NHS needs new approach to consultation

Expect a spate of announcements of reviews, reorganisations and reconfigurations this week as NHS organisations get on with plans for releasing savings that they have had to keep under wraps during election purdah.

Campaigns obligatory for prospective MPs

Many in the NHS have been looking forward to the end of campaigning.  Whatever the outcome, we know the scale of the economic challenge.  The end of election purdah means we can get on with setting out some of the changes that will be necessary.

But, regardless of which party may have the best policies, this hung (sorry, balanced) parliament is undoubtedly the worst result for the NHS.

Not only does the lack of a clear way forward mean that some elements of purdah remain in place – with the NHS still unable to make major decisions that might be impacted by the policies of the new government, for example, A&E and maternity reconfigurations or capital investment plans – it also means we’re likely to have another election sooner rather than later.  This means parliamentary candidates once again ramping up their obligatory ‘save our local hospital’ campaigns.

A survey of parliamentary candidates carried out by the Health Service Journal (HSJ) and published this week showed that 34% of respondents from the main three parties said that they would never support the closure of an A&E in their constituency ‘under any circumstances’.  So, with too many A&E departments, and the need for dramatic and urgent efficiency savings, the NHS has a tough job on its hands. Further party political campaigning isn’t going to make it any easier.  So what is?

In order to make the changes that are needed, the NHS needs to shift the way it approaches consultation and there need to be changes to the rules governing consultations.

Jeremy Taylor, chief executive of National Voices, a coalition of patient campaign groups, has written in the HSJ this week (here for those of you with a subscription) that the NHS needs to get better at involving local people in reconfigurations.  His group recognises that closures are not just necessary, they can lead to better care for patients, but he argues that the NHS does not have a good track record of making the case for change.  He is right.

Too often the NHS produces a jargon-laden document, defends its proposals at a few public meetings, and then sits tight for 12 weeks before carrying on as planned.

But successful change needs ongoing engagement.  This is, after all, what commissioning is all about.  PCTs I am working with are finding commissioner-led ongoing discussions with local patient, public and stakeholder groups invaluable in finding the best options, creating understanding, smoothing the passage of consultation and generating ideas for further improvements.

Providers are also finding internal engagement equally important.  Involving staff in future service models is not just generating clinical engagement; it is the only way to find the best service models.

With stakeholders understanding, if not fully on board, and with clinicians at the heart of these consultations, the public are reassured and politicians more measured in their involvement.

In addition, while ‘fast track’ is not the right term, we do need a system that encourages overview and scrutiny committees (OSCs) to act as partners in finding solutions, rather than as defenders of the status quo.

Changing the NHS approach and the role of OSCs may not make consultations quicker, but it would cut the wasted time, expense and reputational cost of failed consultations that get referred for review.