Community Engagement Test of Change: Larkhall

Introduction

The way people access, share and discuss information is changing.

While organisations such as the NHS remain important and trusted sources of information, people increasingly interpret, validate and discuss that information through conversations with family, friends, community groups, social media networks and other trusted local relationships.

NHS Lanarkshire carried out this Test of Change to better understand how communities receive information, make decisions and engage with health services in practice.

Using urgent care and A&E attendance as a practical theme, the work explored how people decide when and where to seek help, what influences those decisions, and whether more listening-led and community-based approaches could strengthen communication and engagement.

Importantly, this work was designed as a community engagement exercise focused on learning and insight. It was not intended to evaluate service performance or make decisions about service change.

The first phase of the Test of Change took place in Larkhall between January and March 2026.

Why we are sharing these findings

One of the commitments made at the outset of the Test of Change was that communities would be able to see:

• What was heard;
• What was learned;
• How the learning will be used.

This report has therefore been produced as part of that commitment.

Meaningful engagement relies on people being able to see that their contribution has been valued and considered. Sharing learning openly is an important part of that process.

About the engagement

• Engagement period: January-March 2026
• Locality: Larkhall
• Methods: Online survey and face-to-face engagement
• Focus area: Urgent care decision-making and health information
• Responses: 167 survey responses alongside face-to-face conversations and community engagement activity

The engagement was carried out through existing community networks and trusted local channels.
Rather than creating new structures, the approach worked through places and networks where conversations already happen and where trust already exists.

The project was supported by a number of established community partners, including Hamilton Health and Social Care Forum, Larkhall and District Volunteer Group and Larkhall Plan Partnership, whose networks, local knowledge and ongoing commitment to community involvement helped facilitate participation and dialogue throughout the Test of Change.

What we did

The work combined:

• Online engagement through local community networks;
• Face-to-face conversations;
• A short survey exploring urgent care decision-making and A&E attendance.

Early discussions were held with local community representatives and community connectors to better understand:

• How information is typically shared locally;
• Which channels people trust and use;
• How engagement could be carried out appropriately and proportionately.

The intention was to support open conversation and gather practical insight into how people access information, make decisions and navigate urgent care services.

What we heard

Several consistent themes emerged throughout the engagement.

People want practical, usable information

Participants consistently highlighted the importance of clear, practical information.

People wanted greater clarity around:

• Which services are available;
• Which service may be most appropriate in different circumstances;
• How to access support confidently;
• What alternatives may exist to attending A&E.

Many participants suggested that practical decision-based information was often more helpful than general awareness messaging alone.

Decisions are often shaped by confidence and experience

The engagement highlighted that urgent care decisions are rarely based on information alone.

Factors influencing decision-making included:

• Previous experiences;
• Confidence in accessing services;
• Concerns about delays or uncertainty;
• Understanding of available options.

Many people described A&E as the option that felt most certain during stressful situations, even where other services may also be appropriate.

Trust and reach are not always the same thing

Participants continued to identify NHS services and healthcare professionals as trusted sources of information.

However, the engagement also highlighted the important role played by:

• Family and friends;
• Community groups;
• Local social media networks;
• Community venues and organisations.

Information often travelled furthest through local networks where people already had established relationships and trust.

Communities value dialogue

Participants consistently valued the opportunity to share experiences and perspectives.

People were able to:

• Describe barriers and frustrations;
• Highlight areas of confusion;
• Suggest practical improvements;
• Explain how information could be made clearer and more useful.

The engagement reinforced the value of approaches based on listening and dialogue rather than one-way communication alone.

Wider experiences of accessing care

Many participants also used the opportunity to share broader experiences of accessing health services and navigating urgent care.

Comments reflected a range of experiences, including:

• Concerns about waiting times;
• Uncertainty about where to seek help;
• Difficulties navigating different services;
• Previous experiences that influenced future decisions.

While the purpose of this Test of Change was not to evaluate service performance, these experiences provided important context for understanding how people make decisions when seeking care.

The feedback reinforced that communication is only one part of a wider picture. Factors such as accessibility, confidence, previous experiences and wider system pressures also influence behaviour and decision-making.

Relevant themes have been shared with appropriate colleagues as part of the wider learning from this work.

What we learned

Several important lessons emerged from the engagement.

People make decisions within real-life contexts

The engagement reinforced that decisions about urgent care are often influenced by confidence, uncertainty, previous experiences and conversations with others, rather than information alone.

Trusted local networks matter

The work demonstrated the value of community networks and local relationships in helping information reach people and supporting understanding of that information.

This does not replace formal NHS communication. Rather, it highlights the potential value of combining organisational communication with trusted community channels.

Communication is only part of the picture

Clear communication remains important, but it cannot solve every challenge affecting urgent care decision-making.

Access, experience, confidence and wider service pressures also influence behaviour.

Communities want ongoing dialogue

People valued opportunities to contribute their views and wanted to understand how those views would be used.

The engagement highlighted the importance of visible feedback and ongoing conversation rather than one-off engagement activity.

Existing community networks can support engagement

The Test of Change demonstrated that meaningful engagement can be carried out through existing relationships and networks without the need for significant new infrastructure.

The findings should be understood as community insight gathered through engagement activity.

They are intended to support learning and future development rather than provide statistically representative findings for the wider population.

How this will shape future work

The learning from this Test of Change will help inform future communications, engagement and planning activity across NHS Lanarkshire.

Future work will place greater emphasis on:

• Listening-led engagement;
• Trusted local dialogue;
• Practical, decision-based communication;
• Visible feedback to communities;
• Working through existing local networks where appropriate.

The feedback gathered through this work will help shape how we communicate and engage with local people in the future. It will also help inform the next phase of Our Health Together – NHS Lanarkshire’s approach to working with communities, staff and partners to improve health and care services

Future phases will seek to broaden participation further, including greater engagement with younger people and groups less represented during this initial phase.

Any future development will continue to be undertaken proportionately and in partnership with local communities, Health and Social Care Partnerships, third sector organisations and wider partners.

Thank you

Thank you to everyone in Larkhall who completed the survey, took part in conversations, shared information through community networks or contributed their time and views.

The willingness of local people and community organisations to participate openly and constructively made this work possible.

NHS Lanarkshire would also like to acknowledge the support of Hamilton Health and Social Care Forum, Larkhall & District Volunteer Group and Larkhall Plan Partnership, whose partnership, local insight and trusted community connections played an important role in the success of this work.

At its heart, this Test of Change reinforced a simple but important principle:

Meaningful engagement works best when people feel listened to, respected and able to see how their contribution helps inform what happens next.

This project was a small but important step in helping NHS Lanarkshire learn from communities and strengthen how those conversations continue in the future.