Could changes made during lockdown support continuous and co-produced engagement?
Yes. A lot of local decisions like healthcare and transport will now be engaged on retrospectively. This offers an opportunity for experience-led, on-going co-production, but risks challenging trust in the engagement process if residents feel the decision is done and dusted because it’s already been implemented by trial.
We’ve developed an approach to engagement to meet this challenge available here. This article offers a summary of some of our reflections and insights when developing this offer.
In the last three months society has had one collective interest; defeat COVID-19. The public have had one action; stay at home. The government, local councils and health and care systems have taken a range of actions including drastic changes to services that would normally involve lengthy public engagement and consultation prior to being implemented. For the most part, even highly engaged citizens will feel this lack of discussion is acceptable in a crisis. But what happens now? Will normal engagement service be resumed, or might public authorities have got a taste for ploughing ahead without the hassle of asking people what they think?
We don’t yet know what the long-term impacts of the lock down will be for society and the way organisations engage their citizens and service users in change, but we’ve been thinking about three factors at the heart of involving the public:
Change is often initiated from a sense of urgency and/or dissatisfaction with the current situation. Tackling COVID-19 is a clear and urgent objective that has united society in the short-term, but will it have long-term implications for our priorities and thus what the state – local and national - wants to achieve through service provision?
Yes, if we look at current health and transport plans in London. The Health Service Journal reported NHS London plans which highlight how the experience of COVID-19 is changing local healthcare objectives, as meeting patient need could now involve maintaining system infrastructure needed to sustain readiness for future pandemics.[1] Londoners are encouraged to not use public transport, and the London streetspace[2] strategy has been designed to enable a ten-fold increase in cycling and five-fold increase in walking. The guidance against public transport is temporary, but the resulting emphasis on cycling and walking could enable investment and infrastructure changes that last beyond the crisis.
Like encouraging walking and cycling, the objective of reducing inequality has long been ‘a good thing’, but has been thrown into sharper relief by COVID-19. The crisis has shown how a pandemic can impact everyone but not impact everyone equally. Could this pull ‘reducing inequalities’ up the agenda when it comes to redesigning services? The Health Foundation argue that a new social compact is needed, backed by a cross-departmental health inequalities strategy[3].
The RSA have developed a matrix to make sense of the decision-making made during a crisis and what it means long-term. They argue that changes can be categorised in four ways: stopping activity, pausing activity, temporary measures, and new innovations. Thinking about local change within one of these four ways can help us focus on what’s worked and what should last[4]. The RSA model can be helpful for organisations as they reflect on the changes they have made and need to decide what to end, what to amplify, what to let go and what to re-start.
If we apply this model, and the changing needs of the public to decision making – does this change what we ask the public when we involve them?
Normally, you engage and consult before doing something, and now we’re consulting afterwards; does this make any difference?
Yes, we think it does. Engaging after a change has been made impacts one of the primary challenges with engaging the public ; that people often favour the status quo for a range of reasons[5]. The benefit of engaging people once a change has been made is that they get to react to their actual experience rather than their assumptions about how it will feel. We can see councils and some health systems doing this now, using online platforms like Commonplace and Engagement HQ to gather residents’ views about existing temporary changes before deciding whether they should be extended and prolonged. This is an approach that we are familiar with from our evaluation work – much of the work we do is formative evaluation that is designed to enable policy makers and delivery teams to learn what work works from doing. The NHS Plan Do Study At model[6] is a useful framework for using ‘doing’ as an opportunity to learn.
So– should this be the way we test out change going forward? Crisis or not, is it better to have a go at something – temporarily and as economically as possible – so that people can see how it works before you ask them what they think about it?
Possibly – although some changes are harder to ‘trial’ than others. It would fundamentally change the nature of engagement about potential change, as it would enable people to talk about their experience rather than their assumptions about impact. This in turn might make it easier to involve the public in more nuanced, impactful co-design and co-production.
In our view, engagement is at its most impactful when citizens get the opportunity to genuinely shape a service in a co-produced way and have the opportunity to stay involved. Could engaging citizens after an initial decision has been trailed support this approach?
On-going engagement could be supported by an online platform that supports citizens to continually feedback on the new health service or cycle lane. Co-production could be supported by enabling citizens to experience the change in real life, and compare to the previous system. Then, engagement practitioners can support citizens to produce amendments or reversals.
With this in mind, we have developed an approach to engagement moving forward that is informed by four factors; inclusion, shared narrative, deliberation and strategic support.
[1] https://www.hsj.co.uk/coronavirus/exclusive-fundamental-changes-to-londons-nhs-in-wake-of-covid-19/7027606.article
[2] https://www.hsj.co.uk/gloucestershire-hospitals-nhs-foundation-trust/trust-to-temporarily-downgrade-aande-amid-concerns-of-permanent-move/7027760.article
[3] https://www.health.org.uk/publications/long-reads/will-covid-19-be-a-watershed-moment-for-health-inequalities
[4] https://www.thersa.org/discover/publications-and-articles/rsa-blogs/2020/04/change-covid19-response
[5] http://pastatenaacp.org/wp-content/uploads/2017/03/Beckhard-Harris-Change-Model-DVF.pdf
[6] https://improvement.nhs.uk/documents/2142/plan-do-study-act.pdf
