Its a curious thing…

I’ve started this blog a few times as I reflected on a recent piece of engagement work for a public health department within a Local Authority. The curiosity I was considering was how a discipline steeped in issues such as inequalities could find the principle of engaging with people who use services, stakeholders, residents so difficult to execute. But perhaps it’s not so surprising coming, as they have , from the NHS where Commissioners were drawn kicking and screaming into meaningful engagement and consultation processes. By the way as if further proof of this I’ve just looked through the presentations to a local CCG ‘patient engagement event’…..and disappointed to see they are still pushing PPGs as the primary way to get involved in their decision-making process when there is so much good practice going on elsewhere myhealth

Perhaps the gap between theory and practice should have been filled by engagement professionals with a toolbox of evidence based approaches and practical tips to make it easy for commissioners. Actually I think much of the time they/we make it harder not easier. Talking to commissioners sometimes remind me of holidays in France when I’d spend ages preparing my schoolboy French to go and ask for something at the campsite shop and despite thinking I’d perfected the pronunciation I remained unintelligible until I drew a picture.

My reference point is simple; public services should be run based on the principle of as much public involvement as possible. Tax payers have a right to have a say and decision-making is better when it’s based on user experience. The commissioning cycle provides a framework to consider this;

Commissioning/engagement cycle

In the Local Authority I’m working in we have used this framework to plan for the engagement of young people at each stage

Activity Detail Action Timeline
Needs Assessment/Option Appraisal Consult via focus groups and surveys to establish the needs of the local community in regard to sexual health services.Target Groups:

  • Young people who are cared for and care leavers.
  • Young people with special educational needs or disability.


Andy Mills to provide discussion guidelines.Young Advisors to assist in facilitating consultation depending on availability.


TCS to facilitate consultation with cared for young people and care leavers.

10th October 2014
Procurement Evaluation Panels to meet to consider tenders Develop process to involve YA in scoring of tenders (interview process) Mid November
Mobilisation and Contract Management Service Users to provide o-going mechanism to ensure service meeting needs of clients Use techniques such as ;Mystery shopping to test experiences of services users Mobilisation from Jan 15, contract goes live July
Review See above

With thanks to Laura Goodfellow at the Children’s Society

If the comments above were about the ‘carrot’, then there’s a ‘stick’ too. Here are some areas where decision-making by public bodies has been challenged on the basis of poor public engagement or consultation. Known as the Gunning or Sedley principles after case-law from 1985, ‘consultations’ should be at a time when proposals are still at a formative stage, sufficient information should be provided to enable intelligent consideration and an intelligent response. Adequate time should be given for this purpose and the product of the consultation should be taken into account during decision-making.

So we can wait until the judicial process compels public health to engage with people who use their services, stakeholders and residents or we can take a moment to consider how to do so meaningfully before we re-commissioning substance misuse, smoking cessation, weight management, school health, health visiting services etc


Local Authorities took responsibility for a range of public health activity as a result of the Health and Social Care Act 2013. Many contracts which were subject to novation to Local Authorities have not been subjected to market testing for many years (if ever). Local Authority CEOs and elected members have therefore required this process to be undertaken within a 2-3 year window (we are now in year 2)

organisations with expertise and capacity should consider offering support to public health departments often lacking these skills in order to design and implement meaningful engagement at all stages of the commissioning cycle.