Engaging with all communities
4. How are you doing in genuinely engaging local communities, including those seldom heard, in determining what you do rather than commenting on your decisions?
This question is about fulfilling the NHS's duty to enable people to influence what happens to themselves, their families and their communities. It is about going beyond your engagement with individual service users on matters of day to day delivery to engaging with communities on issues about wider health needs and how services are organised to meet those needs. This will help to develop a sense of belonging to a locality that is vital to community cohesion. In many communities the process of community engagement needs to go beyond the identification of needs and issues. It is actually part of the approach to delivering solutions through community development and outreach work.
Self assessment questions
- Have you and your LSP partners identified all the diverse communities within the area you serve?
- Have you discussed with each of those communities how you can best engage with them, recognising that innovative approaches may be needed to engage with seldom heard groups?
- Have you implemented methods of engagement based on those discussions?
- Do you encourage methods of engagement that bring together people from different backgrounds wherever possible?
- Are you developing a constructive relationship with the new Local Involvement Networks in your area?
- How do you ensure that you are listening to all sections of the community and taking account of their comments?
- Who sets the agenda for engagement with communities?
- How often do you change decisions as a result of community engagement?
- How do you make sure that people know what action you have taken as a result of community engagement?
- Are you aware of potential friction between different communities and how do you address those frictions?
- Do you recognise the value of community engagement as part of the approach to addressing needs (i.e. through community development work)?
- Are you aware of how new initiatives, such as patient choice, impact on all the different communities in your area?
Some examples of good practice
Many examples of good practice in engaging with communities (particularly seldom heard groups) are described in the following publications: 'A dialogue of equals' (Department of Health, 2008); 'Community engagement and community cohesion' (Joseph Rowntree Foundation, 2008); 'What works in community cohesion' (CLG, 2007); 'Community cohesion: seven steps: a practitioners' toolkit' (Home Office and ODPM, 2005) and 'Community cohesion: an action guide' (LGA, 2004). The first of these contains, in chapter 2, a helpful discussion, based on Arnstein's ladder of citizen participation, of how to move through different levels of participation from Informing, through Consultation, Co-production and Delegated control to Community control.
Derby City PCT, supported by the Centre for Innovation in Health Management at Leeds University, has established a project which aims to create a dialogue with communities. This is with the aim of developing a better understanding with local communities about respective roles and responsibilities and involving people in co-producing solutions to health issues affecting their communities. The project also aims to create greater involvement of the local people in the commissioning process and to raise the value that communities put on their public sector services. The work is being piloted in two areas: One of these is Normanton which is a very diverse community including a longstanding Asian community and regularly receives new migrant communities. The project has identified tensions between the established and new communities and is addressing these by considering new approaches to supporting the new entrants in understanding the area they are entering and how the existing services can be used. The second area is Sinfin, a fairly isolated and fragmented community of mainly white working class people with high rates of premature mortality. In this project, community development and health workers are considering what is important to the residents in this area and supporting them to consider how they can promote healthy living. They are also planning a 'Health carnival' as a promotional event involving all the local communities.
In Coventry the Community and Voluntary Sector Empowerment Network provides support to new arrivals in the city. Peace House demonstrates the value of working inclusively; enabling refugees and asylum seekers to self organise and address local issues in the context of wider international events. The Eve group, which is part of the network, provides valuable support to help women to challenge the dominance of men's voices and enables them to speak for themselves.
Translation or promotion of English speaking
The question of communicating with people who do not speak English as their first language has been controversial in the past, but there are signs of a consensus emerging. Opinion was divided as to whether translation is a barrier to integration, or whether it is a stepping stone to better language skills. In 'Our shared futures' (2007) (Annex D), the Commission for Integration and Cohesion argued that:
"Local Authorities and their partners should consider moving from a position of automatic translation of all documents into community languages, towards a more selective approach - driven by need, and set firmly in the context of communications strategies for all residents."
The Commission found that some public agencies were automatically translating documents into community languages with the best of intentions but without really considering the need for it. They recognised that language barriers can perpetuate inequalities.
"Taking health services as an example, if people don't know how to access services, they may not get the care they need. Even if they go to the right doctor, without good English they might not get the right diagnosis, or understand it, and may not take the treatment prescribed. But that does not mean automatic translation into community languages of the majority of public documents is the answer".
They recommended a series of questions for local partners considering what and how to translate:
- "Is it essential that this material is translated?
- If so, does it need to be translated in full?
- Are you using the right data to select the languages to translate this material into?
- Have you considered the cost/benefit analysis for this translation?
- Have you explored whether other local agencies might already have these materials available in translated form?
- Are there practical ways you can support people to learn English even while producing this translation?
- Are there practical ways you can keep up with changes within the community?
- Will this material be developed in a way that is accessible for all communities?"
An important aspect of the Commission's proposed approach is that courses in English for people who speak other languages (ESOL courses) should be widely available. Unfortunately we have found evidence in some parts of the country of severe shortages of ESOL teachers and pressure on the courses that exist.
An initiative to give young people a voice on major social issues was announced by Communities secretary Hazel Blears on 15th October. Two youth advisors supported by a panel of seven more young people will meet with the Secretary of State once a month to discuss issues ranging from youth homelessness and urban regeneration to community cohesion and the Olympic legacy. This builds on a series of schemes around the country to listen to young people in ways that suit them rather than using more traditional methods. Jane Brooker-Wood of IDeA has been involved in a scheme set up by Lancashire PCT. She says:
"Our Lancashire team are truly inspirational. Whenever you need the input of young people on how they should, could and now are involved in the review, assessment, planning and provision of health services, they're your guys!"
NICE has produced new guidance on community engagement and health. The guidance aims to support those working with and involving communities in decisions on health improvement that affect them (including the NHS, councils, the voluntary and community sector and private sector).
Involving disadvantaged communities is central to the national strategy for promoting health and wellbeing and reducing health inequalities. Community engagement activities can range from one-off consultation exercises through to longer-term activities, which allow communities to play a developed role in planning and delivery of services.
Camden Council has used neighbourhood renewal funding to commission the development of three training courses aimed at improving the health and employability of the community living in the West Euston single regeneration budget (SRB) area. These courses are open to all but are particularly aimed at the local Bengali community.
'Working our way to health' aims to improve diet, encourage physical activity and prompt smoking cessation of men living in Sefton. This will help to increase life expectancy and reduce incidences of coronary heart disease (CHD), diabetes and cancer. The programme targets men aged 35 and above, who may be unemployed, on incapacity benefit, acting as carers or in low-paid jobs in disadvantaged areas of Sefton. Areas targeted include Bootle, Seaforth and Dunningsbridge Road.
Fenland District Council in Cambridgeshire has been focusing on the needs of its traveller community. Older travellers have been provided with information on how to lead an independent life. Children are given details about education. Council staff have also been trained in cultural awareness to help them understand the needs of the traveller community better. A brilliant example, which allows travellers in Fenland to mix outside their immediate community.