Starting community conversations

The Deputy Chief Executive and Chief Nurse at the Royal Devon and Exeter NHS Foundation Trust, explains why ‘leading from behind’ is the perfect way to take community engagement forwards:

The NHS has long recognised the importance of engaging with patients and the public, but this has all too often been a process led by health organisations and focused purely on the health services themselves.

Across East and Mid Devon, we’re working to change that dynamic into one where we as statutory agencies join rather than dictate community engagement.

We’ve started by bringing together all the different groups in what we call ‘community conversations’, in an initiative which aims to pass leadership on engagement to local communities, and better connect GPs and other health professionals, local government, social services, the voluntary sector and local people, in ways that work for them.

As a trust, our work on transforming engagement started back in 2016, when we added the contract for community services across eastern Devon to our acute hospital services. At the time, a legacy of difficult public consultations meant that we had a huge amount of work to do to establish trust and understanding with local people, and we promised to strike up a different conversation with our communities.

From our engagement work in previous years, we knew that people in our area tended to identify themselves centred around the market towns, so we approached the natural community leaders in those hubs, and asked them to gather people together. Finding just one or two people in each place proved to be a real springboard for community conversations, bringing together statutory organisations with citizens, voluntary sector organisations, local authorities, police and ambulance trusts, fire services, and local community leaders to look at health and wellbeing.

The approach to the conversations has been different in each community, and we’ve been careful to lead from behind, offering support and information to support decision-making but not dictating the agenda or running the discussions.

Connections are being forged through face-to-face meetings, phone conversations and virtual membership on social media, as just a few examples.

What’s key is that each conversation is bringing professionals, organisations and communities together in ways that make it easy for them to talk to each other and deliver a joined-up response to the needs of local people.

The feedback and progress so far have been incredibly positive and some of the groups have already pulled together their own priority plans, based on what they see as the strengths of the local area, what everyone has to offer, and what matters most to them.

The introduction of these community conversations and the way they empower local health professionals to work together with each other and local people has led to an increase in collaborative practices, and as Chief Nurse, I’m delighted to see so many nurses getting involved.

Being clinically credible when having conversations is really helpful and nursing is a trusted profession. Many of our nursing colleagues have the confidence to step up and engage with people, and they’re building ongoing relationships which will help us strengthen community care.

Because health and social care teams are co-terminus with the community conversation boundaries, nurses play an integral role in how we hear those voices and plan services to meet the needs that have been expressed. I think that by nature, nurses see the person in the patient and understand how the whole team wraps around them. Community conversations simply do this on a wider scale.

I am very fortunate to be leading on the development of integrated care models within our local sustainability and transformation partnership (STP), but I understand that other chief nurses are also involved to varying degrees. I would encourage everyone to claim this ground for nursing – we have a great set of skills to take our STPs forward; don’t wait to be invited.

A shift is underway in our engagement; we are now just one of many partners and our communities are starting to take the leading role in their own wellbeing. Maximising the coordination of current resources and strengthening the connections that support people in their communities have become the drivers rather than the engagement of old which too often focused on service ‘losses’.

There are now ten community conversations underway, growing organically and reaching varying levels of maturity, and we continue to offer admin support and some financial assistance to those that need it.

What’s key now is to remember that we can’t over-manage this type of engagement and we have to become ever more comfortable with communities, rather than health professionals, leading the way in wellbeing.

This has been a huge learning curve for the Trust and it’s a journey I would recommend to others. We’ve already received interest from other areas in the south west and we hope that our example will help others in a drive for real community engagement.

Photograph of Professor Em Wilkinson-Brice

Em Wilkinson-Brice is the Director of Staff Experience and Leadership Development at NHS England. Em qualified as a nurse in 1992 in Exeter. She was appointed to NHS England in September 2019 following roles spanning over 30 years in the NHS bringing clinical operational experience, working at executive level as Director of Nursing and Facilities at Derby Hospitals NHS Foundation Trust.

Em returned to Exeter in July 2010 where she undertook various executive roles alongside the Chief Nurse role, including Chief Operating Officer, Deputy Chief Executive and lead for integration across Devon. In recognition of the close working partnership between the Trust and two local universities, Em was awarded Associate Professor Faculty of Health and Human Sciences at both Exeter and Plymouth Universities.

Em has a keen interest in people and workforce, health and wellbeing, staff experience and organisational culture. She led on responding to the national workforce challenges of Covid-19. Em remains a practicing nurse and has a Master’s Degree in healthcare management and became a Chartered Fellow of the Chartered Institute of Personnel Development (CIPD) in 2022.

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