It’s been a year now since the establishment of new powers for the Secretary of State for Health and Social Care in relation to major service change. The ‘call-in’ power was built into the Health and Care Act 2022 and, after some political ping pong and departmental development, was enacted in January 2024.

So how have systems, partners and stakeholders responded to this power in the first year of its existence? And how has it been exercised by the Secretary of State since?

While some expected this new power to be a significant risk to the effective and timely delivery of change programmes, the reality is that the power has barely been used.

In 2024, at least 30 call-in requests were made. So far, the power has not been used by the Secretary of State to direct a commissioner to take a course of action. Some call-in requests have been rejected because they do not meet the criteria for a viable call-in.

Since January 2024, however, systems have been required to notify the Secretary of State of proposals for major service change, and many of these proposals have been subject to the potential of a call-in.

Stakeholder understanding and utilisation of this power has been inconsistent across schemes. Though there were a few bumps in the transition from local authority scrutiny committees’ referral power into this new power, few authorities have made the request for a call-in. Whether they would have utilised their referral power for proposals they’ve chosen not to request a call-in for would be an interesting investigation.

We have seen single scrutiny committees make, re-make and restate the importance of their call-in request, but unlike the referral power there is no obligation for the Secretary of State to accept these requests. There is also the frustration that, once a request has been made, there is no timeframe with which the department must make a decision about it. This had led to lots of requests hanging in the ether, deprioritised in favour of other departmental decision making.

There is, however, a requirement that the Secretary of State make a decision within six months in relation to a call-in once it has been accepted. As we’re learning in real-time, though, the penalties for missing this deadline seem few and far between.

We have seen new developments through the establishment of this power. Individuals, campaigners and campaign groups now have an earlier route to indicate dissatisfaction prior to judicial review. The right for any individual to request that a scheme is called in has been used by these stakeholders already. This, though, has also happened in inconsistent ways. In some places, individuals have encouraged the local authority to exercise this power. In others, groups of individual campaigners have independently submitted call-in requests. This has led to some disarray in how call-in requests are managed and how they are assigned value.

We may see individuals use this power to request more frequently after the recent announcement by the government of changes to the judicial review process for national infrastructure projects. This is particularly pertinent to schemes in the New Hospital Programme, which now won’t be subject to the High Court appeals process if a judicial review is called.

I suspect that the original intention of the call-in power was to allow the Secretary of State to make significant asks of the commissioners of change, be it in the way they conducted an options appraisal or the way in which they worked with their local authorities, or perhaps even in the decisions that they make.

In practice, we’ve instead seen a year where the use of the power has been trialled, but tested very little. Without the outcome of a call-in on our hands it is hard to determine what the department considers an acceptable scope and scale for a legitimate call-in to be made, and changed, by the intervention of the Secretary of State.

This puts our friends and colleagues in NHS organisations in an interesting predicament, but one that nevertheless creates opportunity.

The power (and its associated statutory duties such as the notification duty and the as-yet enacted catalyst power) are likely to be reviewed in light of its use – or lack of – over the year.

This gives stakeholders of the department an opportunity to reflect on whether this enactment has brought programmes closer to the ambition of making timely, collective and collaborative decisions about major service change, or whether it has instead unintentionally impeded the progress of decision making.

If, as I suspect, the latter is more likely, this gives the department an opportunity to better engage with NHS organisations at the coalface of change programmes to understand how their original vision – of timely intervention, and quick resolution in areas of dispute – can be more effectively achieved. Whether or not this requires statutory intervention is a question best solved by meaningful involvement with those subject to that intervention.

For now, the call-in power remains in effect and the associated requirements of notification still apply to programmes of major service change. We’re excited to see whether the anniversary of this power inspires senior decision makers to better consider how they can effectively support organisations with delivering change at the pace the NHS needs to be able to thrive.

Blog by: Jonny Williams

It’s been quite a week for the NHS at a national level. Hot on the heels of a Public Accounts Committee report questioning the ambition and drive behind the forthcoming 10-year plan, the House of Commons Health Committee has voiced concerns over NHS England chief executive Amanda Pritchard’s evidence.

Meanwhile, the government’s new planning guidance—Road to recovery: the government’s 2025 mandate to NHS England— reiterates that local systems must do more to “live within their means”.

In the midst of this flurry of news coverage and announcements, it’s clear that local NHS organisations face unprecedented pressure to balance their books. Health and social care secretary, Wes Streeting, has made it plain that “tough decisions” will be necessary, including the possibility of service closures. Health Service Journal this week also reported that the “culture of overspending” is over. The government intends to hold the NHS to account for exceeding budgets and, as Mr Streeting suggests, will back local leaders if they need to make unpopular choices.

While these measures may seem daunting, NHS bodies have a powerful resource at their disposal: the communities who depend on their services. In this climate of heightened financial scrutiny and political pressure, public engagement offers an additional layer of accountability.

When decisions are made transparently, and communities are brought along from the earliest stages, it’s easier to demonstrate how every pound is being spent.

This helps ensure that, even if certain services are reduced or decommissioned, there is a credible, well-evidenced narrative about why and how those conclusions were reached.

By drawing on the NHS duty to involve, following the NHS People and Communities guidance, and embracing genuine participatory methods, local systems can forge better outcomes—even in challenging financial circumstances.

Addressing public scepticism and rebuilding trust

The Public Accounts Committee’s report highlights a disconnect between grand ambitions for NHS recovery and a perceived lack of radical thinking among senior leaders. Public scepticism is also on the rise, particularly regarding whether new funding and efficiency measures will bring tangible benefits.

This is in line with last year’s report, ‘Independent Investigation of the National Health Service in England’, by Lord Darzi. In it, Darzi highlighted that “patients feel increasingly disengaged from decisions about their care” and reinforces the idea that “engaging patients and the public in service design leads to more effective and responsive healthcare solutions.”

Transparency and community involvement can help rebuild that trust. By inviting the public to understand the difficulties the NHS is facing—particularly the spiralling costs and the urgency to save money—leaders can demonstrate that decisions are made openly, for the benefit of patients and communities. The public might still not like or support those difficult decisions, but they will at least understand them.

Meeting legal and statutory duties

Under the NHS duty to involve, organisations must seek the views of service users when planning or making changes to services. The NHS People and Communities guidance tells us that healthcare leaders must work in close partnership with the public, local government, and the voluntary sector. Amid warnings that some services may close—and that “unpopular” decisions may be needed to address deficits—really living these requirements is how we make sure we don’t further erode public confidence.

Using participatory methods to shape decisions

In a week when senior officials are under scrutiny for lacking bold plans, participatory approaches such as co-production and citizens’ juries and assemblies can spark fresh thinking.

These methods invite patients, carers, and community groups to help design and refine proposals. Instead of consultation as an afterthought—where communities simply react to decisions—they can be central to the decision-making process:

• Citizens’ assemblies or juries: Small, representative groups of local residents hear evidence, deliberate, and craft recommendations.
• Co-design workshops: Frontline NHS staff, service users, and community representatives collaborate to develop new models or redesign services more efficiently.
• Focus groups and listening events: Targeted forums, often arranged in partnership with voluntary or advocacy groups, to capture diverse perspectives and champion under-represented voices.

By placing service users at the heart of discussions, NHS leaders are much likelier to pinpoint solutions that meet genuine needs. This can also cushion the impact of tough decisions and embed a sense of shared responsibility.

Blog by: Caroline Latta

This week the government announced that the New Hospital Programme, originally launched in 2019 by the then Conservative government, has a revised timetable for delivery.

Where many systems were preparing to lay the groundwork (literally and metaphorically) for construction, this recent announcement is a huge setback to delivery.

It’s good news that management of the RAAC hospital schemes are approved to continue.

There are pragmatic and reasonable explanations for delaying the delivery of these schemes (including the 18 which are not even set to begin until after 2030). Public finances are stretched, international policy has impacted the cost-effectiveness of construction works, and the original timeline was inspired more by political ambition than by the reality of major construction projects.

As we’ve seen before when public sector infrastructure projects are cut or delayed, the biggest impact seems to fall on the local people who rely on these facilities.

For nearly six years, patients and the public in these systems have worked with NHS communication and engagement teams, and senior leadership teams, to build a truly collaborative vision of the future of healthcare provision in their communities.

They’ve attended workshops, answered surveys, and had their current hospitals – many of them held up with scaffolding, with the promise of imminent improvement – decorated with information about their soon-to-be new hospital.

The NHS in turn has built strategic plans, made far-reaching financial assessments, and invested significant human time and energy in getting these schemes from political plans to practical reality.

There is a significant risk to successful programme delivery in NHS change programmes when stakeholders are marched up the steepest of hills, only to be abandoned there – whether by national government, local systems, or unexpected opposition.

There is an intangible cost to the effective delivery of change when patients and the public are promised one thing, only to be promised another the next day. Faith in the NHS as an organisation to deliver effective change can be really impacted by these setbacks.

The work to bring stakeholders together, to coalesce around a shared vision for the future as well as how to get there, is a significant investment of time, energy and faith. We know first hand that so many of the local New Hospital Programme teams have given all of these investments, and the potential impact of losing all this to delay is significant.

It must also be said how sad it is to hear that many of these programme teams, who have worked diligently to deadlines and met the aspirational targets required of them, now face the possibility of redundancy as a result of this announcement. Their hard work and dedication to delivering real change for the public has been commendable.

Delay is inevitable in some way or another. Multimillion-pound public sector programmes are subject to intense scrutiny and value for money considerations. Delay to ensure that changes are sustainable, economically efficient, and in the best interests of the most people should be welcome.

It is right that the new hospital programme takes a realistic approach to delivery. No one should take public support for granted, though, or assume it’s easily transferable to a later point in time. It will be interesting to see if the government offers local systems any support in maintaining public interest and favour in the actual delivery of these schemes.

Blog by: Jonny Williams

We’ve been supporting commissioners and providers to gather feedback on learning disability short breaks, involving people with learning difficulties and complex needs and their families in rethinking short break services in their area. We asked Stand’s Gail Cobb to tell us about the trips she and the team organised for families to experience some different short breaks. 

For Gail, one moment stands out vividly. It’s the radiant smile of a woman whose joy transformed a hesitant leap into a moment of pure magic.

Everyone watched as a participant with a learning disability and complex needs, was seated and hoisted high on the king swing ready for the ride. At first, Gail admits to holding her breath, wondering if the daring drop might be too much. Watching alongside, Mum shared that her daughter enjoyed being in a hoist at home, often swinging for fun. But neither of them had imagined she could take part in activities like this. As the swing dropped the rider’s smile lit up, it was clear this was a breakthrough. Her exhilaration showed that, sometimes, the limits we perceive are far smaller than the opportunities waiting beyond them.

These trips were about opening doors to new experiences and making short breaks stimulating as well as safe. Standing at the Calvert Kielder Centre deep in the Kielder Forest in Northumberland, one family said “If we could just move what we’ve got here to our area”. It was a powerful statement, reflecting a shift in what they imagined short breaks could be. This was about exploring what might be possible with the right support, training, and creativity.

Moments like that participant’s smile offer tangible proof that inclusive and imaginative experiences can redefine expectations. For Gail, another highlight came on a buggy ride through the serene expanse of Kielder Forest. With the participant hoisted into the adapted buggy in their moulded wheelchair seat and securely harnessed. Family members were delighted by how calm and engaged they remained during the whole ride. A simple ride in a buggy became a sensory experience that showed the potential impact stimulating short breaks can have.

Feedback from these trips is already being used to shape a vision for the future of short breaks in the area. Families want staff who don’t just know procedures but take time to understand the quirks, preferences, and personalities of those they support. The joy, connection, and unexpected discoveries these moments bring are impossible to quantify; their impact is undeniable.

“Go where the energy is” was the mantra Gail and the team embraced when recruiting families for this initiative. For those who are taking part, the energy is infectious, sparking new ideas and expectations for what could be achieved closer to home.

Sometimes, all it takes is a smile to remind us of what’s possible. An instant of unfiltered joy has become a beacon for a future where short breaks are stimulating, enjoyable and inspire families to dream bigger.

To see what other projects we have been involved in, take a look at our success stories.

Photo: Of course the team couldn’t just watch the king swing. Anna and Shaun were brave enough to have a go and share the joy!

Lord Darzi has published his independent rapid review of the NHS. The report is an important first step in identifying the problems facing the NHS, shedding light on its increasingly precarious state, revealing significant deterioration over the past 15 years. 

The review highlights critical issues including long waits for children’s mental health services, underperformance in cancer and cardiovascular care, and the strain on accident & emergency departments. It tells us these issues are linked to thousands of avoidable deaths annually. Lord Darzi stresses that the NHS is at a crossroads, and urgent reform is essential to ensure its survival.

Lord Darzi has taken evidence for his review from a wide range of sources. At Stand we’re particularly pleased to see that a critical piece of evidence was the submission from the Independent Reconfiguration Panel (IRP) which reflected many of these concerns and showed that the role of major service change in the NHS is being considered meaningfully when reviewing overall NHS performance.

After all, reconfiguring services at a large scale to improve performance, workforce efficiency, estate utilisation and clinical outcomes is why the process of major service change is often intense and thorough. 

In their letter, the IRP draws the conclusion that the balance between reconfigurations for the purpose of improving clinical outcomes and patient care is heavily outweighed by the need for organisations to improve financial, estate and workforce sustainability. 

It emphasises the tension between financial constraints, workforce shortages, and ageing infrastructure, all of which are driving service reconfigurations. These factors often overshadow the primary goal of improving clinical outcomes. 

Darzi’s findings resonate with the IRP’s long-held belief that patient care must remain central, even when reconfigurations are driven by economic pressures. And as part of his recipe for reform, Lord Darzi says the government must “re-engage staff and re-empower patients” and make care “closer to home”.

As NHS leaders consider their next steps, engaging staff, patients and the public will be vital in ensuring that reforms deliver the quality of care that is expected. The power for staff, patient and public involvement to steer and shape these large-scale changes towards better patient outcomes is undeniable. 

Involving people and transforming services is what we do. And we love talking to colleagues about the challenges they’re facing. Drop us a line at hello@wearestand.co.uk or give us a call.

Blog by: Jonny Williams

One of the biggest pieces of work when delivering an NHS major service change programme is to formally consult members of the public. From pre-consultation engagement to extensive media and stakeholder planning, to independent analysis, the process of public consultation can seem mountainous.

So why do we carry out public consultations in the first place?

A large part of the reason is so that NHS organisations can meet their duty to involve the public, as set out in the NHS Act 2006 (as amended).

NHS organisations have a duty to involve patients and the public (by means of providing information, consultation, or in other ways) in:

a) planning commissioning arrangements

b) the development and consideration of proposals for changing services

c) decisions they make.

But, as the legislation itself says, your organisation can meet this requirement “whether by being consulted or provided with information in other ways.” So why is it so common to decide to formally consult the public on NHS service changes?

This is where the local authority health scrutiny regulations come into play. Regulation 23 requires NHS organisations that are considering a proposal for substantial development (sometimes referred to as substantial variation) of the local health service to consult the relevant local authority or authorities. As part of the duty of local authority Health Overview Scrutiny Committees to effectively scrutinise health services, it is typical for NHS organisations to also consult the public to seek their views on proposals.

So that’s the legal bit. But here’s the perennial question: do we consult because it’s the law, or is it the law because it’s good to consult?

Public consultation can provide health and social care commissioners with information about a service they commission that they may not already know themselves.

The clinical quality of a service is paramount, but so too is its accessibility, its sustainability, and its effectiveness in reducing inequalities. These aspects of a service are less easy to define without engagement with the people who are affected by them: patients, the public, staff, seldom-heard communities, and other stakeholders that have experience with this service.

Moreover, the NHS is a much-loved institution. Its services are cherished; it’s embedded into the life and spirit of communities across the country. From cradle to grave, a single NHS building can feature in the lives of entire families. They may be born there, have their own children there, and say goodbye to loved ones. This can go on generation after generation. Thousands of people will do the same. Changing these institutions can be emotional for everyone impacted.

By formally consulting the public on NHS service change proposals, it becomes much easier to hear the voices of everyone that has a role to play in that service, from the clinicians that deliver them to the community that receives them.

Public consultation is more than just an opportunity to discharge legal duties: it is an expression of the value that patients and members of the public can bring to the future of NHS services. This is an invaluable resource for any commissioner or provider that wants to make meaningful, long-term change to improve services for communities.

The Stand team are recognised experts in planning and delivering public consultations. Our clients come to us to help them understand the issues, involve their stakeholders, and develop proposals for changes to services. We love to talk about all things service change, so if you have a challenge you want some insight on get in touch.

Blog by: Jonny Williams

That we are more than halfway through the general election will be welcome news to many. If the outcome of the election is clear and a government is formed quickly, we can look forward to NHS England’s pre-election guidance being lifted straight away and the business of patient involvement and public consultation resuming.

Over the years NHS England appears to have taken an evermore cautious approach to these restrictions and one of my mini professional frustrations of the election being called is that there will be another inevitable delay in the promised publication of an update to the PADS service change guidance.

For those of us working in service change Planning, assuring and delivering service change for patients (PADS) is the go to document. It’s our script, our framework and our guide. I make no secret of how good I think different aspects of the document are. I’m a long-term fan.

But no matter how solid the fundamentals of the document are, the reality is PADS is woefully out of date. Published in May 2018 the main document refers to Sustainability and Transformation Partnerships, NHS Improvement, the Five Year Forward View, and CCGs. The references to legislation are mostly outdated and some important legal changes aren’t reflected. The addendum issued in 2022 takes account of the big capital projects in the new hospitals programme and leaves many other questions open.

Whispers on the grapevine have told us an update is imminent for some time. We expected an update in July 2022 after the implementation of the Health and Care Act. We waited in 2023 as several opportunities passed with no news. An update could have followed soon after this year’s January publication of regulations for the secretary of state’s new intervention powers and to update the health scrutiny rules. It could have happened at the end of the financial year as it has before, or followed the local authority elections. Now it will be July at the earliest and given summer breaks possibly not until even later in the year.

Why am I bothered, you might ask? After all, my colleagues and I get to keep working with a document and process we know inside out and back to front. The world has moved on since 2018 and some of the known shortcomings that have developed in PADS are becoming like old friends. Without an update, a brilliant document (to my mind one of the best guidance documents NHS England has produced) loses relevance and credibility.

I’m looking forward to the new PADS including more on acceptable or expected approaches to developing proposals for changes to services. I’m looking forward to greater regulatory clarity on the process where urgent changes to services are required on a temporary basis. I’m looking forward to seeing greater prominence for health equity and environmental considerations in service change programmes. And I’m looking forward to newer clients being able to read and understand the document without a guide to the institutions and documents of NHS past.

So while I love the cut and thrust of political debate in a general election, there’s a professional part of me that can’t wait for it all to be over, so at least there’s a chance that the next version of PADS will drop into my inbox. I promise to share my excitement with you all when that happens.

Blog by: Paul Parsons

As the health and care landscape in England continues to evolve, the NHS is navigating a series of pivotal changes aimed at improving service delivery and patient outcomes. 

At Stand, we are committed to staying at the forefront of these developments, providing insights and support to help drive effective change. 

This June, we are excited to be attending NHS ConfedExpo 2024. We’re looking forward to meeting with industry leaders and stakeholders to discuss some of the most pressing issues in NHS service change. 

But what are we thinking about here at Stand?

Estates and infrastructure

The NHS’s physical infrastructure is a critical component of its ability to deliver high-quality care, but many buildings are in dire need of repair.

With an ageing estate and increasing demand for services, there is a pressing need for modernisation. This includes not only refurbishing existing facilities but also strategically planning new builds to meet future healthcare needs. But how can we do that with limited access to capital?

The New Hospital Programme has been working for five years now on developing future hospitals, but pace is slow and funding is limited to certain Trusts. 

At Stand we’re thinking about how the public, for whom many of these buildings have sentimental and community value, can be engaged with to develop estate solutions that meet future needs while remaining community driven. We’ve worked with Trusts to review community services, and to make plans for changes to urgent care that take a multi-Trust approach at a provider collaborative level.

Digital transformation

Digital transformation is often spoken about as a critical factor in unlocking greater potential in service delivery.

We think that one of the most exciting areas for digital transformation is the use of greater digital tools to engage people and communities in change programmes. But there are also risks associated with this new technology, from access all the way to AI and bots intruding on paid-for public workshops.

We’ve had the great fortune of working with a number of clients where we’ve been able to leverage greater access to digital technology in the general public.

From livestreaming public hearings, launching and managing social media campaigns, to running online telephone interviews and focus groups, access to the public through digital tools has never been easier. And our experience has helped us to understand what the risks of these digital tools may be, and how we can work best to mitigate them.

Making change with limited capital

Financial constraints are an ongoing significant challenge for the NHS, particularly when it comes to capital funding for major service changes.

The upcoming General Election could introduce big shifts in the amount of capital that the NHS receives. This remains a big ‘if’ in the world of health and social care, however, and doesn’t resolve the pressing capital issues of today.

Despite these limitations, there are innovative approaches to service redesign that we’ve been fortunate to support. Sometimes these changes can bring emotive changes to the landscape of healthcare in a system. We’ve seen firsthand what the power that public and community engagement in these changes can do when it comes to making change with limited capital.

Integrated Care Systems and Provider Collaboratives

The introduction of Integrated Care Systems (ICS) in 2022 has changed a lot about the way that healthcare organisations can commission and deliver services. 

Since then we’ve also seen that Provider Collaboratives can play a great role in better organising the way that services are delivered locally. 

ICB Boards are still settling into their role as commissioners of a larger landscape of healthcare, and it hasn’t helped that they’ve been instructed to reduce their workforce to reflect restricted spending. Understanding the power and potential of these new organisations is going to be crucial to delivering transformative services in the future.

We’ve worked with lots of ICBs and provider collaboratives to support them to explore how they can work with the public to understand the changing needs of their local population.

Putting people at the heart of decision making 

We’re really excited to soon be talking to our friends at Care Opinion and The Point of Care Foundation about patient experience as the starting point for major service change as part of our podcast, Not A Consultation.

In difficult financial circumstances it can be really difficult for NHS organisations to invest time and energy into developing meaningful involvement strategies with patients and the public. 

This is where Stand really shines. We know from our experience that the best changes to services are made in partnership with the people who use those services. 

Our aim at Expo is to show everyone how our work to date has meaningfully involved the public in decisions about health and care, and how that involvement has positively shaped the future of those services – including how they’re managed and how much they cost to deliver.

Say hello to us at stand A23 at NHS ConfedExpo 2024!

We are thrilled to be a part of NHS ConfedExpo 2024, where we will delve into these critical topics and more. Our team will be on hand to share our insights and learn from others in the field. We invite you to visit our stand, engage with our experts, and hear how we can support you and your programmes to make change with the voice of patients and the public at its heart.

Blog by: Jonny Williams

It’s hard to believe that it’s now been a year since I hung up my regulatory boots and made the move from NHS England (NHSE) to Stand.

In that time I have been overwhelmed by the amount of great stuff I’ve had the joy of working on with my new colleagues.

During my time at NHSE I loved working on service change. I had some great opportunities, especially working with the Department of Health and Social Care to develop new policies. It was also a testament to my team that in the three years I worked with them we were able to launch the first ever handbook for major service change, a national learning and development programme, and so much more.

To be able to build on that at Stand with practical, hands-on experience of supporting clients with their programmes of change has been remarkable.

Here, I’ve already had the privilege of working with so many people on so many different projects – from helping a team in a provider organisation to reimagine the future of their workforce; to working hand-in-hand with cancer alliances to redesign the delivery of oncology services; and to lead on facilitating workshops to help commissioners appraise options for major service change.

All of this has been done with the cause of championing the voice of patients and the public in mind, which is so much at the heart of what we do at Stand.

It’s also been a pleasure to bring my experience of policy and training to help develop Stand’s unique service change snakes and ladders training, and to provide expert briefings to organisations on new regulatory changes for major service change.

What has been the most thrilling aspect of this year, however, has been getting to know the heart of Stand: its people.

Stand describes itself as values-led and value-driven. Nowhere before have I seen a group of individuals hold as hard and fast to that belief as I have with my colleagues here at Stand.

I have been welcomed with open arms, celebrated for my professional achievements, and supported in my personal needs. I am respected and appreciated by my colleagues, as much as I respect and appreciate each and every one of them. Above all, we enjoy each other’s company and enjoy the work we do together. It’s hard to understate how much I have valued that in this past year.

To be able to help our NHS colleagues to tackle tough issues in a challenging environment is an honour; to do that hand-in-hand with such wonderful people as Stand’s staff is a joy.

I’m looking forward to all that comes in the next year, and all the great clients, partners and friends I’ll get to meet – especially at NHS ConfedExpo, where we’ll be exhibiting once again this year!

Blog by: Jonny Williams

A little while ago, we were playing around with ChatGPT and prompted it to explain the Gunning Principles, the legal requirements for public consultation, in the style of superstar drag queen, RuPaul Charles. The result amused us and we posted that on socials as a bit of Friday fun.

Fast forward a couple of months and a stakeholder responds to one of the public consultations we run for NHS clients, quoting that post to explain the Gunning Principles to our client.

We talk about the Gunning Principles all the time. They guide our actions and are a key consideration in the advice we give our clients. Looking at why the stakeholder chose to quote our ChatGPT post rather than something more formal, we noticed we haven’t published anything about the Gunning Principles. That’s an obvious omission now we think about it.

Sometimes the most obvious omissions go unnoticed until a stakeholder points them out. That’s part of the reason for running a public consultation on proposals for changes to health and care services. It’s one of the things we discuss at length with our clients when we’re helping them prepare for a public consultation.

And where stakeholders have a valid point about errors or omissions, it’s right to address those. We’re big on living our values and modelling the behaviours expected of our clients, so this post aims to fill the gap.

In 2014^[1], justices at the UK Supreme Court restated that public bodies’ common law duty of procedural fairness applies to public consultation. They confirmed the criteria for procedural fairness in public consultation that were first established in 1985^[2], now commonly known as the Gunning Principles. One of the Justices commented that it is hard to see how any of these four requirements could be rejected or indeed improved. The requirements are:

1. Consultation must be at a time when proposals are still at a formative stage.
2. The proposer must give sufficient reasons for any proposal to permit of intelligent consideration and response.
3. Adequate time must be given for consideration and response
4. The product of consultation must be conscientiously taken into account in finalising any statutory proposals.

In the four decades since that first case, scores of public consultations have been measured against these requirements by the courts and we’ve learned so much more about each of the principles.

Proposals are essentially at a formative stage if the consultor hasn’t made a final decision on the whole of the issue. Consulting organisations don’t have to include proposals they think are unviable and they can choose the range of proposals they present in a consultation, as long as stakeholders can see how they got there, understand the discarded ideas, and have a chance to influence the decision, including offering alternative solutions.

The requirements for intelligent consideration and response are more complex. The consulting organisation must provide enough information for stakeholders to understand and respond to their proposals. What one stakeholder needs to give proposals intelligent consideration can vary from what another stakeholder needs. If NHS consultors follow their regulator’s requirements and process for producing a draft business case, like those set out in NHS England’s service change guidance, publish that document and its background information, and carefully monitor requests for other relevant information, they will be a long way, if not all the way to meeting that requirement. The guide we use is that if it is part of the evidence base that informs any part of the process or the decision they’re taking, consulting organisations should publish it for stakeholders to review and add to. Think back to that first purpose of consultation set out by the Supreme Court Justices.

How much time is adequate time for stakeholders to consider and respond to their proposals depends on the issue, resources available, the view of regulators and scrutineers, and local policy.  Stakeholders will have a view. Mostly public consultations on NHS service change proposals last between six and twelve weeks. Shorter and longer consultations might be appropriate in specific circumstances. The consulting organisation can extend the consultation, if it believes that is necessary to ensure the consultation process is fair.

Finally, the principle known as conscientious consideration, the decision-makers must actively take into account the feedback and learning gathered in the consultation when they make their decisions. That should be done openly with materials published and decision-making done in public.

Together, these principles are at the forefront of consulting organisations’ minds from the earliest stages of planning for a public consultation right through to decision-making meetings. We’re sure to learn more about them in years to come.

^[1] Lord Justice Wilson in Mosely v London Borough of Haringey [2014] UKSC 56

^[2] R v Brent London Borough Council, ex p Gunning, (1985) 84 LGR 168

Blog by: Paul Parsons

Hi, it’s Callum again. You may remember me from such hits as my “Starting with Stand” blog that I wrote a couple of years ago. A lot has changed since then, not least the fact that I’ll not be with Stand for much longer. The 15th of December, my 922nd day at Stand, is my last. I thought it might be nice to talk to you about my experience, and what I’ve learned in my two and a half years here.

As I mentioned in my last blog, this was my first office job, which was a massive culture shock for me coming straight in from university. Going from only really working for myself, to working with a group of people towards a common goal was a big jump for me; and it didn’t always go as planned. I had to get used to other people’s working patterns, the different ways they liked to brief and be briefed on different projects. It’s taken a while for me to get used to this, but with time and patience I have. 

I’m not the same person that walked into my internship two and a half years ago. My policy work has grown exponentially better thanks to fantastic guidance from Paul, Caroline and Jonny. The situation reviews that I prepare at the start of new projects have never before been so insightful (from what I’ve been told). 

Who knew, before I started, that I would now have the distinct privilege of being a vaguely competent podcast editor!

More importantly than all of that though, I can honestly say that I have never been so at peace with myself. I have confidence in my abilities, and understand my own limits. It is only because of the support that I have benefitted from Stand that I felt confident enough to take the next step in my career. I wasn’t looking for a new job, with colleagues like these who would!? However, when I saw it, I knew that it was time to move on. Everyone at Stand has been on the receiving end of at least one transport related 15-minute long tangent from me, so they understood as well as I did that this was an opportunity that I couldn’t let pass me by.

Working at Stand has been an absolute privilege. I cannot imagine a better group of people to start your professional working life with. The understanding, empathy, and consideration they have shown me throughout is more than anyone could possibly have expected, and I will miss everyone terribly.

Thank you all for everything you have taught me. I am a more rounded, knowledgeable, confident, and generally better man than I was just a few years ago. I hope working with me has been a tenth as enjoyable as it was working with all of you.

So long, and thanks for all the fish!

Blog by: Callum Currie

In many ways, the passing of the Health and Care Act in 2022 feels both a moment and a life time ago.

In that time we have seen Integrated Care Systems formally established, Integrated Care Boards and Integrated Care Partnerships formalised, and systems operating – and beginning to think – in much larger footprints, while managing place-based and neighbourhood relationships.

Many parts of the Health and Care Act are still to be enacted, though, including regulations that will introduce new elements to programmes of major service change and amend existing scrutiny powers.

Anyone with experience in delivering service change will agree that a comprehensive understanding of the associated legal duties is paramount to success. This includes the powers that local authorities have to scrutinise proposals.

As part of the process of implementing these new regulations, the Government has been clear that local authority Health Overview Scrutiny Committees and Joint Overview Scrutiny Committees will no longer be able to formally refer service change proposals to the Secretary of State.

Instead, the Secretary of State will have the power to ‘call in’ proposals for change and make recommendations. So what does this new ‘call in’ power mean for the role of local government in major service change?

Well, the answer isn’t clear to anyone yet. For twenty years, local authorities have been able to use their referral power to ensure that proposals for major service change are rigorously scrutinised. Losing this ability will be a big change. Some fear that scrutiny committee members will be less able to effectively represent the interests of their residents in discussions about NHS services in their area because of it. What is certain is that some things will have to change to make sure local authorities still play an active and meaningful role in scrutinising these services.

So what does this mean for the new and changing face of collaboration between commissioners, providers, and their local authority colleagues?

We know one thing: the new regulation requiring commissioners to notify the Secretary of State of proposals for major service change means that ambitions for change will be clear, clearly set, and importantly – public.

This could be an opportunity for local authorities and commissioners to work more closely together at the early stages of a service change to identify and agree common priorities before proposals are made public through the notification duty.

The best change programmes don’t engage with local authority scrutiny because it’s the law; they do it because they know that working in partnership with local government is effective, supportive, and drives positive change. Commissioners and local authorities have a strong, shared knowledge of the patients and the public that they serve. Sharing that knowledge in constructive ways bolsters the benefits of the changes that are being proposed.

With solid shared plans, and cards on the table from the point of notification, NHS organisations could work collectively and collaboratively with their local government partners towards a vision for better services that improve how patients and the public access health and social care in the future.

Will this change work to meaningfully develop the relationship between NHS bodies and local government? And will the removal of the referral power delegitimise the role of local authorities, or serve to give them greater opportunity to get involved at earlier stages?

These are questions we’re looking forward to seeing play out, as well as supporting, once the regulations come into force some time in the new year.

Note: we love to talk about all things service change. For an informal conversation about the details of these new regulations, get in touch with us at hello@wearestand.co.uk.

Blog by: Jonny Williams

Check out our bonus episode on our podcast, Not a Consultation where we discuss these changes further and how they might affect service change programmes. We’ve got some tips for managing what’s coming too.

On the 30th June NHS England published the highly anticipated NHS Long Term Workforce Plan. It’s a doozy of a document, coming in at over 150 pages. Here at Stand we’re wondering: what do these plans mean for public involvement?

In the plan, NHS England details its ambition to train, retain and reform the NHS workforce through a number of government-backed commitments. These include things like expanding training places, incorporating Artificial Intelligence (AI) and technological innovations, and to reward staff with better career progression and development opportunities.

A recent report from The Health Foundation found that the NHS is the thing that makes people feel most proud to be British. An alarming number of them though – 75% – fear that the current condition of the NHS means that privatisation and cost-based treatments are inevitable.

There’s a gap between the delivery of high-quality, clinical care that NHS staff are focused on, and the experience of care that patients receive. In the latest British Social Attitudes Survey, overall public satisfaction with the NHS has dropped to 29%, the lowest it’s been since 1983.

This gap, coupled with significant financial pressure and the need for urgent and long-term reform (and a global pandemic to boot), means the importance of engaging and involving the public is greater than ever.

No national or local target acts as a better arbiter of how the NHS is performing than the patient who experiences poor care, and the ambitious approach in the workforce plan will inevitably change who will see, triage, and treat patients in care.

We think it solidifies the need to take a community-centred, preventative approach to the future of healthcare if the NHS is to survive.

To make these new and changing roles and services work for the future of the NHS, it will be more important than ever to ensure the public understands and supports these changes.

As involvement practitioners, we know that patients and service users understand the significant pressure the NHS workforce is under.

The need for workforce reform is widely understood from clinicians to councils, and to patients and the public. The importance of communicating the details of that change, and involving people in it, should now be as important as the change itself.

We know that services work best when they’re co-designed with patients. When they are centred on their needs and designed to provide clinical excellence delivered by a strong workforce.

The Long Term Workforce Plan is a bold strategy to expand and diversify that workforce.

How we make these ambitions a reality is by taking patients with us on the journey, shaped by their lived experiences, and by constantly seeking to improve in providing the best possible care.

Blog by: Jonny Williams

June is Pride month. All around the country people will be out celebrating diversity at community events large and small. There will be glitter. There will be face paint. There will be brightly coloured feather boas (and that’s just in my house!). There will be flags. Progress pride flags. Trans pride flags. Bi pride flags. And a whole host of other bright, brilliant, celebratory flags brightening our streets and workplaces.

Pride at work is fundamental for me. Being able to be out as yourself at work is a given for lots of people now. It isn’t for everyone and certainly not in many countries. Unlike many of my queer contemporaries starting work in the mid-nineties, I was totally out in both my first two jobs after uni. Working as a society officer in the Students’ Union, then as a development officer for a local LGBT charity, being an out gay man wasn’t just okay, it was an advantage.

That changed when I moved to a bigger organisation. Some of the team there were supportive, or didn’t care. Others I was told not to tell if I wanted to ‘get on’. That meant constant vigilance. Checking and editing what I said as I was saying it. Watching how I acted. Hiding. And all that pretending took energy that I could have been channelling into my work. I found it massively draining and couldn’t sustain it for long. Ever since I’ve chosen the earliest appropriate opportunity to come out in any new environment.

Being able to be myself I’ve always seen as a strength. And when it came to setting up Stand, encouraging people to be their authentic selves at work was a cornerstone of our efforts to create a high-performance culture.

It’s there in our values under Stand at ease: “We know we’re at our best when we’re authentic. We’re kind and constructive. We don’t judge. We feel safe showing vulnerability. We’re proud of who we are.”

And in that statement we aim to share values aligned with those of Pride with everyone.

Caroline puts it brilliantly, “Pride at work is absolutely hard-wired into Stand’s values. When everyone feels safe being themselves, we’re better at supporting each other to do a great job and be happy at work and at home.”

We asked the team what pride at work means to them.

Gail said “Pride to me is about celebrating acceptance. We are all humans and deserve to be able to be comfortable and true to who we are.”

Sue told us that for her “Pride at work means that everyone I work with is equally special. We are not labels, we are each precious individuals.”

And Jonny told us that “Pride at work for me means being able to be my authentic self. As someone who is LGBTQ+, you find yourself ‘coming out’ every day – to new colleagues, to clients, to the patients and public that we talk to. Stand lives by its value of standing together – with my colleagues, I’m supported to be my authentic self at work, and celebrated for the diversity I bring. I couldn’t be more proud to belong to such a welcoming team.”

The impact of the Pride movement and the progress made over the years has been immense. Our aim at Stand is to pay that forward. Every day of the year.

When Gail asked her teenage son what Pride means to him, he said “It’s about not only accepting who you are but being happy to show it off.” We couldn’t agree more, Luke.

Happy Pride everyone!

 

Blog by: Paul Parsons
Photo by: Jonny Williams

Last week, the government announced the next wave of hospitals to be included in England’s New Hospitals Programme (NHP), the largest capital infrastructure project for NHS estates in recent times and the biggest access to significant capital that Trusts have been able to get in a long time. But it isn’t all roses: many of the schemes that already have NHP approval have been bumped down the list in favour of a number of RAAC schemes (‘reinforced aerated autoclaved concrete’… we know…) which have taken priority. On top of that, the overall budget for the NHP seems to have been reduced. Capital allocations for each of the sites announced last week aren’t yet public, and will only be once business cases have been approved.

The announcement is good news for a wave of sites that desperately need an influx of cash to improve crumbling estates and get on with the business of delivering excellent care. As one site used to put it, “we have more scaffolding poles holding up the building than we do members of staff working in it.” Refurbishing these sites in safe, sustainable and future-thinking ways is a win for the patients and public who’ll use them.

There are consequences of reprioritising any list. Now communities in Hampshire, Nottingham, North Devon, Preston, Lancaster, Sussex and others find their promised new hospitals a little further away than perhaps they hoped. The Secretary of State could easily have replaced those schemes, rather than delayed them, so it’s a positive that they are on the list. But delaying to the 2030s leaves the projects as hostages to electoral fortune. Will the promises of these new facilities be able to survive two general elections and multiple spending reviews?

In very interesting timing, on Tuesday Keir Starmer, the leader of the Labour Party, spoke outside an ambulance station in Essex to set out Labour’s vision for the NHS if they win the next general election. Accompanying this was the detail of the party’s third mission to ‘build an NHS for the future: that is there when people need it; with fewer lives lost to the biggest killers; in a fairer Britain, where everyone lives well for longer.’ Amongst the anecdotes and ideas was a commitment by the party, if they become the next government, to review capital spending on NHS infrastructure projects including the New Hospitals Programme.

All of this adds up to a lot of uncertainty for systems that have spent a lot of time, money and effort to develop meaningful plans for the future for their struggling services. And further delay means it’s even more important to keep engaged and communicating with the people impacted by the delay to those changes, which in turn costs further time, money and effort.

In a world of short-term budgets dependent on the whim of the government of the day, it can be difficult to see the woods for the trees when it comes to the argument for immediate investment for long-term gain, especially when it comes to estates – and prevention, too. Another blog post, anyone?

Blog by: Jonny Williams
Photo by: Pixabay

You think you need help to get your service change project delivered, but how do you choose the right consultancy to help you?

Budgets are tight and timelines short for NHS service change project managers and programme directors. Getting the right strategic advice and expert delivery you get provided by the right specialist patient and public engagement consultants will play a pivotal role in managing your programme to a successful conclusion.

Do you even need external support? 

Our NHS organisations are full to the brim with experienced patient involvement and public engagement professionals. Look around you and you’re sure to find a team who are at the top of their game. Of course, there are all sorts of reasons why they might not take the job on. They might not be familiar with the latest service change requirements. It might be some time since they led a service change involvement exercise. Or they might simply be too busy with other things to take it on. If they can’t help directly, at least you’ll have some internal experts to help you choose the right external consultants to support you. 

If you do need external support, these six things will help you choose the right patient and public engagement consultants.

• Be clear about your objectives

NHS service change can be a daunting process. Being able to describe the outcomes you’re aiming for will mean the right agency will understand your business objective and help you understand how to get there. If they aren’t asking you lots of difficult questions about your programme objective, they probably aren’t the right consultants for you.

• Are they specialists in service change?

Anyone can turn their hand to NHS service change and it might go okay. We think it’s important that you get support from people who really know their stuff. People who can spot problems before they arise and whose work won’t leave you and your team hanging out to dry in front of a court, or facing a critical review by the Secretary of State. 

• Have they got recent experience?

The legal and regulatory requirements for NHS service change are complex and continuously evolving. It’s one thing being able to quote the guidance documents, and another thing entirely to understand how to apply it among the operational pressures that most service change programmes find themselves under. 

• Do they have a successful track record? 

Check them out. Most good agencies or consultancies are proud of the work they do and shout about it. Look for case studies and testimonials that demonstrate a solid understanding of the challenges of service change and how to overcome them. Google them. Look at any news stories they feature in.

• What are their charges and payment terms?

Your budget will be the biggest consideration in how much you spend. Consultancies charge for their services in different ways. Some charge per hour. Sometimes they charge a fixed rate per project. Sometimes it’s a pre-agreed plan of work covered by a monthly retainer. All of those approaches are workable. Shop around and choose the one that suits you most. Be aware that some agencies will be more flexible than others in adapting to the inevitable bumps you’ll experience in the project road. Some will quote a price that allows them to flex and absorb many of those bumps. Some will charge extra for everything they do that’s not detailed in the original project scope. If anything about the payment terms strikes you as odd, for example we’ve known consultancies wanting the whole fee or large amounts of it upfront before they do any work, then they probably aren’t the supply partner for you.

• Can you trust them?

This sounds like a harsh question, but after the technical considerations, it’s an important factor. You have to know you can work with these people. You’re choosing a team to support you for at least a few months and, on a big programme, possibly as much as several years. Talk to them about their approach to work and the values that they hold themselves to and you’ll soon get an idea about whether you’ll be able to trust them and work well with them.

Blog by: Paul Parsons

The 2023 pre-election period is a week old. Every year when it kicks in, the phones at Stand Towers ring and our inboxes start to ping with quite reasonable questions about what it means and how it should be applied locally. This is the first time Integrated Care Boards have dealt with scheduled elections, so it’s probably not surprising that we’ve had more questions than normal from friends in ICBs about what it means for them and how they should apply the rules.

This year, district council, unitary authority, metropolitan district, and mayoral elections will take place in England on Thursday 4 May.

On 16 March, NHSE issued guidance on the need to observe a “pre-election period”. It states that it should start as soon as formal notice of an election is given locally and in any case no later than 27 March. Ten days might sound like unreasonably short notice of what you have to do in these cases, but the elections aren’t a surprise and the guidance is a reissue of a document first published in its current form in 2019. The expectations are very familiar.

The guidance tells us that “The pre-election period is designed to avoid the actions of public bodies distracting from or having influence on election campaigns.”

What does the guidance mean specifically for NHS service transformation processes?

If you’re in the early stages of talking about the need to change services in an area, we’d be reasonably expected to steer clear of:

•  any activities that could draw attention from the elections,
•  issues that could be picked up by candidates as election issues, and
•  holding or attending events where NHS representatives might be asked to respond to questions on controversial issues.

If you’re planning a consultation or any other public exercise exploring or discussing service change proposals or the need for change, don’t launch it in (or in our view, immediately before) the pre-election period.

If you’re already running a consultation or another exercise to publicly discuss service change proposals, you can continue into the pre-election period. You shouldn’t advertise or promote the exercise until after the election.

Simply put: plan to finish your exercise before the pre-election period.

If your exercise must run into the pre-election period, plan to finish a little while after the election to allow for final chance promotion.

If, for any of the many good reasons to extend an exercise, you need to run into the pre-election period, consider adding the extra time you need after the election.

Don’t publish the outputs of a consultation or other involvement exercise during the pre-election period.

In board meetings, avoid publicly discussing or making decisions on issues that could be controversial.

What does the guidance mean for involvement?

Involvement covers such a wide range of activities that it’s difficult to have a rule. Easier to think of a principle that the NHS doesn’t want to draw local authorities into anything that could be uncomfortable for them, compete with candidates for the public’s attention, or raise issues that could influence or become subject to campaigning in the election.

• Patient experience audits and surveys should be able to continue with no problem.
• Meetings and events that local people can participate in are probably best left until after the election.

There is nuance in how to apply the guidance. Can activity in an area of an ICB footprint where there is no election continue, while activity in another area has to stop?

What happens when urgent service changes are needed in the weeks before an election?

Planned well, the pre-election period is an ideal chance to do the background work needed to launch an involvement exercise, or to analyse and report on the findings of an exercise that’s recently finished.

If you have any questions, we’re here to help. Get in touch like others already have.

Blog by: Paul Parsons
Photo by: John Mounsey

A few days ago, the UK government published its response to a public consultation it held in late 2021 on changes to flexible working laws.

Now, the outputs of so many UK government consultations end their days languishing in a Whitehall black hole with no prospect of ever informing public discussion, that

“Government publishes response to public consultation”

could be the news in itself for involvement and consultation anoraks like us. But this time there’s more to it.

The consultation response stood out for us. Flexible working is so much a part of our way of working at Stand and we wouldn’t be Stand without it.

We want talented people to want to work with us. Whether they are in our amazing staff team or one of our fabulous freelancers, we want them to be able to bring their best to work every day.

Few people naturally have the kind of work-shaped hole in their lives that the wise and inimitable Dolly Parton immortalised in her iconic 1981 tune 9 to 5. And even if they did, our brains all work best at different times.

The government’s response to its consultation got us talking about what flexible working means for each of us at Stand.

The most common theme was our appreciation of the time flexible working gives us for our families, and for our parenting and caring responsibilities.

“I can work around the school runs and be able to go to school events.”

“I know there is no judgement when I need to step away for a break, or pick the kids up from school.”

“I can respond to family needs, knowing this is recognised as important by the people I work with.”

We recognised that we all work best at different times:

“It gives me the chance to work when I work best, meaning I get the best out of work and our clients get the best out of me.”

“When I need to concentrate on producing something, I work best in the evening when there are no distractions.”

“I can work at times when I can give my best.”

“I’m an early riser and work best first thing in the morning. I get loads done and avoid disturbing others by scheduling emails to send later.”

We talked about the benefits it brings to our wellbeing:

“In these dark winter days, working flexibly allows me to get outside during the day to enjoy the light and the air, which I love.”

“I have a healthy work-life balance which makes me happy.”

“It keeps me healthier mentally and physically.”

And we talked about how it motivates us:

“Flexibility at work motivates me and makes me more productive.”

“Working flexibly helps us appreciate and trust each other more – we all give 100%, whatever work pattern we’re working to.”

“I love the respect and absolute support for people’s non-working time.”

So perhaps if Dolly were to rewrite her song four decades on, it might go something like this:

Working flex-ib-ly
That’s the way to make a livin’
Time for fam-i-ly
There’s some takin’ and some givin’

Helps you use your mind
When it’s fresh and activated
It’s the way to keep you
Sharp and motivated

(Or perhaps not, we know Dolly would do a better job!)

We’re a small team with a strong set of shared values, so maybe these things are easy for us. We value flexibility as a core strength. And our clients tell us they value it in our approach.

Everyone at Stand – the people in our staff team, the expert freelancers who work with us, and our directors – all fit their work around their life.

We know we can always improve, so if you have ideas or experiences of flexible working that you’d like to share with us, please leave a comment.

And if you’re a public involvement and communications professional, or experienced in service change, and you might be looking for a more flexible approach to work, why not look us up?

Thanks to Bukky, Gail, Alison, Pippa, Caroline, Siân, Michelle, Karen and Paul for sharing their thoughts with us for this piece.

Blog by: Paul Parsons

The news that local authorities in England will retain their power to refer disputed health service reconfiguration proposals to the Secretary of State “until the new reconfiguration provisions take effect” will make many NHS programme managers a bit twitchy. Especially when coupled with the news that “changes to the reconfiguration process introduced through the Health and Care Act 2022 [The health secretary’s new intervention powers] will not be implemented immediately” with exact timelines “still to be determined”.

Reconfiguration programmes rely on planning that understands and nails down risks in tight monitoring and management frameworks.

One of the huge benefits of the current scrutiny framework is that it has been in place for two decades and is well known and understood. It’s reliable and predictable. It works best when the relationship between the scrutiny panel and local NHS leaders are open and respectful. It is strong enough to withstand tensions when those relationships are not present.

We know the power to refer will go, but we don’t know when. We know there will be a new process to support the Secretary of State’s power to intervene in service reconfiguration programmes, but we don’t know what that will be.

So, we enter a twilight zone for health scrutiny.

For those of you steering sensitive service change proposals through the rigors of the scrutiny process right now, this will be an unwelcome sprinkling of uncertainty as some scrutiny panels race towards using that referral power while they still can.

The new guidance, Health overview and scrutiny committee principles, sets out five principles and ways of working between Health Overview and Scrutiny Committees (HOSC), Integrated Care Boards (ICBs), Integrated Care Partnerships (ICPs) and other local system partners to ensure the benefits of scrutiny are realised:

• outcome focused
• balanced
• inclusive
• collaborative
• evidence informed

The principles are good. For many they will prove to be a solid foundation for open and trusting relationships that stretch way into the future.

At the moment scrutiny committees can refer a reconfiguration of services on three grounds. 1 – that the NHS didn’t consult them. 2 – that the time allowed for consultation or the information provided to support consultation were inadequate. And 3 – that the change proposals are not in the interest of the area of health services in the area covered by the committee. It’s this third one that will perhaps be the most significant loss. That has been local politicians’ chance to make the case to their constituents that they did all they could. Using it has elevated the issue above local politics into the Independent Reconfiguration Panel (IRP) process. The IRP’s rational and objective take on these issues has provided the route to overcome many a local impasse.

The big danger is that under the new system we will see much greater politicisation of local health service decisions. I’m hoping that eventuality will be avoided with regulations for the new process that are as balanced as those we’ve become used to.

The reality is that the remaining powers will still be sufficient to compel NHS bodies to take scrutiny seriously. And scrutiny committees will have to think differently about how they wield those powers.

If you want to talk to us about how to assess and manage the risks for your reconfiguration programme, drop me a line to book a free call with us Paul@WeAreStand.co.uk

Blog by: Paul Parsons

When I interviewed Caroline and Paul about our plans for Stand at the beginning of the year, we didn’t expect to be an award winning team six months into it.

Paul and Caroline are very modest about the work that they do, but given what they’ve achieved in two years, I decided to enter Stand for an award. In April, I received a call to say we were shortlisted for the Newcomer of the Year award for the North East Business Awards’ Durham, Sunderland and South Tyneside heat.  I immediately rang Caroline and Paul to tell them the good news and we were jumping with joy – literally! 

We joined the other finalists last week at Ramside Hall. Just to be celebrating with the other regional businesses was enough for us. When our category came up and they said our name, you may have heard our scream in the next village. Wow! We couldn’t believe it. We were straight on the phone to the team to share the good news with them before it was announced on social media. 

To have recognition for our achievements gives us the message that what we are doing is right. What started with just two directors two years ago is now a team of twelve, and we are without doubt a happy and energised team.

As Paul said, when he was interviewed by Journal Business Live, “This is for the team – they are so amazing. We’ve got a great group of people and we’re lucky to work for people who really appreciate us and who keep coming back for more.”

Paul and Caroline launched Stand in March 2020. They have a great shared history, both as colleagues and as friends. Their respect for each other and passion for what they do is truly inspiring. They wanted to specialise in patient, public and citizen involvement from the start.

However, only days after the company launched in March 2020, the NHS announced it was suspending all work on service change projects, to deal with COVID-19. Lockdown came a week later. 

The timing of the launch of Stand meant Caroline and Paul had to adapt to huge changes. Like everyone, they had no time to ponder and were immediately thrown into what response COVID needed. They leaned hard on their values and the COVID-19 Vaccination Programme is a good illustration of this. Stand joined the programme (hosted by Newcastle Hospitals) six months into the pandemic. As Caroline states in her blog The wider learnings of the COVID-19 vaccination rollout, “We knew that relationships would be the key to the success of the programme. Building and sustaining relationships through trust and open communication was made a priority in our strategy. Time and again in the tight spots, when it looked like our attempts were proving impossible, those relationships  delivered.”

Winning Newcomer of the Year was a very proud moment for us. We do our jobs because we passionately believe in the public informing decisions. We will go head-to-head with other heat finalists at the North East Business Awards’ grand final in September and we can’t wait! 

Blog by: Michelle Bainbridge

Moving from options development into a public consultation period is one of the most challenging aspects for any strategic change programme.

Stand’s director, Caroline Latta, shares four key considerations to have in mind when planning your consultation timeline.

Picture the scene. You’ve worked hard with clinical teams, commissioners, stakeholders, patients and partners, and there’s strong consensus on the business case for change.

Together, you’ve developed great working ideas, developed and applied evaluation measures to include the elements that are important to staff, patients and the public.

And you’ve finally got a robust set of proposals. You are ready to move into the public consultation phase.

You may as well try and nail down jelly. 

Mapping out a public consultation strategic timeline, bringing together all the threads of planning from your options development phase, is one of the most daunting tasks for any change programme. 

The need to delicately balance the timing of multiple aspects of the change programme can be a kaleidoscope of interlinked issues. 

• Is the timing of NHS regulatory assurance, organisational governance, and consultation with health scrutiny committees lined up? 
• How long should the live public consultation period be? 
• Should it be longer to take holidays into account? 
• How much time is needed for drafting and signing off of consultation documents, accessible formats, surveys, focus groups? 
• At which points do key stakeholders need to be involved? 
• What is the best timing for the schedule of public events? 
• And are key leaders available to front them? 

With so many moving parts to align, getting back to key principles is the best way to create a clear roadmap through to the final end point of decision making. 

Map it out and write it down

Start by setting out a timeline, adding in key milestones such as those above and share it with your programme team. 

Include key meeting dates such as boards and committees, include preparation timescales, map out the public start, middle and end dates, when key public events or other research methods could take place. Add in the post consultation timeframe paying attention to when the analysis of feedback would be available and dates for consideration of feedback and decision making.

Gain feedback and contributions from colleagues so that everyone can agree and sign up to the timeline as being realistic and achievable.

Now we have deadlines to focus on and move the programme forward.

Governance trumps all

Public consultation is about making better decisions, so it stands to reason that the governance framework for decision-making is paramount. It provides the statutory legitimacy for decision-making and accountability to the public.

Be crystal clear about how the programme governance works in relation to the decision-makers and other statutory partners. For example:

→ The transformation programme board recommends the final business case to the provider trust.

↪ The provider trust wants to sign it off, before it’s submitted to NHS England and Improvement for assurance.

↪ NHSEI assures the business case and returns it to the statutory commissioners

↪ The commissioners approve the business case for public consultation. 

In simple terms, making sure the right schedule of meetings are at the right time and in the right order to pave the way for assurance and agreement.

Right now decision-makers are Clinical Commissioning Groups (CCGs). That will change on 1st July, when the Health and Care Bill gains Royal Assent when Integrated Care Boards (ICBs) will take over. That means decisions based on a consultation that starts now will be made by your ICB. 

So it’s wise to involve your ICB leaders at the earliest stage you can, because they will need to be satisfied that the duty to involve patients and the public in developing the proposals, the public sector equality duty, and all the other legal duties that come with a public consultation on a service change proposal have been met.

Remember the statutory duty to consult with Health Overview and Scrutiny

Working out the best way to discharge the statutory duty for NHS commissioners to formally consult a local authority on substantial changes is best done in partnership with health overview and scrutiny (HOSC) officers.

They can offer sage advice on how to ensure elected members are involved in the right ways. It’s worth remembering that with local authority elections in many parts of England taking place in May 2022 may mean changes to HOSC membership – so all the hard work you’ve done to develop relationships and gain understanding about the case for change might need to begin again. 

The critical dates for the HOSC are the date by which the local authority must respond to the consultation proposal and the date by which the NHS body intends to decide whether to proceed with the proposal – and it is the NHS’s responsibility to publish these dates and any changes to them.

Forward thinking change programmes will have worked with elected members during the business case development phase, making sure councillors had an opportunity to fully explore the issues in advance. Committees will be interested in communications and involvement aspects of the consultation so it’s always a good idea to ensure you share those plans and provide an opportunity to influence them. It’s likely the committee will wish to have their formal consultation meeting with the NHS on the proposals a few weeks into the live public consultation so they are able to observe the live phase underway, noting the questions and concerns from the public. 

As the HOSC will need to provide a formal response about the proposals to the commissioners, allowing their views to be taken into account at decision making, the committee will likely wish to hear the public consultation feedback to inform their thinking – all extremely important dates that should be agreed with scrutiny officers and mapped into the timeline.

Accept the timeline will keep changing

At Stand Towers, we know how hard managing a consultation timeline can be, and we want you to know that the timeframe for every single consultation we’ve worked on over the last 20 years has changed in some way, manner, shape or form after it’s been nailed down and approved.

It’s inevitable because of the multiple forces outside of the programme’s control. So let your timeline breathe a little. Build in practical contingency from the start and know what impact a change here or there will have on the whole programme. HOSC asks for an extra meeting. Your assurance team asks for amendments that will take an extra week. A key governance meeting is postponed to deal with system pressures. What impact would those have? Preparing will allow you to better manage those bumps in the road, adding flexibility and the opportunity to adjust without busting the timeline completely.

You know how it is. You’ve worked hard to get your change programme off to a good start. Scope agreed. Objectives endorsed. Budget approved. Clinicians are actively engaged and you’re getting a great response to your patient involvement activity. Everything appears to be swimming along nicely.

Then, at an open engagement event, in response to tenacious questioning from a local campaign group concerned that this conversation spells the end of their much cherished hospital, one of your leaders (the chief officer perhaps) drops the C-bomb.

Consultation.

“We’re a long way from any decisions about this.”

They’ve started well.

“We’re here to get your input, to understand things from your perspectives as patients.”

There’s the focus on the process you briefed them on.

“That will help us work out what might be possible. This is just the start of our process. We want you to be involved from the start. That’s why we’re here.”

Brilliant. We got there without using the double-down position. You can breathe again.

 “And of course, we’ll consult you before we make any changes.”

Arrrgh! There it is. Boom! The genie is out of the lamp. A few weeks of well-planned informal engagement and data gathering becomes a much larger exercise.

It’s not uncommon. We’ve had conversations with two change programme teams in the last fortnight that have unwittingly made the promise. And we don’t blame anyone for stumbling into the trap.

There’s a common understanding in the NHS, in England in particular, that there’s a statutory duty to consult the public on changes to services, and making a public statement to that effect hardly seems a stretch, if that’s the case.

Too bad then that it isn’t.

We always start our briefings and development sessions for NHS leaders with a few range-finding questions. These are busy people. Our executive directors, chairs and board members. Their time is extremely valuable, so we want to make sure the 45 minutes they’ve given us are well-used. We don’t want to spend a second of it telling them things they already know.

One of the questions we ask (spoiler alert for future attendees) is:

Who in the room is aware that NHS bodies have a duty to consult the public on service change? 

Sometimes the room knows what we’re getting at immediately and quickly assures us we can move on.

At least half the time there’s a chorus of nods. Then we spend some time unpicking that understanding.

It’s a duty to INVOLVE individuals who use the services and individuals who might use the services.*

And the legislation gives us a handy definition of how we can do that: “by being consulted or provided with information or in other ways”.

In. Other. Ways.

We’re on record countless times as big fans of public consultation and we’re big supporters of the Consultation Institute. Done well on the right subject, it’s a powerful tool for explaining publicly the complexities of the services we provide and making sure everyone who wants a say in changes to those services has their views taken into account.

But the programmes that need what’s often called “full” or “formal” consultation tend to be the big and potentially controversial ones.

“In other ways” gives us the scope to take a proportionate approach to these exercises. We can use innovative approaches to involve the people who have lived experience of our services, and the people who are most likely to need to use them in the near future helps us develop and improve them, or deal with challenges.

The factors which may mean that a public consultation is required for your programme are complex and varied.** The most obvious of them is making a promise to consult stakeholders or creating an expectation that we will. So let’s avoid that.

When we enter a proposal-development process with a properly open mind, we don’t know what change proposals will emerge at the end, so we don’t have the information to assess whether a public consultation will be required.

In practice, the change proposals might be much smaller than the original aspirations.

By talking to service users, an aspiration to close an urgent care centre might become a proposal to require people to access the centre through 111. But if you’ve told your stakeholders you’ll consult them before you make any changes to the service, you’ll still have to formally consult them on that much smaller, possibly less controversial change, or you’re likely to end up in a judge’s bad books.***

So let’s ban the C-word from our service change programmes. Let’s keep it for the times we need it. When we’ve involved people in developing our proposals. When those proposals have been signed off by the board. And when the need to hold a public consultation on those proposals has been properly considered.

Until then get a jar ready and collect a pound a time for your favourite charity.

That’s our proposal. What do you think?

P.S. If you’re looking for a standard alternative phrase, try this: All our decision making is subject to appropriate patient and public involvement. You’re welcome 🙂

Blog by: Paul Parsons

 

*s242/13Q/14z2 of the NHS Act 2006 (as amended). There are some additions coming in the new legislation.

**(See 6.2 Deciding to consult the public in the legal duties for service change guide Stand’s directors wrote with Capsticks for NHSEI.)

*** See Buckingham v Corby CCG 2018.

In a week of heart wrenching stories from Ukraine filling our social feeds, a little nugget of NHSEI (NHS England and NHS Improvement) news was enough to bring a little light into my day.

That news? The NHSEI system transformation team launched a new interactive handbook for service change.

Granted, the list of people this news will bring joy to is a short one, but for this dyed-in-the-wool service change anorak, any new document on health service change is exciting.

Major Service Change: an interactive handbook sets out in 83 pages the context and process of service change in twelve easy-to-read sections. Together they chart the course and requirements of a service change programme. And it links directly to an enormous resource of secondary documents in a whole new indexed resource on Future NHS (*if you’re not a member, sign up).

So what’s new? Well firstly, it’s important to point out what’s not new: all the current guidance and law stands. And the 2018 planning, assuring and delivering service change for patients (PADS) takes pride of place in the handbook’s main list of key resources. Of course we’re proud to see the guide on legal duties for service change, Caroline and I wrote with Capsticks for NHS England in 2020, also on that shortlist. The handbook explains it’s written in February 2022 based on legislation and guidance that applies now. The introduction acknowledges there will be changes when the Health and Care Bill becomes law, so we can be pretty sure there’s an update draft already waiting in the wings for publication in a few months’ time.

The most obvious development strikes as you click on the index. An introduction and eleven stages of service change that expands the six-stage summary process that’s illustrated in PADS, and we’ve relied on as the basis of our plans for years. 

The first of these stages is ‘Drivers and context’, which points to the rigour needed to give your change programme a solid start. Including an important message to start by developing a solid understanding of the situation and challenges. Every change programme has a starting point and the handbook encourages us to know where we are now in detail, before we start working out where we should put our new Hyper Acute Stroke Unit, how many Urgent Treatment Centres we need, or whatever other change programme we are working on.

The handbook helpfully splits the NHS assurance process out into its three stages and sets them out at the relevant points in the process. This means readers get a much more accessible explanation of the requirements of each assurance point than has been available before. That’s going to be incredibly useful to people who are coming to service change for the first time.

Proposal development and options appraisal approaches are under ever increasing scrutiny from the public and local politicians, and we’re given much more detail about these than we’ve had before. And by setting out an eight-month process for planning, preparing, delivering and reporting on a public consultation, the document gives change programme planners a handy and, I’d argue, reasonable insert for their timelines. This gives me hope we’ll see fewer programme timelines arriving on communications and engagement colleagues’ desks with a three-month non-negotiable window to do everything.

Each section of the handbook treats us to an impressive bank of helpful documents. There are case studies, example cases for change documents, webinars, example pre-consultation and decision-making business cases, slide decks on important aspects of the process, and we’re given links to external web-based resources. 

All in all it gives us more than 1200 pages of additional documents, that together look uncannily similar to our own resource library. On top of the legal duties guide in the key resources section, we’re pleased to see a webinar Caroline and I did for the transformation team in October 2019 on planning and conducting a public consultation included in the public consultation section.

And among these hundreds and hundreds of pages, it’s nice to see the return of some old favourites like the previously underused and under promoted Toolkit for communications and engagement teams in service change programmes, which by mishap or design seemed to have disappeared from the public website in 2019.

Inside the sections, I have a few questions about some of the drafting choices that I’ll pick up with the team. And a concern or two that the very accessible language and layout might mean some programme leaders less familiar with these processes might underestimate some of the requirements. These are minor points. 

Overall the document is a triumph. It’s clear to see the effort and commitment that’s gone into developing the handbook. It’s a huge achievement. It shows in one place the complexity involved in running a service change programme and the breadth of the considerations that need to be taken into account. It will be invaluable to change programme leaders across the country including the service change programmes Stand supports.

Congratulations to the transformation team and everyone involved in bringing this together at NHSEI. It will be a game-changing resource.

Oh, and the handbook tells us an addendum to PADS will be published shortly, so brace yourself for more excitement from Stand Towers!

Blog by: Paul Parsons

The COVID-19 vaccination programme has been the runaway success of the UK’s response to the pandemic.

Stand were asked to support the North East and North Cumbria’s COVID-19 Vaccination Programme, providing strategic communication and involvement advice and operational support to the vaccination programme’s leadership team. The mission – to vaccinate as many people as possible, as quickly as possible.

Stand’s director, Caroline Latta, shares her observations on the wider learning for communications and transformation professionals from the fastest and most successful vaccination rollout in the history of the NHS.

 

Relationships count

It’s a universal truth that relationships count, things get done through relationships and trust.  The vaccination rollout has proved that strong relationships make all the difference, both building on those already there and developing new ones, when it comes to getting things done quickly.

The extensive network and professional relationships we’ve built over twenty years working with NHS and public health colleagues across the country are particularly strong in the North East.

Joining the regional COVID-19 Vaccination Programme, hosted by Newcastle Hospitals, six months into the pandemic, we knew that relationships would be the key to the success of the programme. Building and sustaining them through trust and open communication was made a priority in our strategy.

Time and again in the tight spots, when it looked like what we were attempting was about to prove it was impossible, those relationships delivered.

 

Everyone is a leader

Everyone at every level was a leader in the vaccination programme. No single partner, person or place was more important than any other. Everyone at every level had their role to play.

From the outset, the vaccination programme took the view that it is local leaders at all levels who make things happen. It was the regional programme’s role to co-ordinate and to filter the important clinical policy and key message must-dos from the loud noise of mass information overload. Our job was to support clinical commissioning groups, primary care and local authority public health leadership to stand up local services, quickly.

Lots of leaders in a rapidly changing environment needed up-to-the-minute sources of information they could trust. Our large engagement events, often with hundreds of attendees, were open, honest and transparent where programme leaders would respond to unfiltered questions and listen directly to the challenges being faced out in the field.

The approach meant local councils, hospitals, GPs and community networks could work together extremely closely to reach as many people as possible for their vaccination.

 

Single clear messages for cut through and amplification

 It was vitally important at a time of national emergency, with so much fear and uncertainty in relation to the pandemic, that public confidence in the NHS’s ability to deliver vaccination to the full adult population was established and maintained.

The national strategy saw single clear messages about who was eligible and when, balancing the pace of national rollout and vaccine supplies, no easy task.

While sometimes there wasn’t the clear forward view of when new age groups would be announced, it was right that this was nationally controlled.

The benefit of this was a sense of fairness and equity for the population which enabled a high level of cut through of messages.  National, regional and local media reporting the same messages, consistently amplified through local authorities and NHS organisations’ social channels.

This made it easy as possible to act with a single voice and have clarity on what was being asked by the national NHS vaccination programme team and government, and a clear call to action for the public.

Newcastle Hospitals was one of a handful of centres across the country to vaccinate the first patients on 7^th December 2020 and opened the country’s first large vaccination centre at The Centre for Life soon afterwards.

The regional and national media have supported every single milestone, from opening new large vaccination centres, mobile services and new age groups opening up. Made possible by the willingness of the vaccination programme leaders to step forward to be interviewed, supported with clear messages and briefing.

 

The importance of good data

 At the outset of the vaccination programme, the availability of good data was limited. This changed rapidly, with data becoming available to allow the vaccination uptake to be viewed in real time. This allowed regional and local vaccination leaders to identify the areas where vaccination uptake was lower, understand communities were affected and take action. Through the leadership of the Director’s of Public Health, the different approaches taken to address inequalities and to engage people from underrepresented groups were mapped across the region, captured by geography and population group. A catalogue of information demonstrating a wide range of different interventions was developed to share good practice. Importantly, four key learning points are transferable to inform future planning for COVID-19 and other vaccination programmes:

1. Better information for communities and professionals such as alternative language, easy read, etc
2. Increasing accessibility, taking the vaccine to the people
3. Empowering communities, using community champions and other trusted voices, and
4. Partnership working and collaboration, linking with businesses and the community and voluntary sector.

 

Reflections

The pandemic response has highlighted as never before the value of communications and engagement as a strategic function in NHS organisations and public health departments. Nowhere was that more evident than in the rollout of the vaccination programme.

It was never going to be an easy task. The foresight of programme leaders in the North East and North Cumbria to put strategic communications and engagement at the heart of the programme meant it was as smooth as it could be, with many challenges quickly resolved and others identified and avoided before they occurred.

Over the course of the rollout, the regional vaccination programme itself, with the support of local authorities, opened seven mass vaccination centres who were able to vaccinate thousands of people a day. The sheer volume and geographical spread of primary care networks, hospital hubs, and later, community pharmacies, saw nearly 300 vaccination outlets that have provided over 6 million first, second, booster and other doses in-line with JCVI advice.

See more on our work with the COVID-19 North East and North Cumbria Vaccination Programme