COVID-19 affect on involvement activities

Produced by NHS England and NHS Improvement:
Good practice for working with people and communities during the COVID-19 outbreak (updated 16 December 2021)


This is an update to the document produced by the NHS England and NHS Improvement Public Participation team in May 2020 on working with people and communities during the COVID-19 pandemic. It covers practical advice and suggestions for engagement practitioners and others working with people and communities during the ongoing COVID-19 response.

The pandemic is far from over and there remain considerable pressures on health and care services. In light of this we have updated the document to ensure that it continues to help colleagues consider their approaches to working with people and communities over the coming months.

This is good practice advice and not formal or statutory guidance – existing statutory guidance still stands.


The COVID-19 pandemic has posed fundamental challenges to public authorities in how they go about meeting their usual duties. Patient and public participation is no exception and we must continue to prioritise the health, safety and welfare of patients, staff and wider society.

The disproportionate impact of the pandemic on those who already face the greatest disadvantage has highlighted the importance of working in partnership with people and communities. We have seen through the pandemic how engagement practitioners have adapted their approaches to ensure people are still involved in decisions about health and care services.

There are some specific suggestions about particular scenarios in the next section, but there are also some general principles to follow when thinking about public participation over the next few weeks and months.

Essentially, for all engagement activity which is underway or planned, there will be four options (not all mutually exclusive):

  • Continue as planned
  • Postpone the activity
  • Decide on the most appropriate method of engagement for example, face-to-face or virtual
  • Cancel

There is no obligation for patient and public participation to be face-to-face and any such engagement activity should only be undertaken where not prohibited or discouraged by the latest government advice.

Some questions to think about when deciding on the best approach for your particular activity or proposal:

  1. Are any of the participants known or likely to be in one of the ‘at risk’ groups, or particularly impacted by COVID-19? (check the latest guidance).
  2. What is the most appropriate method for engaging with the target audience? If it is digital, do participants / your target audience have access to the devices and data needed? If not, could they be supported to access online methods, or contacted by telephone?
  3. Do relevant staff members, especially clinical staff, have the capacity to be involved in engagement activity at the moment?
  4. What would be the impact of postponing the activity? Could any of the negative impacts be mitigated against?
  5. Have you considered how you will involve people and communities and, where appropriate, work with community leaders to reach diverse communities?
  6. How will those who have been engaged receive feedback? Whilst services are being developed / set-up at speed the method of providing feedback should be agreed and communicated at the earliest point.

Your responses to these questions can guide your decision making and risk assessments / mitigation around the different engagement activities you have underway / planned, including most appropriate next steps.

Communication and community response

Whatever the outcome of your review of existing / planned engagement activity, it is important to maintain two-way communication with your local partners, including local Healthwatch, patient groups and the voluntary, community and social enterprise (VCSE) sector, as well as patient and public voice (PPV) partners.

We have seen how working with people and communities is essential to understanding local populations and ensuring an effective response to the pandemic. The NHS vaccination programme has demonstrated how working in partnership with the VCSE sector and local community leaders can support systems to reach diverse communities, using local assets to promote community action.

Your communications team will already be implementing a response plan. Consider working with them to promote volunteering and community action to support people whilst self-isolating; stay as well as possible whilst waiting for routine health care; and continuing to build community networks.

Advice about common scenarios

Q: We are about to launch a consultation on a major service change / reconfiguration, what should we do?

 A: The coming weeks and months are likely to see very high demand on frontline services, so it makes sense to delay any significant activity to free up capacity. Members of the public are also likely to be limited in their ability to get involved due to illness, self-isolation, caring responsibilities and the current focus on COVID-19. Many groups and networks who would usually form a staple part of your consultation activity may not be meeting.

These factors may mean the consultation is not the best use of public resources or make it more difficult for some consultees to be reached and/or to provide a meaningful response. We recommend that you consider these factors when making changes to your consultation plans. 

Q:  What if we need to take an urgent decision during this new COVID-19  variant outbreak? 

 A:  At the time of writing, the NHS duty to involve the public is unaffected by the new COVID-19 variant outbreak or any emergency legislation. However, where there is a genuine and pressing need to make a decision about, or a change to, services to protect the health, safety of welfare of patients or staff, then the NHS duty to involve the public may be met by very limited public involvement – but at the very least changes to services should be announced to the public at the earliest reasonable opportunity.

In such circumstances, you are not required to consult your local overview and scrutiny committee prior to taking the decision (but you should still promptly notify the committee of the decision taken and why no consultation has taken place).

This approach should be used only when necessary and it is likely that regular engagement with patients, staff and other stakeholders will be essential for practical reasons in any event (for example so that patients understand how to access services). It remains important to liaise with your overview and scrutiny committee, local Healthwatch and other key stakeholders, ideally before taking the decision, where possible. It is important to keep a record of any such decisions including any involvement in the process. Remember too that you may need to carry out further engagement in future if it is intended that temporary changes will become permanent.

Q: Do we still need to meet the requirements of the Public Sector Equality Duty (PSED) under the Equality Act and health inequality duties under the Health and Social Care Act during this latest outbreak?

A: The NHS duty to meet the requirements of the Public Sector Equality Duty (PSED) under the Equality Act 2010, and the duty to have regard to reducing inequalities between patients in access to health care and outcomes under the Health and Social Care Act 2012, is unaffected by the new COVID-19 variant outbreak or by any emergency legislation.

You should ensure that you follow the processes and systems already in place to provide assurance that you are meeting the duties relevant to your organisation. Compliance with these duties is even more important during this health emergency because of the disproportionate and adverse impact of COVID-19 on groups by reference to protected characteristics and those experiencing health inequalities.

Q: We are about to start engagement / consultation in response to a provider giving notice / a need to retender a service, what should we do?

A: Many of the considerations relevant to major service change / reconfiguration apply – as outlined above. In addition, it would be appropriate to consider interim approaches which could help to ‘buy time’ and enable the engagement / consultation to be postponed to a later date – for example, extending the current contract or arrangement, or enacting a temporary change to service provision. If you must go ahead at this point, consider virtual / online engagement approaches, and working with local Healthwatch / a relevant patient group to ensure some meaningful patient / public participation, even if this is from a smaller group. Remember to keep a record of any engagement activity that takes place.

Q: We are recruiting Patient and Public Voice (PPV) Partners, do we need to stop?

A: As with all potentially ‘non-essential’ activity, consider the impact on staff capacity at this time of high demand. However, there is no requirement to pause this recruitment, assuming your existing communications routes are still operating. Consider the most appropriate method for interviewing shortlisted candidates for example, virtually using video conferencing. If you are targeting the recruitment at groups known to be more likely to be digitally excluded, for example inclusion health groups, you should consider how digital access issues can be addressed for example, through training or presentation of materials in different formats or if postponement may be appropriate.

Q: We have a number of established forums / groups for hearing from members of the public, with meetings scheduled over the coming weeks and months, should we cancel them?

A: People may be reluctant to meet face-to-face. During the pandemic we have learnt that other methods of engagement, for example virtual meetings, have proven to be just as effective as face-to-face meetings. You may want to consider teleconferences, video conferences or webinars. If this format will not work for group members, then it may be necessary to postpone the meetings.

Equalities and health inequalities

Tackling health inequalities across health and care is a central priority for systems, one that has been given new impetus by the disproportionate impact of the COVID-19 pandemic on communities. Working with people that experience health inequalities will be a fundamental part of addressing unequal access to services and health outcomes. It is only by understanding the experiences and perspectives of those who face barriers to care and support, and have poor experience and outcomes, that opportunities for improvement and investment can be developed.

It also supports the building of trust between communities and public services – through greater mutual understanding and the establishment of meaningful relationships. The solutions to reducing health inequalities will often be found in the assets that already exist in communities.

NHS volunteer responders

Health and social care professionals in England can refer vulnerable patients who are self-isolating for a maximum of four weeks support to NHS volunteer responders for help with tasks such as collecting shopping and prescribed medicines, driving patients to medical appointments or transporting supplies between sites.

You can make referrals through the NHS volunteer responders referrers’ portal or by calling 0808 196 3382.

The scheme is also open for self-referrals for people who were advised to shield, vulnerable groups and those self-isolating at home from coronavirus. More information on who is eligible for support is on the NHS Volunteer Responders website. These people can ask volunteers for short-term help by calling 0808 196 3646 between 8am and 8pm. Please pass this number on to patients who could benefit from this support.

You can find more information about the programme on the NHS Volunteer Responders website.

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