A key theme for new models of care is that unless it does things differently with people and communities, the NHS cannot become sustainable.
All local areas are now drafting plans to engage their patients and communities… against a timetable so short that it is simply impossible to engage their patients and communities in the plans.
In this blog I look at the centrepiece of the new NHS: the ‘Sustainability and Transformation Plans’ (STPs) being produced by 44 brand new regional geographies, known as ‘footprints’.
My focus will be on how engagement with people, communities and the voluntary sector should be tackled in order to get out of the Catch 22.
The mechanisms for change
The future of health and care is to be safeguarded through ‘new models of care’.
But meanwhile every local area must get cracking, now, on planning to establish the new models, and this is being driven through the STPs.
First, all local areas were asked to band together into larger ‘footprints’ for collaborative planning and working at scale. This is not just NHS: local authorities should also be involved.
The 44 footprints areas have been published, averaging 1.2 million people and typically enclosing four or five CCGs.
Second, each area must be led by a single nominated ‘senior leader’ from either health or social care. So far we only know who eight of them are.
Third, the NHS Planning Guidance instructs each footprint to prepare an STP to tackle the big challenges facing the care system, by 30th June.
STPs and ‘engagement’
The Planning Guidance issued last December is unequivocal about the requirement to engage people in the new ‘place based’ approach to planning and delivering services:
Success depends on having an open, engaging, and iterative process that harnesses the energies of clinicians, patients, carers, citizens, and local community partners including the independent and voluntary sectors, and local government through health and wellbeing boards.
Plans should include ‘a step-change in patient activation’; designing ‘person centred coordinated care’; and ‘a major expansion of personal health budgets’.
Overall, footprints must be clear about how they will ‘embed the six principles of engagement and involvement’ which National Voices helped to develop. We have produced a briefing explaining what he six principles are.
Following up in February 2016, a letter to NHS chief executives said that getting it right meant to ‘engage patients, staff and communities from the start, developing priorities through the eyes of those who use and pay for the NHS’, and that ‘STPs will need to be developed with, and based on the needs of, local patients and communities’.
To all of which the voluntary sector response could be, ‘Come on, get real!’
The guidance shows the classic ‘magical thinking’ of policy makers: if we say something, then not only is it real, it must have been enacted already.
But around the country, voluntary sector ‘infrastructure’ – the collective organisations that help give coherence to the sector by keeping them informed, convening them together, brokering contact with statutory bodies, lobbying for funding and involvement – is depleted as a knock-on result of the swingeing cuts to local authorities.
These organisations, and the groups and charities most concerned with health, care and wellbeing, have struggled to connect to the fragmented healthcare system left by the 2012 Act.
Now they have to get to grips with vanguards, devolution areas, 44 footprints – developments which threaten to leave our sector behind or in the margins.
Unlike the footprint leaders, pioneers and vanguards they have no ‘national support offer’ to help them participate in collaborative leadership.
At this point, many local or regional VCS groups may know little or nothing about planning guidance, footprints, or STPs. We are only just finding out which footprint we are in; we don’t know who is leading them; and, since they are not statutory organisations anyway, they have no duties to consult or engage with us.
Even if they did, would they be able to? In the time available to compile the STPs how could they mount any adequate engagement exercise?
What is to be done?
Here are some suggestions we are making for how to overcome the Catch 22 and ensure that the original and welcome goal of the NHS leadership -- for better engagement of people and communities -- is achieved.
1. Recognise that good engagement can’t be done by June
Let’s not believe that rhetoric is the same as reality.
2. Take a five year view and ensure STPs do the same
The most important thing is that the engagement with people and communities should be a continuous process over the next five years. Subsequent guidance, support to the footprints and refinement of plans during the summer, should prioritise clarity about embedding coproduction with people and communities in year-on-year operations.
3. Emphasise ‘coproduction’, not ‘engagement’
So far I have used the shorthand word ‘engagement’, but NHS ‘patient and public engagement’ has consistently failed people and communities.
And already we see vanguards delegating ‘engagement’ down to single staff members as a niche specialism, and to a marginal role in planning; or satisfying themselves that they have the odd bit of ‘patient representation’.
For the Five Year Forward View goals, this will not be adequate. What is needed is coproduction, whereby people, service user and carer groups, community organisations and the voluntary sector are brought into the collaborative leadership, planning, and service redesign at various strategic and practical levels.
4. Stop right there: do not reinvent that wheel!
One element of support to footprints will be new ‘how to’ guides. There is absolutely no need for such a guide on ‘engagement’.
Excellent resources already exist; new ones are likely to be worse.
NHS England’s own ‘Transforming Participation’ guidance and resources (which National Voices helped to produce) are a key platform; while different aspects of engagement are covered in more detail in NHS Networks’ SMART guides to Engagement.
However, there is a need for stronger resources on coproduction and codesign (see 3, above). Invest in these with VCS partners.
5. Publish early and communicate proactively
At each step of this process, early publication of details, plus concerted communications (through many networks, not just the HSJ!) will better enable voluntary sector groups and organisations to inform their stakeholders and to engage with footprint and devolution leaders.
Put full contact details for the footprints in a single place on the Web. Make sure the STPs go straight to publication at the end of June; and let local and regional stakeholders know how they can contribute to further refinement.
Thursday 17 March 2016