STPs must involve local people to avoid becoming expensive door stops

NHS England’s expectation that local people must be involved in developing Sustainability and Transformation Plans (STPs) could not be clearer.

Its guidance explicitly states that producing the plans should involve “developing a shared vision with the local community”.

The success of the strategies depends, it continues, on “having an open, engaging and iterative process that harnesses the energies of clinicians, patients, carers, citizens and local community partners”.

However, there are early signs the NHS is in danger of following the same old failed planning script and missing the opportunity to plan services in a radical new way; this is not just about organisations coming up with ideas they think will benefit populations. They need to be working in proper partnership with local people if they are to avoid throwing good new money after bad.

There are reams of evidence which demonstrate how consulting with groups and individuals outside the usual pool of suspects results in successful ideas that make an impact

Further guidance published in February revealed regional plans will be judged on the “reach and quality of the local process, including community and voluntary sector engagement” but this should not be the main motivation for taking this seriously.

The “transformation” part of these plans will only be successful if leaders engage with groups who are not usually given the opportunity to get involved in decisions over how resources are spent and how services are delivered.

Getting public engagement right on STPs is in everyone’s interests; there are reams of evidence which demonstrate how consulting with groups and individuals outside the usual pool of suspects results in successful ideas that make an impact.

Take Hannah Price, a 15-year-old patient at East and North Hertfordshire Trust. Hannah wanted to improve communication between hospital doctors and young patients following a bad experience. The trust encouraged her to create a poster suggesting ways that professionals could interact more effectively with young people, then invited her to speak at the trust’s AGM, before turning her idea into a film.

Social media success

The campaign clearly touched a nerve, as within 12 hours of being launched on Twitter, it received more than 60,000 retweets and the video was viewed almost 500 times. Hannah is now promoting the campaign at hospitals across the country and the campaign won a national NHS Innovation Challenge prize.

Likewise, when South Staffordshire and Shropshire Healthcare Foundation Trust was planning a hospital redesign, it took a service user to highlight how the lack of outside space and relatives’ areas included in the draft plans would impact negatively on patient experience and recovery.

The service user highlighted the importance of family and physical health in her own mental health recovery. Her feedback was discussed at board level and has since been incorporated into the architects’ plans, which now include extra features like sensory walkways and bigger outside spaces for visiting families to enjoy.

Meanwhile, over in Australia, the City of Melbourne has gone a step further, randomly picking 43 residents and business owners to form a “people’s panel” with remit over its 10-year, $5bn financial plan.

Unencumbered by political or institutional allegiances, and given open access to information, the panel came up with a detailed strategy covering rate rises, infrastructure and asset sales that was accepted almost in full by the city council and was widely hailed a success.

Commissioners are complaining that appointments for the 44 “footprint” leaders are being tainted by top-down control, and there has been predictable squabbling over the boundaries of regional health systems

In fact, on a recent trip to Australia I discovered the concept of ‘deliberative democracy’ is being tested by some forward-thinking commissioning agencies, who are looking at committing to pursuing people panels’ recommendations before any formal planning processes gets under way. This means community views really will underpin the design of services.

NHS England is not asking the NHS to set up citizen’s juries and it is certainly not suggesting patients should have unfettered access to public funds. It simply wants leaders to consult widely so that priorities on delivering improved health and wellbeing, improved quality of care and sustainable finances for the next five years are set, quite logically, “through the eyes of those who use and pay for the NHS.”

Power struggles

There are worrying signs that this vision is already being overshadowed by organisational and geographical battles – the very thing STPs were meant to avoid. Commissioners are complaining that appointments for the 44 “footprint” leaders are being tainted by top-down control, and there has been predictable squabbling over the boundaries of regional health systems.

These power struggles mean nothing to the people who use services or – in the main – to those who work in them.

Unless leaders can overcome a historical obsession with organisations and structures, and a paternalistic approach to public engagement, these plans are at serious risk of being derailed.

Nick Goodman is managing director of Membership Engagement Services