Public Involvement and the NHS – not good enough!
Nuffield Trust Research published in 2023 survey shows the decline in trust in the NHS over time.
As we start a period with a new government it has never been more important that local NHS services take meaningful system level action to develop stronger relationships with the public.
It is quite clear that we cannot rely on peoples automatic support – not least because large sections of the press and social media increasingly default to blaming health professionals and NHS management for the problems that the NHS faces. We need the public to be able to articulate what they would like to see in the NHS – at the moment we are too easily at the mercy of well intentioned but ill informed analysis – see below!
Public Involvement has always felt like a Cinderella activity in the NHS. In one way this is understandable – the purpose of the NHS is to deliver services to improve health – its purpose is NOT to provide public involvement.
Integrated Care Boards leadership
Integrated Care Boards are expected to produce a separate involvement strategy.
This requirement is spelled out in “Working in partnership with people and communities: Statutory guidance” published in 2022
I have had a look at the three strategies in Yorkshire and I am underwhelmed. The three ‘strategies’ are here.
Humber and North Yorkshire ICB
Concerns
Not accessible – they are all very long – it is ironic given that they are involvement strategies that they appear to have given little thought to who might want to read these. All seem to have sections that are cut and paste from the original statutory guidance – they read more as high level manuals on practice.
Lack of clarity – they don’t feel clear about what the role of the ICB is with regard to involvement. They have a tendency to default to how the public will be involved in the working of the ICB. There is insufficient recognition that the role of the ICB is to commission services in their area – and presumably this therefore means services that have strong accountable relationships with the public.
No analysis – there is little or no analysis of the current state of play of involvement and engagement in each of the NHS organisations that they commission. There is also little clarity about practically what good should look like in terms of feedback and involvement in decision making structures. This means that champions for involvement in NHS organisations and outside such as Healthwatch are not given levers they can use to strengthen involvement.
Structures – None of the strategies describe how the ICB itself will change the way that it works to ensure that involvement and engagement is treated as a strategic priority going forward. This is important – a clear locus such as a committee responsible for involvement provides a place to organise, discuss and influence.
What good looks like
There are plenty of examples of good practice most of these are small scale and reliant on individuals.
I have mentioned some of these in blogs I have written in the past.
The include the work of the Birley Practice in Sheffield – using a Facebook group to develop stronger dialogue with patients about the service and to help patients understand what staff are trying to do.
The Peoples Voices Partnership in Leeds – originally established by Healtwatch Leeds and now part of the City’s Health and Care Partnership.
Care Opinion – which uses intelligent story telling software to give patient feedback and encourage dialogue. Frankly I find it staggering that none of the plans I read give a feeling for the degree of effectiveness of different patient feedback mechanisms by NHS organisations and their relative merits.
Going Forward
In my view this is urgent – leaders in Integrated Care Boards need to take a step change here – it is crucial to the future of the NHS going forward that ICB and their NHS organisations develop a strategic framework that meaningfully and comprehensively improves involvement with the public.
What do you think?
Local Democracy and Health 
Really interesting blog and some great points. Happy to chat about our approach and share some more of our work with you if that would be helpful. In the meantime, you can see examples of this on our website. West Yorkshire ICB is committed to meaningfully and comprehensively involving people with lived experience and the public in its work, and gathers insight and views from all communities and partners across West Yorkshire.
Thanks Penny – appreciate the comment – I am back for a quick holiday now and will be in touch – best wishes – Mark