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 Healthy Cities P roject, Liverpool (UK) has developed an integrated plan to improve health, the City Health Plan (CHP). Based around the key areas of the former nation al health strategy for England, 'The Health of the Nation: a draft CHP was developed by five task groups. Although multi-sectoral, these groups were n ot able to achieve the desired level of participation from the community, o r from those working in health, local government or voluntary sectors. One of the main goals of the consultation was to redress this situation and ach ieve wider participation. Objective: To assess how adequately the consultat ion process carried out in Liverpool contributed to broad-based participati on in the development of the city health plan. Subjects and methods: (i) Se mi-structured interviews with 20 key informants and 17 facilitators who hel d consultation meetings in a variety of settings, and seven minority group contacts; (ii) Self-administered questionnaires to participants who had att ended consultation meetings. So far as was possible, the design encouraged participation in defining the goals and content of the evaluation. Main que stion areas: Views on the importance of participation in planning; evaluati on of the consultation against respondents' criteria for successful partici pation in the CHP; views on the purpose of the consultation, and on the met hods used to publicise the CHI: inform participants about its purpose and c ontent, and obtain their opinions about the plan. Questionnaires to those a ttending consultation meetings examined how adequately this process permitt ed participation in contributing to the final version of the plan. Findings : This was the most ambitious public policy consultation ever undertaken in Liverpool. There was wide agreement that participation was vital. Expectat ions varied considerably, but for many commitment and optimism co-existed w ith cynicism about real involvement and achieving change. The consultation was widely appreciated, but some aspects which might improve effectiveness were identified Most important was having more opportunity for participants to understand and think through the implications of the CHI: and keeping p eople in contact with the process of revising the plan. Conclusions: There is a growing expectation for public policy to be multi-sectoral and partici pative: this study reports experiences of putting this into practice on a l arge scale. Despite people expressing mixed feelings, there was a lot of su pport for the methods used. Clear aims about the level of participation sou ght, adequate resources, time and facilitation, and good two-way communicat ion can be expected to provide for wider and more effective participation. However, given the investment of time and personnel deployed, this experien ce raises important questions about the feasibility of achieving wide parti cipation in the development of urban (health) policy on a more routine basi s.