Raising the stakes

The questionnaires covered policies and budgets for consultation, groups to be consulted, incentives, methods, barriers and management of corporate reputation.

Community consultation is based on information, representation, feedback and participation. It is concerned with external stakeholders taking a full and active role in decision-making and strategic planning. The concept of a 'stakeholder' is key. It means anyone who has a legitimate interest in what the organisation does. This may be individuals or groups that have an interest in an HA and the potential to influence whether it achieves its long-term aims.

For most practical purposes, HAs are referring to geographical areas when they talk about 'communities'.

Communities are also, typically, residential or workplace in nature. But in the context of engaging and communicating effectively with all relevant stakeholders, it is important to recognise that many people see themselves as belonging to communities defined in other ways. Some communities may, for example, be defined on the grounds of race, class, religion or sexuality.

The variety of communities is a very real challenge which HAs face in developing effective strategies.

For HAs, stakeholders include patients, service users, employees, general practitioners, NHS trusts, primary care groups/primary care trusts, partner organisations, local community groups and the general public.

There is an almost universal acceptance that some form of involvement of interested parties is essential in planning effective strategies. It is essential for:

the success of the organisation - successful strategies depend on the engagement, participation and empowerment of relevant stakeholders;

managing risks - the focus should be on assessing the power, likely impact and predictability of stakeholders, and planning should take account of, and mitigate the risks of, this involvement;

wider societal reasons - public involvement in decision-making can be seen to have wide social benefits and can help to improve an organisation's reputation.

For HAs, as publicly funded organisations, the latter point is of particular importance. They have a broad societal role and, as such, we might expect a more explicit incorporation of relevant stakeholders' views and interests into their strategies than could be expected in profit-driven organisations.

HAs have long recognised the need to communicate effectively with their stakeholders. Indeed, the provision of information is at the heart of the knowledge and understanding on which the modern NHS depends.

However, the new challenge is not confined to outward communication, but on inward communication - the views and information HAs receive from local people through community consultation.

The majority of HAs are increasing the extent to which they consult with stakeholders in developing service plans and health improvement programmes. Others have strategies, plans or guides in place specifically for public involvement. Some are engaging with their stakeholders as an essential component of long-term strategic planning in order to improve their understanding of, and response to, the views of local people.

The results showed that 92 per cent of respondents had identified the key organisations to be consulted. As a follow-up, the questionnaire also asked respondents to indicate whether their arrangements/plans for community consultation included a range of key external stakeholders.

The results are shown below, indicating some variation in the extent to which HAs are consulting with key stakeholder groups (see figure 1).In terms of corporate reputation HAs considered the most important factors were accountability for financial performance and service performance followed by responsiveness to interested parties.

It is clear that HAs are using a variety of techniques for community consultation. The research sought to identify whether certain techniques were being used corporately in a general sense (across a number of functional areas), or whether their use was restricted to more selected or specific areas (a few main functional areas).The results demonstrated that while a wide variety of techniques are being employed, their use is generally restricted to selected or specific areas.

The questionnaire asked what progress HAs had made in budgeting for the likely cost of consultation. A quarter had made extensive progress, one half some progress and four had made no progress. Fewer than half the HAs had reported to the board on the costs of consultation.

The results suggest that community consultation is being used more for service planning than for general corporate strategic planning purposes.

The findings lend weight to the view that a major challenge for HAs is the design of community consultation processes linked to general strategic planning rather than the issue-specific consultation that can be carried out in relation to individual service areas.

The research suggested that the key factors prompting an increase in reliance on community consultation are HAs' own strategies and directives from the Department of Health. The main threats or barriers to progress on consultation were seen by HAs as being resource constraints, competing priorities and timing difficulties.

As with any element of service or strategic planning, community consultation needs to be based on consistent policies and procedures that have been agreed corporately and communicated to all concerned. HAs also need to give careful consideration to the design of any consultation process, bearing in mind the stakeholder groups involved and the relevance and applicability of the different techniques that can be used.

Community consultation also needs to be carried out with relevant stakeholders. Decisions on what constitutes a relevant stakeholder need to take account of a number of factors such as:

power and influence of different stakeholder groups;

risks of not consulting with some groups;

ease of accessibility and cost justification for engaging with the stakeholder;

representativeness of the stakeholder concerned;

receptiveness/willingness of the stakeholder to being involved in any process of community consultation.

In carrying out the research, PricewaterhouseCoopers identified a number of important tips relevant to the development of community consultation:

Stakeholders have differential access to information. Any information supplied by HAs should take account of the needs of different stakeholders.

Consultation should be economic, efficient and effective, but also userfriendly. Costs should be commensurate with the resources at stake in any decision and its strategic importance.

Having identified who is to be consulted, HAs need to clearly articulate who will take final decisions and how the results of the consultation process will be used. At the end of the process, feedback should be given and there may also be benefits in feeding back the reasons why action cannot be taken in response to stakeholder views.

Many HAs clearly see community consultation in its rightful place as one of the key processes involved in strategic planning. Having robust mechanisms in place to anticipate and respond to stakeholder views should enable HAs to maintain their reputations in the years to come.