Constructive conversations: real and meaningful engagement with citizens
Featured article -
31 May 2017
Lord Victor Adebowale and Dr Henry Kippin, Chairman and Chief Executive of Collaborate CIC, a social consultancy
Under 15% of citizens consistently feel they have an influence on the actions of service providersSurvey work carried out for Collaborate by Ipsos MORI
Sustainability and Transformation Plans are a paradox. They are the best hope of embedding place-based planning and cross-sector collaboration within our health and social care system. But they also expose the difficulty of doing it in practice. The STP process has collaboration at its core. Every draft emphasises the need for deeper integration across NHS and social care services, and the need for system leadership that can take a set of high quality but siloed institutions into a new world in which responsibility for better local health outcomes is shared.
There is much to be positive about. Serious conversations about what sustainable primary care really looks like. Vital work to build the evidence base for preventative and more social models of care. Creative thinking about how to manage demand through and between care settings, with acute trusts incentivised to do things differently. The potential of…whisper it… joined up commissioning of out-of-hospital services driven by the need for a well-working care market as a shared priority.
As planning tips into implementation, health and care leaders will need to ask themselves some serious and honest questions. How ready are commissioning and delivery partners to make these changes stick in the real world? Is the shared vision and system behaviour in place in the boardroom and beyond? Can relationships between GPs, social workers, mental health practitioners and community nurses hold the weight of the changes we are expecting of them?
Our experience is that work will be needed to answer these questions effectively. Collaboration readiness must be built for delivery plans to be credible. But lets not kid ourselves. Without real and meaningful engagement with citizens - described by SCIE as a ‘missing piece’ - even the best working STPs will represent system change only on behalf of the system itself.
Survey work carried out for Collaborate by Ipsos MORI over the last three-four years suggests that under 15% of citizens consistently feel they have an influence on the actions of service providers. Those with multiple and complex needs feel this most acutely, and evidence from the Lankelly Chase Foundation and others suggests that we have struggled to improve their experience of a system without enough bespoke services and opportunities for the public to really influence them.
Our commitment at Collaborate is to support local leaders who want to take systemic collaboration seriously and make co-production a reality. Initiatives like Oldham's emerging School of Thriving Communities and Coventry's Ignite programme are blurring sector lines and creating opportunities for new models of support to emerge that are shaped by citizens and service users. The changing shape of primary care presents an opportunity for general practice to look outwards to communities and do the same - exemplified by Federations in cities like Leeds.
None of this is certain progress or established practice. Much citizen-led change still happens against the grain, and we need to do much more to translate what our Commission dubbed Place Based Health from the pages of a report to a reality on the ground. STPs should be about more than acute sector sustainability, and must provide the insulation for local systems to be radical in the pursuit of better population health and care. We should all be standing ready in support.