Care services - planning with people: guidance

Community engagement and participation guidance for NHS Boards, Integration Joint Boards and Local Authorities that are planning and commissioning care services in Scotland.

Part 1 - Planning With People

About Planning with People

It is more than 10 years since guidance on community engagement for healthcare was last issued by the Scottish Government. A great deal has changed since February 2010 – not least the integration of health and social care services.

This document replaces previous guidance on engagement, and represents real partnership working in action. Its content has been produced by people from right across the health and social care spectrum, and it will continue to develop as experience of collaborative community engagement grows.

Planning with People is co-owned by The Scottish Government and COSLA.

Although not legally binding, this guidance supports organisations to deliver their existing statutory duties for engagement and public involvement. Organisational leaders should therefore regard effective engagement as a priority.

This guidance applies to all care services – for children, young people and adults. It should be followed not only by health and social care providers but also by local, regional and national planners, Special Boards and all independent contractors and suppliers such as care homes, pharmacies and general practices.

To be heartfelt and effective, engagement cannot be prescriptive. So Planning with People represents a new way of doing things. It promotes consistency, culture change and true collaboration and encourages creativity and innovation, based on best practice. Putting people and communities at the centre of the process delivers the best results.

Planning with people sets out how members of the public can expect to be engaged by NHS Boards, Integration Joint Boards and Local Authorities. Recognising all the good work that is taking place, the guidance is designed to complement and strengthen organisations' existing engagement strategies. It also encourages close working between bodies to minimise duplication and share learning.

Reflecting the spirit of partnership, and to be inclusive of community members who might wish to refer to it, the language used in this guidance is deliberately accessible and jargon-light. Scotland's Health and Social Care Standards use 'care' to encompass both health and social care, so this terminology is used throughout.

The guidance has been developed during the COVID-19 pandemic, which has transformed methods of engagement. Digital approaches, including the use of social media, are fast being adopted and Planning with People acknowledges that trend.

It is important that guidance on community engagement evolves with experience, and there will be dedicated forums where people involved in consultation and engagement activity can share their learning and ask questions. Case studies will illustrate best practice and capture impacts on communities and engaging organisations.

Planning with People will be reviewed in January 2022 and refreshed in the light of experience. Please share your feedback –

Defining community engagement

In order to be effective, community engagement must be relevant, meaningful and have a clearly defined focus.

NHS Boards, Local Authorities and Integration Joint Boards should engage with the communities they serve following the principles set out in the National Standards for Community Engagement.

This defines community engagement as:

'A purposeful process which develops a working relationship between communities, community organisations and public and private bodies to help them to identify and act on community needs and ambitions. It involves respectful dialogue between everyone involved, aimed at improving understanding between them and taking joint action to achieve positive change.'

Purpose of the guidance

Effective community engagement and the active participation of people is essential to ensure that Scotland's care services are fit for purpose and lead to better outcomes for people.

The Scottish Government and COSLA have developed this guidance to support greater collaboration between those making decisions about care services in Scotland, those delivering services, and people in communities who are affected.

This guidance supports public service planners, commissioners and providers to consider how to continually improve the ways in which people and communities can become involved in developing services that meet their needs.

To achieve meaningful and effective engagement, leaders must demonstrate a commitment to it and take action to embed it within their organisations. As well as improving practice, this guidance supports existing legal obligations for engagement and participation.

Engagement that takes place routinely helps to develop trust between communities and public bodies, fosters mutual understanding, and makes it easier to identify sustainable service improvements.

Using the guidance

The guidance is intended for use by people who are experienced in engagement, and those who are new to the field. The purpose is to promote ongoing learning and development.

The guidance applies where decisions are being made about the planning or development of care services. It complements and supports existing local engagement plans, providing a foundation of shared principles that Integration Joint Boards, Local Authorities and NHS Boards can adapt to meet specific needs.

Organisations involved in developing integrated care services in Scotland are expected to follow relevant aspects of the guidance as they plan future engagement activities.

The guidance must be understood and adopted by all stakeholders, and there are key roles for NHS Chief Executives, Chief Officers in Integration Joint Boards and Local Authority Chief Executives who must ensure that engagement is undertaken effectively.

Key statutory responsibilities involving engagement, such as Joint Strategic Needs Assessment and Strategic Commissioning Planning can sometimes be met in the letter of the legislation but not the spirit of the legislation. Organisational barriers to 'walking the talk' must be identified and addressed by effective leadership.

In recognition of health and social care integration this guidance updates existing guidance and replaces Chief Executive Letter 4 (2010) for NHS Boards.

The established major service change decision-making process for NHS Boards remains unchanged.

When to use the guidance

This guidance aims to improve general understanding of what 'effective community engagement' means in relation to the development of care services. Supported by more detailed information, tools and resources, it can be used to develop organisational culture, act as a good practice guide and extend staff training.

It can be applied in any context where community engagement might inform service planning, from large-scale to local initiatives. Key steps in the community engagement process that should be followed in any engagement cycle are outlined below, and more detail can be found in Part 3 - Supporting Information.

NHS Boards, Integration Joint Boards and Local Authorities should explore the opportunities for joined-up engagement activities. Where a number of organisations are undertaking community engagement in a local area the engagement activity should be aligned, where possible. This can help reduce 'engagement fatigue' among communities.

Organisations should work collaboratively to draw on their existing collective expertise and infrastructures to support community engagement. For example, there will be parts of Health Boards and Local Authorities with a strong track record of engaging with specific communities and this knowledge should be shared.

Before embarking on the community engagement improvement journey, it is important for organisations to objectively assess how they currently involve and engage with people. Tools to support honest self-reflection can be found in Part 4 – Policy, legislation and principles.

Policy and legislative context

This guidance has been developed in response to the Ministerial Strategic Group for Health and Community Care Review of Progress with Integration of Health and Social Care (published February 2019), which urges an increase in the pace and effectiveness of integration across Scotland. That includes a proposal to develop revised guidance on local community engagement and participation based on existing good practice, to apply across health and social care bodies.

NHS Boards, Integration Joint Boards and Local Authorities all have a statutory responsibility to involve people in developing and delivering care services.

All relevant public bodies are expected to demonstrate how they are engaging with communities, and to evidence the impact of engagement.

This guidance takes account of relevant recent policy drivers and legislation (see Part 4) and promotes a shared understanding among Scotland's care planners and commissioners to support consistently high-quality engagement with communities.

- Statutory duties of community engagement

The duty to involve people and communities in planning how their public services are provided is enshrined in law in Scotland. This guidance supports care organisations to meet their legal responsibilities.

NHS Boards are bound by duties of public involvement set out in the NHS (Scotland) Act 1978 as amended by National Health Service Reform (Scotland) Act 2004.

For Integration Joint Boards engagement and participation duties are specified by the Public Bodies (Joint Working) (Scotland) Act 2014. Integration Joint Boards are expected to apply this guidance and work with colleagues in Health Boards and Local Authorities to share learning and develop best practice.

The duty to involve people in the design and delivery of care services was strengthened with the introduction of the Community Empowerment (Scotland) Act 2015.

Participation is also a key element of a Human Rights based approach, which requires that people are supported to be active citizens and that they are involved in decisions that affect their lives.

Assurance, support and oversight

Healthcare Improvement Scotland and the Care Inspectorate have statutory responsibilities to assure and support improvement in the quality of care services. Where appropriate they collaborate in the delivery of these duties.

Healthcare Improvement Scotland – Community Engagement (formerly the Scottish Health Council), has a legal duty to support, ensure and monitor public involvement in respect of health services across NHS Boards and Integration Joint Boards.

The Care Inspectorate is responsible for inspecting and improving social care and social work services and regulates all registered services for adults and children.

Healthcare Improvement Scotland and the Care Inspectorate are working with stakeholders to develop a Quality Framework for Community Engagement. This will support NHS Boards, Local Authorities and Integration Joint Boards to carry out effective community engagement and demonstrate how these organisations are meeting their statutory responsibilities to engage. In addition the Quality Framework will provide opportunities to develop practice and share learning.

In partnership with other scrutiny bodies, Healthcare Improvement Scotland and the Care Inspectorate also carry out joint strategic inspections for care services of NHS Boards, Local Authorities and Integration Joint Boards. These inspections examine how integrated services are planned, commissioned and delivered to meet people's needs, and meaningful engagement is taken into account.

Healthcare Improvement Scotland and the Care Inspectorate both work to the Health and Social Care Standards in their scrutiny and improvement activities. The rights of people to be involved in decision-making regarding the provision of care underpin the joint standards, which also require people to be supported to participate fully.



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