With Sustainability and Transformation Plans (STPs) drafted and some areas starting to publish their plans, attention is swiftly turning to their implementation. There are questions about the extent of stakeholder engagement in the process, not least of which the involvement of patients and the public. The public are already aware of some elements of the debate. They know that the NHS has challenges and three quarters (74%) are worried about the future of the NHS. However, they are largely in the dark about STPs and the changes they might bring: our latest survey shows that just 14% of the public have heard of the STP for their area.
And yet, 44% of the public (who gave an answer to the question) want to have a say in the STP for their local area, and a further 39% think that, while they are not personally interested, it is important for people to have a say in their local area’s STP. Just 17% are happy for the NHS to develop the STP for their local area without people having a say.
With early indications suggesting that some STPs will involve significant reconfigurations, lessons from the past clearly demonstrate that this limited patient and public engagement needs rectifying, and quickly. Regardless of the (debated) potential economic and clinical benefits that may result from STPs, the prospect of changing local hospital services is one that has the power to get the public marching in the streets. Hospitals are the clearest symbols of the NHS: they are solid and tangible, it’s where you go if you really need the NHS. Public anger around changes to these services can be substantial and leaders of previous reconfiguration attempts will doubtless remember the hostile, and sometimes abusive, public consultation meetings they have had to endure.
Public backlash to the STPs and potential reputational damage is clearly something the footprints will want to avoid. So, how should STP leaders manage this public reaction? Here are our suggestions drawn from our research and consultations with the public.
Think carefully about how to frame the debate: Generally we suggest that early dialogue is key for co-creating a way forward. In the past, where reconfiguration decisions appear to have been presented to the public as a fait accompli from the outset, there has been a particularly potent adverse reaction. Indeed, in previous research a leader of a “save the local hospital” campaign once told us that their belief that the reconfiguration plans had been presented as a done deal played a key role in later events:
“it was a good thing – as it got us riled enough to get the campaign group going.”
Clearly, very early dialogue is not going to be possible for many STPs given the speed with which they have moved. But STP leaders still need to think carefully about how to frame the debate and where people can be meaningfully engaged. What areas are still up for grabs, or might some level of change still be possible? Where would understanding the patient and public view support implementation of an STP? What areas need further detail and how could patient and public involvement support the development of that detail?
Be open and honest about the challenges ahead: The public increasingly recognise the challenges for the NHS: 84% think the NHS will face a severe funding problem in the future, and only half agree that the NHS is changing so it can provide the service we need for years to come (49%). Despite this, they do not yet fully accept the case for change: two thirds think the NHS should be given more funding so that it can continue to provide services in the same way it does at the moment (65%). Local leaders still need to articulate the severity of the financial situation to help move the accepted narrative towards one that recognises the need for change.
Recognise the emotional connection and explain the benefits clearly and rationally: The public will often react on an emotional level when presented with a perceived threat to their health services. Yet the public do appear to accept the principles behind reconfiguration. For instance, our data suggests that, in a hypothetical scenario, three fifths would choose to be treated at a specialist hospital rather than their local hospital, even if they have to travel further (62%). So a simple argument about what is being gained, focusing on the clinical benefits, needs to be a central part of the communications around any change. This is particularly true while we are still at the point of the public not entirely accepting the need for change: engagement that focuses predominantly on the financial aspects will not be sufficient.
Think about who you need to communicate with: Despite the noise generated by a public consultation, representative surveys will show a much lower level of anger among the local population at large. Clearly, it is important for local leaders to be sensitive to the concerns and anger that are felt by local residents. But equally it is important they don’t over-generalise the reactions they are hearing through the consultation process: if local leaders want to run an effective engagement and communications process, they need to understand precisely who is angry and why, and make an effort to hear from the ‘silent majority’. They also need to engage with minority groups who are otherwise unlikely to have any say in local changes.
Think about how you engage the public: As STPs are implemented, the NHS and its partners may need to look to new and more innovative ways in how they go about engaging local opinion. For instance, when talking to organisations about previous reconfigurations, one had given the local campaign groups half the seats on its planning group; and after agreeing confidentiality ground-rules, shared all the relevant in-house information relevant to the plans. The release of joint press releases was a key factor in bringing down the temperature of the local media coverage.
Proposed changes to hospital services do clearly appear to serve as something of a lightning conductor for public anger. But STP leaders do have some influence over how that public reaction develops. By framing the debate positively, by arguing the case and presenting the evidence in an open and honest debate, STP leaders can help build a local coalition through which they can work out how best to implement their plans.
Technical details: Fieldwork was carried out over one wave of the Ipsos MORI Online Omnibus, and took place between the 9th and 13th December 2016. Data are based on 943 completed surveys. All respondents were based in England and were aged 16-75. Data are weighted by age, region, working status and social grade within gender to be representative of the population.