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 2 - Engaging With People

This guidance supports NHS Boards, Local Authorities and Integration Joint Boards to build strong two-way dialogue with the diverse communities they work alongside and serve.

Engagement should not be a one-off event or only used for high-profile projects. High-quality and ongoing community engagement builds relationships and trust.

Individual engagement projects must be planned as part of the organisation's wider engagement strategy. Leaders must commit the necessary resources - people, time and money.

It is important that community groups are involved throughout the development, planning and decision-making process for service change. Involving representatives of communities to the engagement planning team at the earliest possible stage informs an effective approach.

The purpose of engagement will influence the methods to be used, and in most cases a range of different engagement tools will be necessary to reach the right people. Further information is attached in Part 3 - Supporting information.

Healthcare Improvement Scotland - Community Engagement can provide advice on the type of involvement it would expect to see for proposed engagement by health bodies. It can give views on similar work and best practice elsewhere, support meaningful engagement to take place at a distance, and offer guidance on the evaluation process.

The Participation Toolkit published by Healthcare Improvement Scotland – Community Engagement also provides detail on a range of engagement methods, tools and best practice.

Alongside Healthcare Improvement Scotland – Community Engagement, the Care Inspectorate can provide advice and guidance on community engagement to local authorities and Integration Joint Boards through its link teams.

Link teams recognise multiple services of different types, and the need for regular planned contact to discuss emerging issues. They consist of a strategic inspector, responsible for scrutiny carried out at authority or strategic partnership level; a relationship manager for adult care services and complaints about care services; and a relationship manager for children's care services and registration.

Digital engagement – pandemic learning

The onset of COVID-19 inspired greater collaborative working across all health and social care organisations, and a more joined-up approach in terms of communications and engagement has been evident.

Due to COVID-19 limitations on face-to-face meetings and events, organisations have had to adapt their approach to engagement and have used digital technology, including social media, more than ever before. Although digital technologies will not meet everyone's needs, a growing number of people find digital engagement easier.

Organisations have worked together to develop digital-first approaches to engagement and detailed guidance is being drafted, drawing on the pandemic experience.

Healthcare Improvement Scotland has completed an Equality Impact Assessment of a digital-first approach to community engagement which will be of value in planning and designing such activity.

Healthcare Improvement Scotland produced Engaging Differently for digital engagement during the pandemic.

Steps to good engagement

The National Standards for Engagement set out a staged approach to the engagement journey. Each step in the process is underpinned by principles that should be followed in order to demonstrate good practice.

All steps are important and should be applied proportionately to the scale of the activity and level of change proposed.

Links to more detailed implementation guidance can be found in Part 3 - Supporting information.

This Engagement cycle diagram explains the seven steps to effective engagement with members of the public when planning service change. These are detailed more below
  • Identify the issue Clarity about the reason for engagement is essential. Shared understanding of the objectives will inform the planning process and determine the engagement methods to be used, maintaining focus throughout. Rigorous and wide-ranging impact assessment is vital.
  • Identify stakeholders who may be affected by the issue It is important to identify all groups and individuals within the community who will be affected, or who might have an interest in the decision being made. Recruiting representatives of communities to the engagement planning team at the earliest possible stage informs the process and helps to ensure an effective approach.
  • Plan engagement Identifying the best approaches to reach the people whose views need to be shared is vital. Involving community representatives from the outset of planning, and encouraging their ideas, results in better engagement and robust and sustainable outcomes.
  • Engage those potentially affected Routinely assessing the impact of engagement activity ensures that the right people are being involved, and their experience is monitored. If original goals are not being met additional support may be necessary, or other methods used.
  • Evaluating engagement Ongoing evaluation of engagement improves project and programme management by allowing review and reflection. It helps to monitor progress towards the goals outlined at the planning stage and improves accountability by fully reporting what is being done and what is being achieved.
  • Decision-making Throughout the engagement process, decisions will need to be made and community representatives must be involved so that robust, evidence-based and person-centred outcomes are achieved. When engagement activity concludes it is NHS Boards, Integration Joint Boards and Local Authorities that must approve or reject recommendations. The quality of the engagement process will be taken into account.
  • Feedback Keeping participants informed about the progress of engagement is an important part of the cycle and should take place throughout. When decisions are reached, speedy information should be provided explaining the impact of community engagement on the outcome. Views should be sought from communities on the effectiveness of any engagement to encourage two-way feedback and learning.

Governance and decision-making

NHS Boards, Local Authorities and Integration Joint Boards are required to make decisions about how any changes should be taken forward.

Although there are separate processes each must follow, they are the public bodies that must decide on proposed service changes and developments. In all cases, the decision-making process must be transparent and clearly demonstrate that the views of communities have been taken into account. Organisations will be required to show that these principles are embedded in their practice.

Healthcare Improvement Scotland – Community Engagement has a statutory role across NHS Boards and Integration Joint Boards to support, ensure and monitor patient focus and public involvement activities relating to health services. NHS Boards and Integration Joint Boards should therefore keep Healthcare Improvement Scotland – Community Engagement informed about proposed service changes from the earliest possible stage.

NHS Boards and Integration Joint Boards should have 'engagement leads', members of staff who can provide relevant links.

The Quality Framework for Community Engagement, developed by the Care Inspectorate and Healthcare Improvement Scotland, is aligned to this guidance. It supports NHS Boards, Integration Joint Boards and Local Authorities to meet their legal duties with regard to community engagement, and to continually improve their engagement practices.

The Quality Framework is designed to support both self-evaluation and external quality assurance and improvement activity in relation to routine engagement; specific engagement activities (such as major service change); and organisations' internal governance systems for community engagement activity.

The framework will be used to identify and support improvement in community engagement practice, as well as identify and share good practice.

The decision-making process for NHS major service change is unchanged.
Scottish Ministers will continue to make the final decision regarding whether to approve proposed service changes by NHS Boards that will have a major impact on people and communities.

NHS Boards will continue to make most decisions about how health services should be delivered locally. The outcome of community engagement and other relevant information must inform these decisions.

Integration Authorities were established under the Public Bodies (Joint Working) (Scotland) 2014 Act and include Integration Joint Boards and, in the case of Highland, lead agency partnership agreements. The Act does not identify a process for engagement that must be adhered to for community engagement. It recognises that Integration Joint Boards will have the local knowledge to undertake engagement that best suits their local population.

Local Authorities are responsible for the provision of a wide range of public services. There is no requirement for these bodies, led by elected councils, to adopt a particular decision-making and scrutiny structure. Each council decides the most appropriate structure suited to its particular circumstances and must be transparent about decisions made and the quality of services provided.

Local authorities work with other public bodies to deliver services and are required by law to deliver an integrated approach, along with care providers, through Health and Social Care Partnerships. They are expected to work together to develop common engagement approaches.



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