As well as supporting local public engagement as part of the Next Stage Review we have also supported numerous Trusts and PCTs on major reconfiguration of health services. Sometimes we are called in to help with the design of the consultation itself but we also provide support to the design of the the front end and implementation aspects of service change. Prior to formal consultations we design deliberative processes to engage patients and the public in understanding pressures for change and in contributing their ideas about principles and future priorities – all of which is important in informing the definition of future options. The end of public consultation is typically only the start of the complex task of implementation but it can also signal the need for either a rethink of original proposals or more detailed engagement with stakeholders where there is signficant opposition to the options in the consultation. Our work here has included evaluating the effectiveness of a consultation process, acting as a neutral chair for further engagement of stakeholders and negotiation events to turn areas of conflict into compromise. So what have we learned from our involvement in public consultations, both good and bad? Well apart from the extraordinary difficulty that the health system seems to have in learning and following basic good practice here are some of our own insights:

• Start early – formal consultation shouldn’t be the start of a dialogue with local people. Engagement is for life not just a magical three months. Lincolnshire PCT’s deliberative events with local people were a great example of ways of bringing people with you through discussion and education about the changing context in which health services are provided. Ongoing communication with ;
• Provide examples –many people form their views of health service changes on historical experiences either their own or those of their relatives. Real life pictures and descriptions showing new models of service working in practice provide confidence that some of the more modern proposals that are being put forward are workable
• Get the facts right - people vary in the amount of detail they want to see but some will want to scrutinize the background information. Surprisingly we still see consultations with no ‘numbers’ and no supporting papers. Working papers or web downloads are a good way of providing that supplementary detail.
• Ditch the jargon – an obvious plea for plain English – all industries have their jargon and public services are no exception - often don’t know we are using it – so test out the consultation drafts on some ‘real people’ that don’t live and breathe in your world of work.
• Show the impact – we often see public consultation documents with mini vignettes describing before and after scenarios of health service changes. These can help but what many people want to know is how many people are affected by the proposed changes, what tangible benefits are they likely to see and how will any downsides be managed?
• Imaginative design – the standard public meetings still have a place but typically attract very few people – a consultation that relies solely on this method is unlikely to be effective. Different processes and communication methods –for example, focus groups, text messages, blogs, email groups and tapping into existing networks and meetings - can all help in reaching beyond the usual suspects and engaging specific groups whose views are important.
• Get to the opinion leaders – crucially this includes staff affected by changes as well as community leaders and politicians. This needs detailed work – ideally on a one to one basis - to hear and answer concerns and ensure these significant people are fully informed about the case for change, what the proposals mean for them and ideas they may have for improving them. This isn’t likely to be just a handful of people – we are talking a lot of effort invested in the people that matter.
• Find the good news – we see many consultations which are presented as an inevitable response to pressure and which will reduce patient access. Why would the public or politicians support such proposals? If you are expecting people to back what essentially ‘bad news’ what ‘good news’ can you offer in return?
• Be realistic about support - There are some groups who you may never win round irrespective of how much evidence or opportunities for discussion you provide. Develop a profile of your stakeholder views, be realistic about how far you can expect them to shift and tailor communications accordingly. You may not be able to get local politicians for example to support your cause publicly but getting them to a position where they don’t oppose them may well be a positive result.

This entry was posted on Tuesday, July 17th, 2007 at 11:57 pm and is filed under News.
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