NICE Guidelines on Community Engagement

Professor Chris DrinkwaterNICE Community Engagement

PDG

• What are the challenges?

• What works?

• What should government and local statutory agencies do?

• Why should we bother?

Framework of NICE Guidance

Aimed at policy makers, commissioners and providers including V & CS, community representatives and members.

• Prerequisites – challenges?• Infrastructure – what do agencies need

to put in place?• Approaches – what works?• Evaluation – why bother?

Prerequisites/Challenges

• Coordinated implementation of the relevant policy initiatives.

• Commitment to long term investment.• Openness to organisational and cultural

change.• A willingness to share power, as

appropriate, between statutory and community organisations.

• Development of trust and respect among all those involved.

Organisational and cultural change

• Identify how the culture of public sector organisations supports or prevents community engagement.

• Manage conflicts between communities (and within them) and the agencies that serve them.

• Incorporate community views into induction and in service training.

Levels of engagement and power

• Negotiate and agree how power will be shared and distributed

- defining project objectives - resource allocation - decision making• Jointly agree ways of working

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Community control

Delegated power

Co-production

Consultation

Informing

More

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Impro

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health

inequalit

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Service outcomes

Intermediate social outcomes

Health outcomes

Pathways from community participation, empowerment and control to health improvement

Enhance

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Impact

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Jennie Popay (2006)

Infrastructure/Challenges

• Partnership working – will LSPs, LAAs, and CAA make a difference?

• Joint training for staff and community members.

• Accessible local venues and need to think through wider accessibility issues.

• Area-based initiatives.

Approaches/What works?

• Recruit and train people from local communities to plan, design and deliver health promotion activities.

• Use existing forums and networks.• Start with what the local

community feels is important.

Evaluation

• Identify and agree objectives with members of the target community.

• Be clear about the theory of change required to achieve success.

• Use a mixed-method approach and make use of participatory research.

Why Bother - Paradigm Shift

20th Century – formalising provision of professional knowledge through systems of training and provision (hierarchical/paternalistic)

21st Century – need to “fully engage” the public as co-producers of health (collaborative partnership)

Health,individual and community oriented preventative action

Health

Hazards

povertypoor housingunemploymentpoor food & nutritionpoor education

Environmental hazards

Community

oriented

preventative

action

Individually

oriented

preventative

action

Intersectoral action for Health. WHO. 1986

Best Value for Alzheimer’s

NICE – drugs to delay progression only available for people with moderate symptoms (MTS over 10).

(5,000 + words of newsprint)

Annals of Internal Medicine – 15 minutes of exercise 3x per week for people over 65 reduces risk of Alzheimer’s by 40%. Greatest benefit to the most physically frail.

(600 + words of newsprint)

Joining-up Locally to Address Inequalities

LA PCT

Public & patient engagement Engaging frontline staff

Public Health Team

Health

NeedsEquity audits

Evidence

SettingsStaff

Services

Outcomes

Locality clustersvaluing diversity

Community development

Community engagement

Training / employinglocal people

Community action

Locality clustersplurality of providers

Shared quality & outcome data

Collaborative approaches

New ways of workingPartnership

TRUST

CONTINUITY

LSPs

NICE Community EngagementWeb-link

Quick Reference Guidewww.nice.org.uk/nicemedia/pdf/PH009CommunityEngagementQuickRefGuide.pdf

Full Guidancewww.nice.org.uk/nicemedia/pdf/PH009Guidance.pdf