Achieving wider participation in strategic health planning: experience from the consultation phase of Liverpool's City Health Plan'

Abstract

Background: As a member of the World Health Organization's Healthy Cities Project, Liverpool (UK) has developed an integrated plan to improve health, the City Health Plan (CHP). Based around the key areas of the former national health strategy for England, ‘The Health of the Nation’, a draft CHP was developed by five task groups. Although multi-sectoral, these groups were not able to achieve the desired level of participation from the community, or from those working in health, local government or voluntary sectors. One of the main goals of the consultation was to redress this situation and achieve wider participation. Objective: To assess how adequately the consultation process carried out in Liverpool contributed to broad-based participation in the development of the city health plan. Subjects and methods: (i) Semi-structured interviews with 20 key informants and 17 facilitators who held consultation meetings in a variety of settings, and seven minority group contacts; (ii) Self-administered questionnaires to participants who had attended consultation meetings. So far as was possible, the design encouraged participation in defining the goals and content of the evaluation. Main question areas: Views on the importance of participation in planning; evaluation of the consultation against respondents’ criteria for successful participation in the CHP; views on the purpose of the consultation, and on the methods used to publicise the CHP, inform participants about its purpose and content, and obtain their opinions about the plan. Questionnaires to those attending consultation meetings examined how adequately this process permitted participation in contributing to the final version of the plan. Findings: This was the most ambitious public policy consultation ever undertaken in Liverpool. There was wide agreement that participation was vital. Expectations varied considerably, but for many commitment and optimism co-existed with cynicism about real involvement and achieving change. The consultation was widely appreciated, but some aspects which might improve effectiveness were identified. Most important was having more opportunity for participants to understand and think through the implications of the CHP, and keeping people in contact with the process of revising the plan. Conclusions: There is a growing expectation for public policy to be multi-sectoral and participative: this study reports experiences of putting this into practice on a large scale. Despite people expressing mixed feelings, there was a lot of support for the methods used. Clear aims about the level of participation sought, adequate resources, time and facilitation, and good two-way communication can be expected to provide for wider and more effective participation. However, given the investment of time and personnel deployed, this experience raises important questions about the feasibility of achieving wide participation in the development of urban (health) policy on a more routine basis.