Changes in structure
To
overcome the problems that were identified, respondents were asked
what should be developed, changed or put in place to make the
commissioning process work more effectively and efficiently.
By doing this it would develop the confidence of local groups,
increase their understanding of the decision making processes
within the health and social services and encourage groups to
articulate their needs and to participate in decision making around
health and social wellbeing issues. The suggestions are summarised
below.
Community involvement
Many
thought there should be some level of community input. They "have
to live with what ever is created … so if the system is not
working well, they will be able to say what is wrong with it".
Involving the community would increase their knowledge and understanding
of the commissioning process. However, it was perceived by many
that if communities were consulted at the moment, they would not
have the confidence, knowledge or skills to put their views across.
One
recommendation was that groups could be doing research on behalf
of the ‘bigger bodies’ to identify need but they have
to be given the personnel and the money to do so.
It
was evident that the communities need to involve the Board. The
technical expertise and knowledge would then be there yet they
would be more accountable to the wider community.
Several
expressed the need to include politicians in the process as they are the communities' elected representatives.
Community
involvement would result in the development of a new method of
consultation and interagency work with equality in the ground
rules and clear policies in commissioning and delivering by governments.
One respondent proposed the development of a local forum, based
on the extension of the GP Patient Groups with local groups and
providers being brought in. Another option was that the board
of the NHSSB, directors and a cross section of the community from
the area meeting on a regular basis.
Health and social care network
The
idea of a 'health' network was proposed by several as a means
of encouraging community participation in the process. This would
result in a collective voice that could be fed back into the Board.
Groups working together would help to alleviate information problems
by exchanging information, ideas and concerns. It is dysfunctional
to do your own thing.
The
network would need co-ordination and cohesion and several respondents
felt that this would be very difficult to achieve. Perhaps "this
could work out of the three Council areas, each having three health
and social wellbeing liaison committees and from these have a
nominated representative body who would meet face to face with
the Board representatives".
The
Board should be aware that they have community groups that can
act as a link between the Board and the community and if they
want information put out they can do it through the community
groups and the networks.
Multi-agency/group working
Greater
use should be made of voluntary organisations eg Anti-poverty
network, Northern Ireland Voluntary Trust, Northern Health and
Social Services Council, the local Councils and ‘grass roots’
health and social care workers to listen to the communities and
to act on what they say. They have a wealth of information and
experience of working with health and social care issues that
can be shared with community groups. However, it may be difficult
for health and social care workers to have an influence as they
may feel vulnerable due to the conflict of interest between the
community and the providers and purchasers of care.
Voluntary
groups, those delivering the services (as they know what their
resources are like), recipients of the service (as they know what
they want and can predict what resources might be needed) should
have an input. The level of involvement should be weighted by
the impact that health and social care has on them and their knowledge
and experience.
Direct contact with community groups
There
is a need to have a point of contact. For example, a person appointed
by the Board to deal with the communities and groups and that
the communities would know that what they said would get back
to the right person. Another alternative was that each department
should have somebody who can explain what the department does.
Health
and social care teams need to be more visible in the community.
Those that already provide a good service in the community should
tell the community what they do through presentations etc. Alongside
this should be the development of more practical teaching and
learning methods and not just the voicing of concerns and views.
Appropriate information using a variety of
channels
A
theme running throughout the study was the need to develop a common
language and mechanism that is clear and easy to access but "until groups
become very expert in their jobs and come up to speed, you are
leaving it very much in the hands of those who perceive or profess
to know most". It is like having two different cultures.
Work has to be done on this interface and relationships need to
be built on.
Seminars,
circulars and press releases that do not use Board jargon but
that have contact numbers and information on facilities included
and current channels of communication being used more effectively
eg radio programmes with regular half hour slots on health were
recommended. People should be invited to comment on papers, documents
and the use of public meetings but carried out in a new way to
encourage participation.
There
is a problem of getting feedback to central decisions and it was
suggested that the people at the top should come and work at the
bottom at some stage. Information needs to be in a clear understandable
language. The Health and Social Services is disjointed and if
a community group builds a relationship with the Trust, the Board
is a whole different organisation.
One
example given by a statutory worker was a ‘listening day’.
This involved having thirty to forty people in listening and talking
circles. The provider comes in and listens and the process can
be reversed when the community listens and the provider talks
ie there is a two-way communication process. The first person
absorbs all the comments and then the circle listens to the response.
This works very well .. people were more open about certain issues
than was expected. They were very interested in discussing their
issues and concerns. People are often so up tight at trying to
get their problems across that they do not listen because the
person they are speaking to is so up tight about getting policy
across that no-one ends up being satisfied. Half the problem
is opening up the channels so that the community has an opportunity
to articulate their concerns, plus the Board has the opportunity
to listen and respond appropriately.
Summary
The
majority of the community group and partners respondents felt
that the current method did not work or could be improved. However,
some respondents did not give an opinion as they felt they did
not know enough about the current system. This "new venture
shows that the Board is doing something". Some health and
social care workers and those working in the Causeway HSS Trust
felt that positive change had started to take place and good links
were being established with groups, providers and purchasers.
In
general, there is a need for a mechanism to be put in place that
is more inclusive, has a common language and encourages community
groups to articulate their views on health and social wellbeing.
There needs to be a clearer point of contact and a channel set
up where communities can collectively put forward their views
to the Board.
