Top Ten Tips for public involvement in health and wellbeing strategies
OK, perhaps it’s more ‘aspects of engagement to think about and do your best to follow the good practice of when producing your Joint Health and Wellbeing Strategy (JHWS), so as to make the exercise as effective and worthwhile as possible, within the limited resources available’. But let’s face it, that’s not such a snappy title. Anyway, hope it will still be useful. Here are the ten things.
- Start early and engage throughout
It’s very tempting to try and get things sorted before going out to the public. Hopefully most people would recognise that only consulting on a final draft of the strategy is insufficient. But who wouldn’t want to do some research, get their thoughts straight and design the process for developing the strategy before starting to engage? Despite the temptation, this risks missing some of the most valuable contributions you may get. Ideas at the very start could alter the entire trajectory of developing the strategy.
People will also feel more part of the process if included from the outset. Besides being good practice, it is also in line with the statutory guidance on JHWSs, which says involving Healthwatch and the local community “should be continuous” (Ref (1), p.12).
- Consider adopting a co-produced approach
This is ‘consider’ rather than ‘thou shalt’ because it’s a big step and it means giving up power and control, which many will be unwilling to do. I am talking here about genuine co-production, with each ‘side’ equal players:
“Co-production is a relationship where professionals and citizens share power to design, plan and deliver support together, recognising that both partners have vital contributions to make in order to improve quality of life for people and communities.” (Ref (2), p.7)
Of course ‘equal’ does not mean ‘the same’. They might be valued equally but they’re different. The public is more heterogeneous, and is not an organised body. While the professionals, from health, the council and elsewhere, will be there by virtue of their qualifications, knowledge and selection, the public has a much wider range of skills, abilities and experience. So equal but with different contributions to make.
(Note that while there’s nothing to stop a genuine co-produced approach, remember that the statutory duty is that of the local authority and CCG, through the Health and Wellbeing Board.
“Local authorities and clinical commissioning groups (CCGs) have equal and joint duties to prepare JSNAs and JHWSs, through the health and wellbeing board. The responsibility falls on the health and wellbeing board as a whole and so success will depend upon all members working together throughout the process.” (Statutory guidance, Ref 1, p.5).)
- Genuinely listen
And show you’re listening – show that all the points raised have been considered. This applies in all settings, from individual conversations through to general communications. Don’t close down debate. Allow off-the-wall ideas, at particular points, recognising that you need to filter and select at others. Give ideas time to be worked up if necessary. You do this already. Of course you do. You may even believe that. But I can assure you, having sat on both sides of the table, it often doesn’t happen as well as it might.
- Work with partners on engagement
Different partners may already involve service users and the public in a variety of ways, with expertise in different aspects of engagement, so by working together you can have a greater and more effective reach and also work more efficiently by not duplicating. (Partners could include the CCG, health providers (hospitals, GPs, etc.), Healthwatch, the voluntary sector, other public sector, the private sector and the public). There are three different ‘levels’ of partnership:
- Co-ordination – e.g. make sure you not holding similar events on the same day or running social media campaigns that will conflict with each other
- Contribution – helping each other out, such as a voluntary organisation providing facilitators for a CCG event or a local authority sending out a Healthwatch survey to its email list
- Collaboration – doing things, whether a one-off event or whole programme of engagement, together, jointly.
- Be transparent
Ensure everyone can see the workings all the way through, should they wish. Make meetings open to the public wherever possible. You could also put all relevant papers, including meeting agendas and minutes on a micro-site. Even better, include a forum function so people can ask questions, comment and debate issues raised by those papers and documents. It doesn’t matter if very few people look at the material – just knowing you can, matters.
- Have engagement open to all throughout
There will be targeted engagement (see the next point) but it should also be possible for anyone to contribute at any point in the process. Even if most people don’t take up the offer, it’s important that they feel confident they would be able to if they wished. And you might just get something very useful that you hadn’t expected.
- Have targeted engagement
As well as being open, there should be targeted engagement to reach as many parts of the community as possible, in particular those who are ‘seldom heard’ and those who normally find it difficult or are reluctant to get involved. It may be worth working in partnership with those who are already working with such people. Similarly, people from any given community, whether BAME groups, young people or travellers, might be prepared to act as ‘peer researchers’. They may be better able to reach more people, ask the ‘right’ questions and interpret the answers, than those without that expert knowledge. More generally, many people can be reached through existing groups such as voluntary bodies, and those supporting people with particular conditions like diabetes, cancer, mental health issues or learning disabilities.
More generally, try to recognise the heterogeneity of the public and avoid having a single mental model. That means avoiding comments like ‘they’re not really interested’, ‘they wouldn’t want to read lots of stuff’, or ‘they don’t understand how health works’. Even if those statements are true for the majority of people, there will be some who are interested and others who are well informed, even if just about particular aspects.
So generally keep things simple, but be prepared to draw on particular knowledge, experience and expertise when it is available.
- Value different sorts of contributions by the public
It’s easy to fall into a pattern of looking for a limited range of inputs from the public, such as satisfaction with services, opinions on proposals or views on priorities. However, the public may contribute to the development of the strategy in many different ways.
Their desires, needs and satisfaction are clearly important and tie in with what they want the strategy to achieve. However, the public has much else of value to contribute.
People’s experiences can help determine how effective current provision is and what needs to change. This could be in relation to individual services but also the whole system of services, how well they work together, any gaps and issues in moving between them. Finding out about people’s behaviour (such as dietary and exercise habits, how often they eat out or their use of transport) could be helpful in devising strategic alternatives.
It’s worth thinking about how much knowledge people have about particular issues. Some may not have much, but their immediate perceptions, for instance of health and other public services, will be important, as they may determine how they react to proposals. Others will already be well informed and that needs to be weighed when considering their views. However, it is also possible to provide information to help people be better informed. This could be through general communications or as part of specific, ‘deliberative’ events, where participants are given and can ask for information, call witnesses, etc.
People have values and preferences which will feed in to the process in a variety of ways. However, beware of asking for people’s ‘priorities’ unless you, and the people you are asking, are very clear what you mean by priority in this instance. If something is a priority, will more be spent on it than other areas, will it receive a bigger proportion of any additional spending or will it just receive more attention? Does it mean that the strategy will address this issue but not others (but what if there are considerable interrelations between areas?). Does it mean, as for mental health, that the area has historically received insufficient attention and resources and this now needs to be re-balanced, rather than that it has some inherently greater value than, say, physical health? Is it some amorphous amalgam of such things which means, in practice, it becomes meaningless?
Another form of input are the public’s ideas and proposals. This could be in relation to particular aspects of the strategy, but it could also be about setting the agenda for the whole process. Finally, the public may be able to contribute to producing the strategy in a range of ways. They can help with organising and facilitating events. Some might help with social media. Others could do background research and write drafts of the strategy.
It is also worth remembering that people often have many different roles and they may be speaking with a particular ‘hat’ on. They may be extensive users of some part of the health service, parents concerned about their children, employees or employers in a significant local company, just interested and concerned citizens or several of these simultaneously.
- Have a range of forms of engagement
Use a range of engagement methods, for different purposes and at different stages.
The nature of the input may vary from precise, quantitative surveys, through open, general conversations to direct participation in producing the strategy. As noted above, some input will be from anyone, wherever it can be found (e.g. comments on a website or open survey), while at other times you will be looking for contributions from particular sections of the community (homeless people, carers, young people etc.). Sometimes you will want to know more accurately the range of views in the community, a representative picture, which you could achieve with a random sample survey. However, while important, those views may be different from the ones people would have if they were better informed and had had chance to consider the issues more deeply and that can be found from deliberative events such as citizens’ juries and citizens’ assemblies.
Whatever the method, try to make it as easy as possible for people to participate, to the extent, in ways, at times and in places that suit them.
- Adapt the engagement to different stages of strategy production
Different approaches to engagement and types of contribution will be most relevant and valuable at different stages of the process of producing the strategy.
For instance, early on it may be more useful to talk to people who are already interested or to use deliberative events to get people’s considered view whilst also encouraging imagination and creativity.
When analysing current problems and issues, a broad range of people’s experience will be important, showing not just how specific services ‘feel’ in practice but where the gaps are between services and the relationship between services and other, informal support such as from family and friends. This could be gleaned from in-depth interviews, surveys, diaries or focus groups.
In the analysis stage, specialist guidance could be forthcoming from those currently or previously employed in sectors such as IT, micro-biology, transport or logistics, which could have a significant impact on health and wellbeing. You may find you have social psychologists, strategic planners or futurologists in the local population who can give valuable insights or signpost you to relevant resources.
Young people may have a particular role to play in generating options – it’s their future after all. This might be in focus groups, via social media or through creative workshops. Also, their patterns of thought may not yet have rigidified into established tramlines.
Strategy selection needs to involve the whole community, but a short, focused deliberative event could provide helpful guidance when the wider community make their choices. And finally, when producing documents (such as a comprehensive strategy, a summary document and an easy-read version) there will probably be people around who are good at proof reading and can ensure plain language is used.
So, there’s a lot to think about, but there is lot of support and guidance out there on community engagement. You may need to be creative to get things done without a lot of resource. But remember, the public can be a valuable resource in its own right, and if done properly, the engagement should enable the production of a much more effective and productive strategy.
Department of Health, Statutory Guidance on Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies, Department of Health, London, 2013 March
Slay, Julia; Penny, Joe, Commissioning for outcomes and co-production. A practical guide for local authorities, New Economics Foundation, London, 2014 June