“Not a nice-to-have” and engagement have been familiar bedfellows for a very long time. Those working in the engagement and involvement field within health have strived to prove that genuine engagement of patients, professionals, communities, voluntary groups and any other stakeholder will improve a service substantially and create relationships that make positive and continual long-term refinement possible.
And so it was exciting to see engagement at the core of STP documents late last year. A letter to all Chief Executives stressed that early funding would be dependent on “reach and quality of local process including community and voluntary sector engagement” and demanded that all plans “be underpinned by a strategic commitment to engagement”. NHSE went as far as to funding a specific guide, via National Voices’ six principles of engagement, to what this could look like and how STPs can tell if they’re on the right track.
For a moment it felt like a breakthrough. STPs are the future of transformation planning, with the premise being that all central funding is allocated through them by 2017/18, – and if engagement is at their core, we could finally be looking at genuinely co-created local services.
However, once you look beyond the aspiration, the same old problems still exist. The STPs have nine ‘must dos’ in their first year and despite a stated desire to transform as they repair, they are all very much focussed on traditional reconfiguration ideas. Of course we should reduce waiting list times or increase mental health provision, but by making these the primary focus of the first year of the STP, a crucial opportunity is being missed.
It’s true that NHS England, in reaction to recent accusations of secrecy, has recently reaffirmed it’s desire for engagement to be centralised, but once again there are negligible mechanisms in place to ensure that this is either measured or incentivised to become a priority for time and resource-short organisations.
Commendable amounts of information have been made public by some footprints, and initial plans mention engagement in that ‘repeat the question’, exam-style way. Yet the organisational structures behind these plans tell a very different story – comms and engagement posts remain unfilled and side lined in a large proportion of footprints. How can a “strategic commitment to engagement” be a bedrock when it’s fed back from a bi-weekly committee meeting?
Once again we hear ourselves saying (shouting) “not a nice to have!” 70% of change programmes fail and lack of engagement is frequently cited as one of the causes. This isn’t a secret or even a challenging concept to grasp.
In their defence, it’s hard to blame systems for responding in this way when the priorities of STPs seem so traditional at their core. The core expectations, that their success and access to early funding will be allocated on the basis of new service models, are made up of quality performance measures that have never traditionally involved the public and patients.
It’s true that these categories have more defined measurements, and engagement is by nature less empirical, but as the Six Principles document notes, there are indicators of success and qualitative feedback processes that can reveal progress or lack of. Why not include these as essentials? They’re rhetorically included so why not make them a measurable requirement?
The STPs are an admirably ambitious mechanism to take the NHS forwards. The synchronisation required to align the multitude of organisations involved, each with their own enormous pressures and incentives, will require staff and system engagement beyond what currently exists in the NHS.
If the STPs are to be successful in achieving goals that matter to their population, they will need to do four things.
1) Understand local health priorities and allow this to lead their work in a way that currently does not happen consistently in the NHS.
2) Crucially, if STPs are to win support and convert the current institutional momentum into a popular enthusiasm, they will need to make sure there are aligning with all their stakeholders, including staff, the public and all system partners. This cannot be done without a strategic engagement process ingrained from the very beginning.
3) Walk the talk and put engagement in the centre of their planning processes
4) Measure the belief in their vision as well as the understanding that staff, organisations and the public have of their own role in in it.
That’s the starting point for genuine change, anything else will see us restart the familiar cycle.