Strategic commitment to engagement with communities
Solent NHS Trust (Solent) is a mental health, learning disability and community trust in the South of England, providing services across Portsmouth, Southampton, Hampshire and on the Isle of Wight. Given the size of the area, the health inequalities experienced within communities vary between the different places. The urban areas of Portsmouth and Southampton tend to see clusters of inequalities, with higher levels of deprivation and growing rates of ethnic diversity. For example, in Portsmouth there is a 15-year gap in healthy life expectancy between the most and least deprived areas of the city and 60% of the city's population live in the two most deprived quintiles (Hampshire and Isle of Wight Integrated Care Board (ICB), 2023).
In 2020 Solent published Alongside Communities, a five-year strategy for the organisation, setting out the approach for working with people and communities from 2020 to 2025 (Solent NHS Trust, 2020). The strategy, co-created with local people and community groups, sets a commitment to "improve health, reduce inequalities and improve the experience of care" by better understanding the health challenges faced by people and communities and what they need from the trust to ensure that services are accessible to all. The trust's objectives for reducing inequalities are:
- Make it easy for our diverse communities to access our services.
- Recruit and retain the right people from diverse communities, offering a local route to employment and career development.
- Value and respect those who use our services and our people as individuals.
- Offer and provide learning and development opportunities to our diverse workforce to help them fulfil their greatest potential.
- Support people with caring responsibilities, those who work with us and those in the local community.
- Further develop our inclusive approach to volunteering, providing step up opportunities into employment.
The engagement approach was developed in partnership with local people, building on trusted relationships that had been built with communities and local VCSE organisations prior to 2020. The trust had previous experience of working in collaboration with local people in research and quality improvement projects, and in improving local services. The strategy marked a step-change in engagement activity, moving to a model where local people are routinely involved across the work of the whole organisation and are integral to decision making processes – "move from 'doing to, doing for, doing with', to 'community doing for themselves'". This is underpinned by a strengths-based approach to working with communities, viewing the potential of communities rather than the problems they pose.
The strategy is embedded within the governance structure of the trust. Responsibility for delivering the strategy sits with the board and is sponsored by the chief nurse as the executive lead. Operational delivery is supported by the director of community engagement and experience, working closely with the associate director of diversity and inclusion. There are also strong working relationships with the research and improvement team. The trust's community engagement group meets quarterly to oversee progress and provide guidance, and reports through to the board via the assurance committee. Explicit commitment from senior leaders within the trust has been key to embedding engagement across the organisation. To measure the impact of the strategy, Solent have co-developed success measures alongside local people.
Since the launch of the strategy, Solent have developed a reach of over 500,000 people within their local area – hosting 14,000 plus conversations with communities over three years, with 6,000 in 2023 alone (Solent NHS Trust, 2024). Engagement activities vary across the trust, including working with service users to improve experiences of care, hosting conversations with communities to identify areas for improvement, 140 active volunteers working in trust sites to improve care, and development of a community hub for partners to come together.
The trust has also developed a network of 320 community partners, members of the community who provide a sounding board, critical companions, for providing feedback. They have established and built connections with previously underrepresented groups and seldom heard communities and have increased these from seven groups in 2020 to 67 in 2023. By engaging with communities, the trust has also increased feedback from people who use services, their families and carers from nearly 18,000 to 35,000 (Solent NHS Trust, 2024). This provides a much better understanding of the experience of using services, what is done well and what needs to improve.
In practice, community engagement involves offering a range of different ways people can participate in activities, recognising that different people will want to be involved in different ways and on different topics. It also involves building trust with local people and going out into communities where people are. A key aim of the approach is hearing from groups that are not traditionally heard from, in order to tackle health inequalities. One example of this has been the use of slam poetry events for children and young people from ethnic minority backgrounds to share their experiences of accessing services.
The Talking change project is another example of working with communities to understand inequalities and barriers faced by communities. The mental health clinical team were concerned that the uptake of and self-referral to support services was not representative, and that ethnic minority groups were more likely to present in acute crises. The engagement team carried out semi-structured interviews with 108 ethnic minority individuals – the interviews were led by team members also from ethnic minority communities. The results found increased levels of stigma related to mental health and lack of appropriate appointment times available for young people living in multi-generational households. As a result, the mental health service reviewed their appointment offers, provided cultural awareness training for all staff, and employed a community engagement worker to reach out to specific groups facing barriers. The trust has since seen higher rates of completion of programmes within the service and is starting to see a reduction in admissions of ethnic minority individuals for acute mental health crisis.
Advice from Solent includes:
- "Start with what's strong, not what's wrong".
- "Discoverables not deliverables – coming alongside communities to work in a very different way".
- "Shift from fixing or prescribing".
- "Work with small places, or small groups of shared interest is best, and much more effective than large scale".
- "Build trusting relationships with the communities we serve".
For more information on Solent's work, please contact Sarah Balchin (director – community engagement and experience): sarah.balchin@solent.nhs.uk.