I have been working in and around health and social care for more than 40 years, mostly advocating for the rights of patients, carers and the public in a number of ways. At times it has felt like an uphill struggle with little by way of tangible progress in changing the power inequalities and inequities that persist across the system.
One of the most interesting, and heartening, developments in recent times has been the increasing emphasis on patient and public involvement and engagement in the development and delivery of health and care services. Integrated Care Systems must now be able to show that they have plans to involve and engage people in what they are doing and most seem now to have sophisticated strategies for doing so. The language is slowly changing, awareness is growing, and it just feels a bit different.
Much of this is broadly to be welcomed, it has been a long time coming. I wish we had made more progress, but I do want to celebrate and support the changes that are happening. In that spirit, and drawing on my experiences, perhaps I can provide a few practical observations about the nature of engagement and the impact it can have.
My first point is that fixed consultation periods, usually to support proposed service changes, are rarely optimal in gaining authentic insights from local groups, communities, and individuals. Real insight is a product of strong relationships and trust, which can only be built up over time.
It requires regular and reliable two-way communication with people. This can only happen if time and energy are put into establishing the ways in which people need to get their communication. We need to ensure that it is accessible to people in the ways that they need, that it is consistent and culturally appropriate, that it is supported by reliable and consistent administration – doing what you say you are going to do when you say you are going to do it.
When you are setting out to establish an engagement process try to find out what cultural reference points (such as language, venues, priorities, customs and traditions) need to be incorporated to build trust in that process. One size will never ever fit all.
It also needs to be clear why you are doing it. Engagement is a means, not an end in itself. What do you hope it will achieve? Are the people you want to engage with equally clear about why it is happening? Engagement is a journey, it is rarely a destination, and we can learn a great deal from that journey. Closing the engagement loop, feeding back to people to keep them informed and engaged is a key part of that journey.
All of this suggests a process that I have been calling ‘continuous engagement’. I have often suggested that local voluntary and community organisations can be valuable partners (when properly resourced) in that process as they are rooted out in communities. Continuous engagement offers a number of advantages in gaining authentic insights, local buy-in, and providing a potential early warning system about emergent issues.
I have found that one of the greatest challenges is to reach groups of people and individuals who are often classified as ‘hard to reach’. In my experience people are not hard to reach if you approach them in the right way, all you have to do is find out from them what the right way is. I have adopted the term ‘Frequently Ignored Groups’ (FIG) to describe them – this term rightly places the blame on us for not doing enough to reach out to them.
A final point I would make is that it is much better to involve people at a very early stage. I hear much about co-production but rather less about co-design. Bringing the end users in at the design stage to sense check what you doing and suggest tweaks as necessary. Perhaps a camel is a co-produced horse if there was no earlier co-design.
There is no doubt that some people still see engagement as messy complex and expensive, I understand that. However done in the right way authentic engagement can be transformative and inspirational. It can drive cultural change and our sense of self in society. A prize that is surely too valuable not to pursue.
I hope these thoughts are helpful and might even promote further discussion.
Chris Bain 