particular methodologies that aid complex decision-making

• Learn from good practice in local authorities and other partner agencies.
• Make sure the views of seldom heard groups are incorporated into decision making.
• Consider approaches that ensure a cross-section of local residents are involved.
• Consider deliberative methods (i.e. that allow people to deliberate on complex information and that allow people to rank priorities). 

Underpin engagement with clear communication strategies

• Engage with stakeholders (including the media and politicians) openly about decision making process and reasons for decisions:
• Work closely with local communication leaders and partners (e.g. in commissioning support organisations). Provide support for leaders who will often have to make and/or defend difficult decisions in public.
• Find out early whether the changes being envisaged need to go through formal (i.e. statutory) consultation processes regarding options available for change. Be clear about the similarities and differences between formal consultation and ongoing or informal engagement 

Build on existing engagement processes and outcomes

• Ensure outcomes from needs assessment and community aspirations work feeds into strategic planning and decisions about priorities. You may need to go back and check what work has been done.
• Use this stage of the cycle to promote and develop ongoing mechanisms for dialogue with local people.
• Potential changes to services can be revealed through engaging patients in the redesign of pathways (stage three). In this case, the ‘flow’ of the cycle can be seen as anti-clockwise! – but better engagement with the public is about prioritising service delivery across all services being commissioned, and engagement with patients about service redesign, can still be seen as different workstreams within the engagement cycle.

Support patient leaders

• Local partnership boards (such as Health and Wellbeing Board) that make decisions on strategies and plans across localities often rely on ‘representatives’ from the community. These people require clarity of role and responsibilities, practical support and learning opportunities.
• Do not rely solely on lay representatives on advisory or partnership boards as sources of expertise or to ‘rubberstamp’ decisions. They should act as ’critical friends’ and ‘community channels’, able to provide strategic advice from the very beginning of planning. Working with lay members and patient representatives is a useful ‘Smart Guide’ on this subject. For more information on patient leaders, go to the Centre for Patient Leadership.