Can the NHS meaningfully consult on its 5-year Joint Forward Plans?

This is Blog No 10

With service levels and public confidence plummeting, can NHS Managers in the new English Integrated Care Boards focus on the statutory requirement to devise, engage, and consult on all-important five-year plans?

By April 1^st?

Of course not. And to be fair, NHS England won’t expect them to. Optimistic legislators required a plan before each new financial year. But as this is a ‘transition year’, they now have till July 1^st.

It was Christmas Eve when Directors of Communications and those likely to be involved in the plan received Guidance PR1940 setting out what is expected of them in the coming months.

There are two ways to view this. Glass-half-full Managers will be glad that, in spite of panic, crisis and strikes, the NHS has focused on the important as well as the urgent and is giving attention to the need to garner public support for five years of considerable change in Health and Wellbeing. Glass-half-empty folk would have stared at the calendar and wondered what it says about forward planning if the Guidance appears just as most of its audience disappeared for several days of well-earned rest.

In a nutshell, Integrated Care Boards in England must produce a five-year plan of immense complexity by working closely with a large list of individuals and organisations that includes all their partners, service providers, neighbouring ICBs and their providers, local authorities, the voluntary, community and social enterprise sector, and basically all the public (on average about a million of them) who are covered by their services. It also has to do this in conjunction with Health & Wellbeing Boards (HWBs) – building on their Joint Local Health & Wellbeing Strategies (JLHWSs) which are informed by the Joint Strategic Needs Assessments (JSNAs)…before seeking approval of the Integrated Care Partnerships (ICPs) who will, of course, need to be assured that the views of the HWBs, Healthwatch and other stakeholders have been fully taken into account.

You will all get the drift, and believe it or not, apart from the acronyms, much of it is eminently sensible.

However, there are three critical ‘C’ questions that must be asked of the NHS right now:

1. Is there Commitment?

What would we all like NHS Managers to be concentrating upon right now? I once met a senior Manager who said she had been given over 20 ‘top priorities’. It is hard to expect the best and brightest of those who run our Health and Wellbeing services to devote but a proportion of their time and treasure to this task right now. Trouble is, the legislation and the bureaucracy make few concessions to what else is on the agenda at any one time. So what exactly is the management commitment? Will ICBs take this exercise really seriously, or will they secure some solid consultants, write a plan as best they can, and go through the motions of engaging with the stakeholder list and deliver a document that just about ticks the box. “After all, it’s the transition year.”

If Managers were honest enough to say that this would be the best they can do in the peculiar circumstances of 2023, they might be relieved of some pressure. After all it is the expectation that often damages us. Would it help to curb the ambition, recognise that this will be an iterative process, year on year, and agree a scaled back programme of engagement this time around? Or will we once again pretend to do the impossible and disappoint a lot of people?

2. Is there Capability?

Last October, another set of Statutory Guidelines emerged. BR1762 is called Working in Partnership with People and Communities and is akin to a comprehensive Toolkit of best practice on how the new organisation should interface with the huge range of stakeholders inherent in the Health and Wellbeing arena.

And excellent stuff it is too, particularly the Ten principles for working with people and communities. I particularly like the one about feeding back to people how their views have influenced outcomes, or the one about using ‘engagement’ to find out ‘if change is working’. Then there is the need for everyone to meet the Accessible Information Standard. And, of course rightly the requirement to use co-production.

How many within the NHS and top-tier Councils have these skills, or sufficient experience in using them?COVID19 and much else has drastically reduced the training available to Communications and Engagement teams, and there are many new recruits that are yet to absorb the basics, let alone the intricacies of community involvement.

I'm not aware that the NHS is planning a giant training programme, though I am confident that The Consultation Institute will certainly have relevant courses. Is there time? How many proficient staff will there be to meet the aggressive deadline of the five-year plan?

3. Is there Capacity?

Even where public engagement professionals of the right skills-set and calibre are available, are there enough of them?

In an average ICB, the engagement required for the five-year plan is not a job for one person – more likely for teams of three to five, with considerable emphasis on direct person-to-person interface with public and patient representatives, Councillors and of course, on substantive issues, clinicians, who, as we have noticed, have their hands full at the moment. Fortunately, there are experienced specialists out there, available for freelance or interim assignments. Shame that the very bosses who demand this work would also prefer not to employ any ‘contractors’ – without whom it may not even get done!

Let us not be too pessimistic. These are legitimate concerns, but there are many gifted people out there with a commitment to make good consultation a reality and to bring communities with us where change is needed. What we need is clear thinking to distinguish between the essential elements of the programme and the ‘nice-to-do’ parts. Digital technology is obviously one of the keys to the puzzle and using the best tools and processes can make a huge difference. If people start NOW, ask themselves the right questions, obtain the right help and secure enough – if not lavish – resources, there could be some genuinely exciting plans approved – that will benefit millions of people.

One final note of caution though. When we wrote The Politics of Consultation, Elizabeth Gammell and I found what is close to being a ‘golden rule’. If you have political opposition to any significant change of public life, they will always examine in detail whether the organisation seeking that change has observed the prescribed procedural requirements. And if it has not, they will base their challenge mostly on that ground.

The substance often gets less coverage, but process failures will attract huge attention.

In crude terms, screwing up the process can risk delaying major improvements to the NHS by years.

So, the pressure is on get this right.

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