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Consultations on changes to health and social care are often approached with a sense of trepidation. Are we required to consult if there are no realistic alternatives? How upfront do we need to be about the fact that changes are due to funding cuts? If we are taking away a service, isn’t everyone just going to automatically object – so what is the point of a consultation exercise? These problems are often magnified within local authorities as decision makers will be held accountable at the ballot box.

But understanding what service users really value lies at the heart of any successful integration project. The public are often sceptical that a win/win situation is achievable, where less money is spent to secure better outcomes. This utopia may be possible but it will involve innovative thinking – the obvious savings will already have been made.

Often what service users want and what those holding the purse strings want is the same:

  • To avoid hospitals visits.
  • To prevent ill health rather than treat it.
  • To use technology to self-monitor rather than rely on input from healthcare professionals. 

Drilling down into the core of what service users value means asking the questions that help people think beyond established models of care. This is the key to thinking outside of conventional parameters.

This is not the traditional consultation exercise, where service users are asked to respond to survey questions about options A, B and C. It is carried out at an earlier stage, through conversations with service users, carers and those delivering care. Often the pressures of time and money – we need to make these savings now – mean this kind of exercise is not carried out. This is a false economy.

Take the lessons learned by local authorities reviewing their estates costs in the face of huge budget cuts. Many were maintaining day care centres. Many of those centres were expensive to run but poorly attended. Of course, no one wanted their local care centre to close. But conversations with local residents meant that some councils came up with more attractive – and much cheaper – alternatives. For most users of the service, the reason for going to a day centre was to combat loneliness and isolation. The same end could be achieved by facilitating a group trip to the local pub –by providing meal vouchers and a bit of organisation. For a lot of residents this was more enjoyable than sitting in a nearly empty day centre somewhere miles from home. In one case a local council funded the purchase of a season ticket for a resident to see his beloved Shrewsbury Town football club. This was a far better combat to isolation for him than attending the day care centre and much cheaper.

You will soon need to go through the traditional consultation exercise once your proposals for change have been developed, but that should be the end of the engagement story rather than the beginning. In this way engagement can be the heartbeat of your integration project, rather than its death knell.