Our rallying call on what really constitutes meaningful ‘engagement’. Why is so important and how could it be done better, in the health sphere, but also more widely. This follows our CEO Glenys Thornton attending and speaking at Healthwatch England’s annual conference in Nottingham on the value of engagement.
The value of engagement in the health sphere is widely recognised in improving health and wellbeing as well as reducing health inequalities. The NICE report of 2008, The King’s Fund report of 2012 and the 2014 Five Year Forward View report all provide comparable statements about its importance. Meaningful engagement has the power to harness the assets of civil society. As our report, The NHS and Civil Society (2013), states:
We believe that the NHS needs to access the strengths of civil society [and people and their assets] to do its job in the 21st Century… It needs to listen to and understand patient’s lives; it needs to enable patients, families and communities to support their own health; and it needs to coordinate care with the powerful informal networks that surround individuals. Without support, cooperation and engagement of civil society [and local people] this will not happen.
Yet, the lack of substantial engagement in health service practice is noticeable. The use of ‘engagement’ in health service materials is not usually questioned, but token engagement is easier than real engagement. Having become a buzzword of sorts, it frequently appears as just another tick box on the list of things to include in every project. This has become especially prevalent given the tension between wanting to design services ‘in the right way’ while dealing with the immense pressure to turn around projects and realise savings quickly in the midst of austerity. It is also due to a ‘culture of experts’ underlying the NHS that tends to elevate professional voices over others, leading to a frequent imposition of solutions and structures on communities and their individuals.
However, if the NHS is to deliver the systemic transformations it seeks then it needs to address these issues and take a deeper look at what effective engagement means, and not just employ engagement for its own sake.
So how we can do it better?
- Put communities at the forefront of change. Our recent publication, Transforming Health, sets out how we can achieve this. Health creation isn’t about “doing health to people”, nor is it about telling them what to do in order to be healthy and prevent disease. It’s about empowerment and fostering community agency. Health creation is about walking alongside people with humility and at their pace to discover the realities of their lives in relation to their health. Using a health creation approach means working with them to generate new ideas that they will drive to create better health. It’s radical because it isn’t easy or straightforward, but it’s important and necessary. We believe that with the right support and facilitation, the answers to our health crisis lie with communities themselves.
- Sitting uncomfortably? Practice patience. History has shown us that change is a difficult process. The key way to practice real transformation, that leads to people and communities creating, for themselves, health and wellbeing, it to appreciate and accept that real and meaningful engagement is slow and messy. It takes times to trust and learn about people’s stories so you can truly understand them beyond their place on a statistics graph. But this is important and necessary if you intend to go beyond superficial solutions.
- Look outside the traditional institutional context. Our focus on engagement, and its subsequent frame of reference, becomes problematic as it leaves out various forms of citizen action. Some of the most radical activity happens outside of an institutional context. As Andrea Cornwall in the Demos publication Democratising Engagement points out, there are spaces that people create for themselves that have an entirely different character from most invited spaces. People collaborating to share resources or information via online networks or informal community groups, for example, are ‘engaged’ although not formally considered part of the engagement process.
- Showcase how meaningful engagement creates tangible benefits for people and communities. To do this we need to build up, over time, an evidence base highlighting how engagement increases community agency, and how that leads to tangible results such as demonstrable community-led change. Engagement also increases the wellbeing of those who participate by raising their self-esteem and building their resilience. There are also broader economic benefits if we get it right. Building this evidence would better generate momentum and support for such initiatives in the long term.
- Disrupt established systems of power. Token engagement ends up benefiting the engagers more than the engaged. A tokenized individual becomes a tool of the powerful, hiding behind the language of engagement. Meaningful engagement challenges this by recognizing the complexity of these issues with humility, as well as attempting to disrupt established systems of power, shifting influence and resources to those with whom you are engaging so they can be the ones leading change while we step back to let them take the platform. We must also actively acknowledge and tackle barriers such as unequal power structures, inequalities and relationships which takes away people’s individual and collective agency.