Health and social care - Planning with People: community engagement and participation guidance

Part 1 – Planning with People

‘Planning with People – Community engagement and participation guidance’ (Planning with People) represents a new approach to engagement. It promotes consistency, culture change, and true collaboration, while encouraging creativity and innovation, based on best practice. It places people and communities at the centre of care service design and change, to deliver the best results. The guidance is co-owned by the Scottish Government and the Convention of Scottish Local Authorities (COSLA).

When ‘Planning with People’ was published in March 2020, it marked the first time in ten years since guidance on community engagement for healthcare was last issued by the Scottish Government. Much has changed since February 2010 – not least the integration of health and social care services and the coronavirus pandemic. The virus and the public health measures necessary to suppress it had, and continue to have, a substantial, wide ranging impact on our lives, and our public services^[1].

This edition of ‘Planning with People’ (February 2023) follows a review of the guidance to make sure it meets the needs of those for whom it is designed, and is aligned to the recommendations of The Independent Review of Adult Social Care in Scotland. ‘Planning with People’ has been updated following consultation and feedback from the wider Scottish public, individuals, organisations representing the equality sector, and health and social care (HSC) engagement professionals. A summary of the above consultations, including Healthcare Improvement Scotland – Community Engagement Citizens’ Panel Survey Nine, can be found in Annex A.

‘Planning with People’ also contains additional supporting information for public bodies, including the Quality Framework for Community Engagement, which was developed by Healthcare Improvement Scotland – Community Engagement and the Care Inspectorate. The guidance has been produced by people from right across the health and social care spectrum, and it will continue to develop as experience of collaborative community engagement grows.

NHS Boards and Integration Joint Boards have a statutory duty to involve people and communities in the planning and development of care services, and in decisions that will significantly affect how services are run.

‘Planning with People’ replaces previous guidance on engagement, and replaces the Chief Executive Letter 4 (2010) for NHS Boards.

The established major service change decision making process for NHS Boards remains unchanged.

‘Planning with People’ applies to all care services; for children, young people and adults. It should be followed not only by health and social care providers, but also by local, regional, and national planners, special health boards and all independent contractors and suppliers, such as care homes, pharmacies and general practices.

‘Planning with People’ sets out how members of the public can expect to be engaged by NHS Boards, Integration Joint Boards and Local Authorities. By recognising all the good work that is taking place, the guidance is designed to complement and strengthen organisations' existing engagement strategies. It also encourages close working between bodies to minimise duplication and share learning.

Reflecting the spirit of partnership, and to be inclusive of community members who might wish to refer to it, the language used in this guidance is deliberately accessible and ‘jargon-light’. Scotland's Health and Social Care Standards use 'care' to encompass both health and social care, so this terminology is used throughout.

The guidance was developed before, during, and after the coronavirus pandemic, which transformed methods of engagement. Digital approaches, including the use of social media, are acknowledged by ‘Planning with People’.

Healthcare Improvement Scotland – Community Engagement (HIS-CE) has a range of case studies to help illustrate best practice and capture impacts on communities and engaging organisations, Healthcare Improvement Scotland - Community Engagement, sharing-practice, case-studies

1.1 Defining community engagement

Effective services must be designed with and for people and communities – not delivered, top down for administrative convenience.^[2] In order to be effective, community engagement must be relevant, meaningful and have a clearly defined focus. NHS Boards, Integration Joint Boards and Local Authorities should engage with the communities they serve, following the principles set out in the National Standards for Community Engagement.

This defines ‘community engagement’ as:

'A purposeful process that develops a working relationship between communities, community organisations and public and private bodies to help them to identify and act on community needs and ambitions. It involves respectful dialogue between everyone involved, aimed at improving understanding between them, and taking joint action to achieve positive change.'

1.2 Purpose of the guidance

Effective community engagement and the active participation of people is essential to ensure that Scotland's care services are fit for purpose and lead to better outcomes for people.

The Scottish Government and COSLA have developed ‘Planning with People’ to support greater collaboration between those making decisions about care services in Scotland, those delivering services, and people in communities who are affected. This guidance supports public service planners, commissioners and providers to consider how to continually improve the ways in which people and communities can become involved in developing services that meet their needs.

Supporting Leadership

The duty to involve people and communities in planning how their public services are provided is enshrined in law in Scotland.

Key statutory responsibilities, such as Joint Strategic Needs Assessment and Strategic Commissioning Planning must be fulfilled both in the letter and in the spirit of the legislation. Planning with People supports care organisations to meet their legal responsibilities.

‘Planning with People’ must be understood and adopted by all stakeholders, and there are key roles for NHS Chief Executives, Chief Officers in Integration Joint Boards, and Local Authority Chief Executives to ensure that engagement is undertaken effectively.

To achieve meaningful and effective engagement, leaders must demonstrate a commitment to it and take action to embed it within their organisations.

Organisational barriers that could hinder or impact negatively on engagement must be identified and addressed by effective leadership.

Engagement that takes place routinely helps to develop trust between communities and public bodies, fosters mutual understanding, and makes it easier to identify sustainable service improvements.

1.3 Policy and legislative context

‘Planning with People’ has been developed in response to the Ministerial Strategic Group for Health and Community Care Review of Progress with Integration of Health and Social Care, which urges an increase in the pace and effectiveness of integration across Scotland. That includes a proposal to develop revised guidance on local community engagement and participation based on existing good practice, to apply across health and social care bodies.

All relevant public bodies are expected to demonstrate how they are engaging with communities, and to evidence the impact of engagement.

This guidance takes account of relevant recent policy drivers and legislation. It promotes a shared understanding among Scotland's care planners and commissioners, to support consistently high-quality engagement with communities.

Statutory duties of community engagement

NHS Boards and Integrated Joint Boards have a statutory duty to involve people in the planning and development of services, and in the decision making process. This guidance supports care organisations to meet their legal responsibilities. It also supports delivery of obligations in respect of clinical and care governance. This includes NHS Boards duty of quality^[3] and requirements of NHS Scotland in respect of clinical governance. ^{[4] [5] [6]}

NHS Boards are bound by duties of public involvement set out in the NHS (Scotland) Act 1978, Section 2B

Integration Joint Boards engagement and participation duties are specified by the Public Bodies (Joint Working) (Scotland) Act 2014. Integration Joint Boards are expected to apply this guidance and work with colleagues in NHS Boards and Local Authorities to share learning and develop best practice.

The duty to involve people in the design and delivery of care services was strengthened with the introduction of the Community Empowerment (Scotland) Act 2015.

Participation is also a key element of a Human Rights based approach, which requires that people are supported to be active citizens and that they are involved in decisions that affect their lives.

Assurance, support and oversight

Healthcare Improvement Scotland – Community Engagement (HIS-CE), Healthcare Improvement Scotland - Community Engagement and the Care Inspectorate, Care Inspectorate have statutory responsibilities to assure and support improvement in the quality of care services. Where appropriate, they collaborate in the delivery of these duties.

Healthcare Improvement Scotland – Community Engagement ensures people and communities are engaged in shaping health and care services. It has a legal duty to support, ensure and monitor the discharge of health bodies’ duties in respect of public involvement, including quality assurance of changes being made by Integration Joint Boards and in primary and community health services. HIS-CE is overseen by the Scottish Health Council, a governance committee of the HIS Board.^[7]

Healthcare Improvement Scotland – Community Engagement (HIS-CE) considers service change to be a service development or change in the way in which patients and service users access services. This may include the enhancement of a service through increased access, new resources and technologies, or new build facilities. It may also include the reduction, relocation or withdrawal of a service or the centralisation of specialist services. Some changes are made on a long-term or permanent basis while others are provided on a temporary basis.

The Care Inspectorate is responsible for inspecting and improving social care and social work services and regulates all registered services for adults and children.

Healthcare Improvement Scotland – Community Engagement (HIS-CE) and the Care Inspectorate, together with stakeholders, have developed the Quality Framework for Community Engagement (the Quality Framework). This supports NHS Boards, Local Authorities and Integration Joint Boards to carry out effective community engagement and demonstrate how these organisations are meeting their statutory responsibilities to engage. In addition, the Quality Framework will provide opportunities to develop practice and share learning.

Further details on the Quality Framework can be found in ‘Part 5 – Governance and decision-making’.

Joint Strategic Inspections

In partnership with other scrutiny bodies, Healthcare Improvement Scotland and the Care Inspectorate also carry out joint strategic inspections for care services of NHS Boards, Integration Joint Boards and Local Authorities. These inspections examine how integrated services are planned, commissioned and delivered to meet people's needs, and meaningful engagement is taken into account.

Healthcare Improvement Scotland and the Care Inspectorate both work to the Health and Social Care Standards in their scrutiny and improvement activities. The rights of people to be involved in decision-making regarding the provision of care underpin the joint standards, which also require people to be supported to participate fully.

Capital Investment Projects

Where capital is required, engagement with people and communities, as set out in this guidance, should be taken forward, in alignment with the Scottish Capital Investment Manual process.