A recent report on sustainability and transformation plans (STPs) has sparked quite a debate about the importance of citizen engagement in redesigning health and care services.
The report, commissioned by the campaign group 38 Degrees and produced by health policy consultancy Incisive Health, found that the “extent of ‘co-production’ with patients and the public appears to have been limited” in the plans. The Nuffield Trust, in its review of STPs, arrived at a similar conclusion.
NHS England has since published a guide on community engagement, which is welcome news. But guidance, as we know, is never enough on its own. We need concerted action at all levels to ensure STPs aren’t a wasted opportunity for meaningful involvement.
We have been here before. Earlier in the decade, in an attempt to shift costs out of hospitals and into communities, the NHS ran what were called “acute service reconfigurations”. This involved reshaping services at a sub-regional level.
Not only were these met with public protests, but the lack of citizen engagement led to ill-considered plans that didn’t reflect people’s aspirations or needs. We must avoid the same thing happening with STPs. Engaging people should not merely be a step in the process, but part of everything we do. We must think all the time about how we can involve citizens in the design, commissioning and delivery of services.
While STPs will soon be signed off, it is crucial that as we move into implementation, citizen engagement is at the heart of decision making. Thankfully there is a powerful set of principles that can guide our thinking and behaviour. As part of the NHS’s Five Year Forward View, the People and Communities Board, with support from the National Voices coalition, developed six principles for engaging people and communities.
Those principles require those undertaking STP planning to work with the knowledge, skills and experience of people in their communities. This should also apply to the implementation of plans.
One of the principles is about ensuring that the “voluntary, community and social enterprise, and housing sectors are involved as key partners and enablers”. This is vitally important, as the reach of a health or care service will be limited by various parameters. However, the combined reach of the voluntary and community sector, alongside services, is far greater.
Another of the principles is that “carers are identified, supported and involved”. Carers have vast experience and knowledge of the strengths and weaknesses of existing services, and great ideas on how they can be improved. They also have needs that are not always sufficiently supported. Involving carers in decision-making is vitally important.
All of these principles are underpinned by the notion of co-production – that is, a way of developing services that has service users and communities as equal partners in shaping how services are delivered.
In parts of the country, efforts are being made to ensure citizens are more closely involved shaping STPs. In both Leeds and Nottinghamshire, officials have gone to great lengths to involve local people in developing their STPs. In York, we have established an integration and transformation board that will co-produce a vision for person-centred and integrated care with local people. But, of course, much more could be done.
As Simon Stevens, the chief executive of the NHS, said recently, STPs are just the start of a process of massive change; the implementation that follows will be the much longer and harder part. We could have started sooner in engaging citizens in STPs, but getting engagement right from now on is still vital to the work.
Martin Farran is director of adult social care, housing and public health at York council and Ewan King is director of business development and delivery at the Social Care Institute for Excellence.
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Citizens must get a say in NHS sustainability and transformation plans
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