Going rogue

Posted 15:37 Wednesday 1 November 2017
Maxine van Bommel

Maxine van Bommel

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Last month, we held two workshops (in Leeds and London) with NHS Trust staff to gauge what these organisations are doing with membership, engagement and local accountability given that authorisations of new Foundation Trusts have seemingly ceased (or at best slowed down significantly). The workshops were part of our preparation for writing a new edition of our Membership Bulletin (released in November) which will focus on the future of public and patient engagement for the 80 remaining NHS Trusts. Here our Research Associate Maxine (who was at both events) gives her views on what we heard…

Within the context of an unfathomable deficit, ever changing healthcare landscape, and do I dare mention the “B word” (Brexit), it’s no surprise that NHS Trusts are struggling to maintain, let along engage with, their membership.

Despite dropping numbers, NHS Trust membership sizes are still anywhere up to an astronomical 50,000. In addition, memberships are often managed by one-man bands in under-resourced departments, with many having barely enough funds to disseminate mass one-way communications, let alone healthier two-way embedded dialogue. Some trusts have no choice but to eliminate postal communications all together; the result of the budgetary axe coming down in all parts of a trust.

Yet, despite ongoing hardships and understandably somewhat minimised motivation to maintain their membership, most non-FTs we spoke to indicated that they would continue to maintain their membership, irrespective of the FT model’s stuttering status.

Unequivocally caught in NHS limbo, many have taken precautionary measures of their own.

Merging membership with other departments such as communications or patient experience are common strategies, paired with changing job descriptions to protect future employment. Removing membership as a strategic objective has been a direct approach by some, while others have taken a milder approach and have trimmed their membership charter or removed FT wording from their communications.

Not yet ready to throw in the towel and with a feeling that public involvement remains a central pillar to strong governance and better healthcare (see The Francis Report), despite barely keeping their heads afloat, the overall consensus is that there remains an untapped value in their current membership and that the need to listen remains. They also represent a significant investment of time and money, and a return on that investment is still available.

But have they actually potentially dodged a bullet, some ask?

Without being pinned down by FT regulation on membership and public involvement, but still fully armed with established engagement channels and a good understanding of the value of engagement, are non-FTs perhaps in a position to circumnavigate some of the all too common membership model woes? 

For starters, many trusts indicated while having a ready audience is useful, engaging with their current membership was challenging due to its sheer size. Keeping tabs on a transient and diverse population is a monster of a task in itself.

Instead, can we focus on maintaining a smaller, representative and albeit perhaps more engaged membership? Can we focus less on the numbers and those early ambitions set out by the Department of Health and Monitor?

Other trusts indicated that the focus on accountability was unrealistic. Explaining this concept to patients and the general public remains a struggle, not to mention translating this into boardroom lingo.

Instead can we talk to our membership about tangible things, the day to day, specific services or something they actually relate to?

Having to consult on macro level strategic decision making was also mentioned. Consulting about matters already decided reinforces apathy and discourages future participation.

Instead, can we get real and talk about things that patients and public have actual influence over?

Whatever the outcome may be, there really is no going back when it comes to public engagement. Now, more than ever, non-FTs will have to innovative to tap into one of their most invaluable assets. 

We explore the subject in more detail next month so watch this space.  Our next Membership Bulletin “Beyond FT status: The future for engagement, involvement and local accountability in NHS Trusts” will be published on November 7 at this year’s NHS Providers conference in Birmingham, and more widely thereafter.

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