Engaging and communicating to deliver better care

Strong engagement and communication with a wide range of people and organisations throughout the health and social care system is vital for the successful delivery of Better Care.

Meaningful involvement of staff, people who use services and their carers can help ensure that new approaches are well informed and sustainable.

Create a narrative for coordinated care

Many places have used stories about how integrated care will offer individuals a better experience and outcomes. One example is Torbay’s Mrs Smith. Other places have developed their own versions, but most have in common a clear description of what the change means for the individual and the benefits it brings. Good narratives tell a clear story of why the change is required, what will have to change and what improved outcomes will arise by when.

To develop a strong narrative:

• Include people who use services and carers as experts by experience. Draw on powerful stories and insights. Since the success or failure of the programme will be judged on local experience of joinedup care, transformation plans should be built on the experience of local people. This will also help to build a brand for local integration to encourage sign-up and commitment (see Principles for integrated care, National Voices).
• Articulate what ‘better care’ and ‘integration’ actually mean in practice. Build commitment across the partnership with individuals using the I-statements from the National Voices narrative to clearly set out what they will do differently to achieve the vision. This could follow the example of Leeds by including high-level commitments from system leaders.
• Make the narrative tangible by integrating agreed performance metrics. Ensure objectives are realistic and discussed with people who use services and carers.
• Be realistic and honest with stakeholders – do not overpromise what can be delivered and recognise the boundaries of the project.

It is important to create a compelling story which everyone at all levels across the economy can associate with and take themselves back to when they are facing a challenging situation to remind themselves that this is why we are on this journey.

Cheshire Local Vision project: developing multiagency response to social isolation

Use a common language

• Create and share a clear and common language that will be used in all communications. Everyone involved in delivering the programme should adopt this shared language and use it to disseminate messages. Ensure this is aligned – both across the health and care system and with other associated initiatives, for example personalisation.
• Revisit the narrative frequently to help ensure that people adopt the shared language and test it on people who use services and staff. Opportunities could include partnership meetings, multidisciplinary teams, community engagement events, team meetings and training sessions.
• Use joint and clear branding of all information, avoiding jargon and acronyms – or use the NHS Confederation’s NHS acronym buster buster to explain.

• Case study: The importance of local context – Salford Open

  Salford clinical commissioning group (CCG), Salford Royal NHS Foundation Trust and Salford City Council have been working together to develop an integrated care programme to meet the needs of a fictional but typical resident – Sally Ford – and her family. Similar approaches have of course been adopted earlier and successfully in Torbay (Mrs Smith), Jonkoping (Esther) and elsewhere. While these all use the device of a person as a means of engaging communities and stakeholders around individual needs, it is worth noting that Sally Ford is from Salford. She speaks with a Salford accent, lives in a Salford street, travels on Salford trams. This then is an example of adaptation as much as of adopting good practice from elsewhere.

  Source: System leadership: Lessons and learning from AQuA’s Integrated Care Discovery Communities, The King’s Fund (2014)

Develop clear measures of success

• Communication strategies need to identify clear outcomes and measures to track performance. Understanding the impact of different engagement activities will help refine the approach and focus on the most effective techniques.
• Frameworks such as logic models or theory of change process maps can help plot the logical links between the main communication and engagement activities, their immediate outputs and the short-, medium- and long-term outcomes.

Understand your stakeholders

• Identify all of the internal and external stakeholders who need to be involved and obtain sign-off from the programme board.
• Explore and surface the core motivators for different stakeholders, understand their stance on integration and develop approaches which address their particular issues or concerns.
• Do not overlook hard to reach and seldom-heard groups.
• Remember that everyone has a communication role, including people who use services and local groups. Map the different ways in which stakeholders interact to identify good opportunities to communicate messages. Identify champions from across the health and social care economy that can play a communication role.

“We work in a knotted ball of string, where you have to be comfortable talking to chief executives one day and patients and health care assistants the next, and where you know it is not linear like a railway track. There are lots of branches off on the way. It is about persuading, not ordering, asking not telling, everybody’s equal – that sort of thing. You have to be comfortable with chaos. And it does need a different sort of manager with different skills, not the tub-thumping showman who needs to be centre stage. You need to have people who can make connections and relationships, and that’s a totally different set of skills.

Jan Vaughan, Associate Director, Cheshire and Merseyside Strategic Clinical Networks

Source: System leadership: Lessons and learning from AQuA’s Integrated Care Discovery Communities, The King’s Fund (2014)

Equip people with the right communication skills

• Offer training and support to communication champions, including people who use services.
• Include communication training in existing training and development programmes, including staff induction.
• Include communication-related objectives in appraisal processes.

Engage local people

• Develop a wider a strategy for engaging with the wider public – use Arnstein’s ladder of participation (see box) to think through the purpose of engagement and the outcomes that are being sought.
• Co-develop and co-produce communication plans and engagement strategies with people who use services, carers and families.
• Create opportunities for feedback from stakeholders, including people who use services, carers and communications champions. Routinely monitor feedback and review narrative, engagement and communication plans.

... in terms of success, one in North West London has been genuine coproduction with lay people … So that is a big success. And more people seeing that whole system integration as the way that we are going to solve the problems that we are in. So in terms of critical mindset changes, I think that those are successes. Failure would be if we don’t let go and allow our enabled local areas to move forward at a pace that is right for them – so the fastest move forward more quickly.

Thirza Sawtell, Director of Strategy and Transformation, North West London Collaboration of Clinical Commissioning Groups

Source: The practice of system leadership: being comfortable with chaos, The King’s Fund (2015)

Engage local politicians

Understanding how to create a public narrative that works to secure buy-in and support from local politicians – usually elected local councillors – is essential. Consider the following:

• If providing information and advice to enable a complex decision, try to provide genuine options with associated risks and implications.
• Be clear about what the elected councillor is trying to do (e.g. make a decision, scrutinise the executive, deal with a ward resident’s query, represent a community group) and provide the right type and amount of information to help them to do it. If unclear; ask, do not just assume.
• Show understanding and respect for politicians’ very different world, for example, ask questions about issues arising at ward level, show that you see issues from their vantage point.
• Have elected members’ confidence that your input is politically neutral – word travels fast otherwise.
• Show a readiness to use elected members’ personal knowledge and expertise (they have lives outside politics!) and make the most of their familiarity with the places and people they have been elected to represent.
• Never let an agreed deadline go by without response – if there is a delivery problem, explain what can be done by when (the politician may need to let others know what’s happening).

Ensure engagement and communications are joined up

Presentations should be delivered jointly by leaders from across the health and social care system, with engagement of people who use services and carers wherever possible. Communications need to look and feel joined up.

Leaders in this role should:

• agree roles and responsibilities to ensure a consistent and comprehensive approach to engagement
• refer to the same narrative, and use the agreed common language
• agree answers to frequently asked questions and provide joint contact points for questions and answers (e.g. on websites and e-bulletins)
• use case studies and examples that accentuate joint working
• co-produce and co-deliver the communications and engagement plan with people who use services, using a broad range of methods and approaches – see Co-production: What it is and how to do it, SCIE
• involve non-executive colleagues from both health and local government (e.g. elected members, NHS trust non-executive directors and clinical commissioning group lay members). The LGA’s A Councillor’s guide to the health system is a useful introduction to respective roles in the NHS and local government
• think creatively about which communication formats or channels can be used to reach a wide audience and maximise engagement.

• Case study: Key success factors for My Life a Full Life programme in the Isle of Wight Open

  Example of how to creatively communicate the programme vision From My Life a Full Life programme on the Isle of Wight

  • People who use care and support need to be made aware of the programme.
  • Targeting and marketing the narrative is essential to success.
  • Engagement and a clear communications strategy are needed at the earliest possible stage.

  

  Contact: My Life a Full Life (Isle of Wight)

Checklist: effective engagement and communications

Effective engagement and communications strategies can draw on the following tools:

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Ladder of Engagement and Participation

Reproduced from NHS England

There are many different ways in which people might participate in health, depending on their personal circumstances and interest. The ‘Ladder of Engagement and Participation’ is a widely recognised model for understanding different forms and degrees of patient and public involvement (based on the work of Sherry Arnstein). Patient and public voice activity on every step of the ladder is valuable, although participation becomes more meaningful at the top of the ladder.

• Devolving: Placing decision-making in the hands of the community and individuals. For example, personal health budgets or a community development approach.
• Collaborating: Working in partnership with communities and people who use services in each aspect of the decision, including the development of alternatives and the identification of the preferred solution.
• Involving: Working directly with communities and people who use services to ensure that concerns and aspirations are consistently understood and considered. For example, partnership boards, reference groups and people who use services participating in policy groups.
• Consulting: Obtaining community and individual feedback on analysis, alternatives and/or decisions. For example, surveys, door knocking, citizen’s panels and focus groups.
• Informing: Providing communities and individuals with balanced and objective information to assist them in understanding problems, alternatives, opportunities and solutions. For example, websites, newsletters and press releases.

Tools and resources

Engaging local people – a guide for local areas developing sustainability and transformation plans (NHS England, 2016) addresses expectations on stakeholder involvement, in particular patient and public participation.

Integrated care: local partnerships to improve health and care (NHS England, 2018) includes information about sustainability and transformation partnerships and integrated care systems.

NHS England’s involvement hub includes a variety of resources on patient and public involvement, including bite-sized guides to participation, governance, payments and expenses, and engaging with specific groups.

A new relationship with people and communities (The People and Communities Board, NHS England) describes how individuals and communities can be more closely involved in developing person-centred health and social care.

Integrating health and care – a must know guide (LGA) highlights the key issues for elected members on integrated care.

A year of integrated care systems: reviewing the journey so far (King's Fund, 2018), examples and case studies from existing integrated care systems.