Service user engagement and health service reconfiguration: a rapid evidence synthesis

Background: UK NHS organisations are required to consult patients and the public about proposals for major changes to services. The evidence base for current UK guidance is unclear. Objectives: To assess what is known about effective patient and public engagement in reconfiguration processes and to identify implications for further research. Design: Rapid evidence synthesis. Setting: Health services affected by reconfiguration proposals in the UK (particularly the English) NHS and similar health systems. Participants: Members of the public and their representatives, patients and patient groups. Interventions: Any intervention to encourage patients and the public and their representatives to be involved in discussions about proposals for major service change. Main outcome measures: Any measure of ‘successful’ engagement as reported by health service decision-makers, patients and public representatives. We were also interested in the outcome of controversial reconfiguration proposals. Data sources: We carried out separate searches for systematic reviews, primary research studies and grey literature. Database searches were limited to material published in English from 2000 to March 2014. Review methods: Final decisions on study inclusion were made by two reviewers independently. We used EPPI-Reviewer 4 (Evidence for Policy and Practice Information and Co-ordinating Centre, University of London, London, UK) to record decisions and for data extraction and quality assessment. We carried out a narrative synthesis using multiple frameworks (including pre-specified research questions and current guidance). In synthesising the case studies, we selected a number of ‘exemplars’ based on quality of reporting and some evaluation of the process of engagement. Results: Eight systematic reviews, seven empirical research studies and 24 case studies (six exemplars) were included. Methods of engagement varied in nature and intensity, and generally involved a mixed methods approach. There was no evidence on the isolated impact of any particular engagement method or collection of methods. In general, engagement was most likely to be successful when the process started at an early stage, offered opportunities for genuine interaction and was led and supported by clinicians involved in delivering the relevant services. The impact of engagement was variably measured and demonstrated. Impact was more frequently defined in terms of process measures than success or failure of reconfiguration. Little was reported on the potential negative impact of service user engagement. Conclusions: Patients and the public could be engaged through a wide variety of methods. In selecting which methods to employ locally, decision-makers should take into account the nature of the local population and of the proposed service changes. Problems often arose because decision-makers paid insufficient attention to issues considered important by the public. NHS England guidance could be a helpful practical framework for future engagement activity. Future work: Clearly reported evaluations of interventions are needed including those that test the sustainability of methods of engagement and their impact over time. The NHS England guidance on planning and delivering service change may provide a foundation for the design of future research. Funding: Commissioned by the National Institute for Health Research Health Service and Delivery Research (HSDR) programme from the University of York HSDR Evidence Synthesis Centre (project no. 13/05/11)