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
