People are open to change if they feel the designers of the process have listened to them, says Nick Goodman
The message from Simon Stevens in his recent interview with HSJ was unequivocal: the new tranche of regional STP leaders must overrule colleagues standing in the way of new care models of care if they are too politically focused on protecting “very local…hospital services”.
This should give some of the 44 ‘footprint’ leaders the extra spur they need to push on with redrawing the NHS and social care map in their areas to meet the NHS England submission deadline this month.
However, dealing with disruptive directors and their “veto power” at the planning stage is likely to be the relatively easy part. Coping with the wrath of local people if they feel ignored will not be so straight forward.
In his interview, Stevens pointed to the devolution process in Manchester, which has seen the creation of a combined authority, as an example of the kind of model STP leaders could emulate to remove barriers to putting plans into action.
But it mustn’t be forgotten that the authorities in Manchester had to fight a lengthy judicial review after a group of local doctors, patients and MPs banded together to contest decisions that had been taken about reconfiguration of hospital services.
While the judge ruled that the Healthier Together consultation that led to the decision was adequate and lawful, the expensive and time consuming case highlighted the real risks if local stakeholders don’t feel properly engaged in change.
Of course, you will never please everyone when proposing big changes to the way people access local health services. Plans that move services out of hospitals, whether to others or into the community, are politically supercharged – but they can be mitigated by proper, carefully planned engagement.
Over the last 10 years many foundation trusts have shown how genuine involvement of lay members can deliver transformed and improved services that also save money. For example, King’s College Hospital Foundation trust is looking at focusing investment in targeted areas that will improve patient experience and outcomes when it completes a year long one-to-one consultation process with past patients, In Your Shoes.
Similarly, the trust’s Cancer Voices and Maternity Services Liaison committee programmes have led to changes to the way relevant services are run to improve patient satisfaction, and ultimately health outcomes.
Outcomes are always the bottom line in the end. Health services exist to help people to get better and live healthier lives. Not to maintain the professional and political status quo in an area if that is no longer serving patient need in the 21st century. Which is why Mr Stevens is no doubt keen to free his STP leaders to break free from historically entrenched positions to realise their transformation visions.
Open to change
However, there is a very real risk in so doing that patient and community views are tarred with the same brush being used to sweep away the old in favour of the new. In my experience working with NHS organisations for 10 years to engage the public as members and governors, people are actually very open to change as long as they feel its architects have taken their views into account.
For example, another foundation trust, this time in mental heath, made significant changes to its clinical strategy after involving external and internal groups. Camden and Islington NHS foundation trust’s medical director invited service users, staff and people from partner organisations to attend workshops as the trust wanted the new plans to be based on what patients and staff on the frontline wanted.
There’s no doubt that bold steps need to be taken to cope with rapidly changing and escalating demand from an ageing population, but it doesn’t have to be combative
The trust then created pathways that ensured service users felt equally in control of their care in partnership with staff, and that reflected concerns that physical and mental health were treated with equal weight.
There’s no doubt that dramatic and bold steps need to be taken to cope with rapidly changing and escalating demand from an ageing population, but it doesn’t have to be done in a combative, top down way. In fact, genuine involvement of people can not only garner support for changes, but also actually give leaders a remit to make even more radical steps based on patient suggestions.
NHS England said local people must be involved “from the start’ in the new STP plans - our ‘Engageometer’ project, which is benchmarking organisations’ level of patient and public involvement across the NHS will show how this is done by the best.
When I step up at our conference Challenge 2020 next month to unveil the Engageometer results of how the NHS is making sure every voice counts, and where organisations sit on the classic ladder of engagement scale, I am confident we will uncover an inspiring picture. Much of the NHS takes its democratic duties very seriously indeed.
As we surge forward into the brave new world of transformed models of care, we must redouble our efforts to ensure that experience and good practice is carried forward, so that the principle of “no decision about me without me” is never forgotten.
Nick Goodman is the founder and managing director of Membership Engagement Services