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

Background: As a member of the World Health Organization's HealthyCities Project, Liverpool (UK) has developed an integrated planto improve health, the City Health Plan (CHP). Based aroundthe key areas of the former national health strategy for England,‘The Health of the Nation’, a draft CHP was developedby five task groups. Although multi-sectoral, these groups werenot able to achieve the desired level of participation fromthe community, or from those working in health, local governmentor voluntary sectors. One of the main goals of the consultationwas to redress this situation and achieve wider participation.Objective: To assess how adequately the consultation processcarried out in Liverpool contributed to broad-based participationin the development of the city health plan. Subjects and methods:(i) Semi-structured interviews with 20 key informants and 17facilitators who held consultation meetings in a variety ofsettings, and seven minority group contacts; (ii) Self-administeredquestionnaires to participants who had attended consultationmeetings. So far as was possible, the design encouraged participationin defining the goals and content of the evaluation. Main questionareas: Views on the importance of participation in planning;evaluation of the consultation against respondents’ criteriafor successful participation in the CHP; views on the purposeof the consultation, and on the methods used to publicise theCHP, inform participants about its purpose and content, andobtain their opinions about the plan. Questionnaires to thoseattending consultation meetings examined how adequately thisprocess permitted participation in contributing to the finalversion of the plan. Findings: This was the most ambitious publicpolicy consultation ever undertaken in Liverpool. There waswide agreement that participation was vital. Expectations variedconsiderably, but for many commitment and optimism co-existedwith cynicism about real involvement and achieving change. Theconsultation was widely appreciated, but some aspects whichmight improve effectiveness were identified. Most importantwas having more opportunity for participants to understand andthink through the implications of the CHP, and keeping peoplein contact with the process of revising the plan. Conclusions:There is a growing expectation for public policy to be multi-sectoraland participative: this study reports experiences of puttingthis into practice on a large scale. Despite people expressingmixed feelings, there was a lot of support for the methods used.Clear aims about the level of participation sought, adequateresources, time and facilitation, and good two-way communicationcan 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 feasibilityof achieving wide participation in the development of urban(health) policy on a more routine basis.