Public engagement generally describes a continuous process in which initial plans from government or similar bodies are shared with the public and other relevant groups to allow their input from the earliest possible moment. Notably, guidance on public engagement from NHS England states that
However, public engagement is often informal and there are some concerns among civil society groups that it’s a rather meaningless activity: those planning changes may have minimal discussions with random groups and present the outcome as if they have made extensive opportunities for input from the public.
In contrast, there is a statutory requirement for NHS bodies to formally consult with patients, the public, other stakeholders and relevant committees when considering a substantial change in the provision of a service (such as the closure of a hospital or department like A & E). Clinical Commissioning Groups (CCGs), local authorities, NHS trusts, NHS foundation trusts and NHS England all have separate, but similar, obligations to consult or otherwise involve the public.
For instance, the NHS Act (2006) requires CCGs and NHS England to ensure public involvement and consultation in commissioning processes and decisions, including the involvement of the public, patients and carers in:
- planning of commissioning arrangements, such as the allocation of resources, and
- proposed changes to services which may impact on patients, such as the way in which services are delivered or the range of services available to them.
And NHS England’s guidance states that adequate time must be allowed for consultation and response where significant changes are being made to services. In addition, consultation must take place while the proposal is still at a formative stage and not after a decision has already been made. Sufficient information must be provided to allow for intelligent consideration and response, and adequate time must be given for consideration and response. Finally the result of consultation must be carefully taken into account.
STPS, patient engagement and consultation
NHS England’s guidance on involving local people in the development of STPs states that it expects all ‘footprints’ to engage with local people through bodies like Healthwatch and other patient and public groups in order to discuss and shape their proposals at every stage of their development. However, draft STPs – unless leaked – were not publicly available before they were submitted to NHS England in October 2016.
In fact, STP footprints are not statutory bodies and so have no legal duty to involve the public in planning or decisions that will have an impact on services. Instead, it is individual NHS organisations within a footprint (CCGs, local authorities, NHS trusts and NHS Foundation trusts) that are legally obliged to consult or otherwise involve the public – if only to avoid legal challenge. Similarly, NHS England has a duty to involve patients in decisions about changing the way that services are commissioned or provided, where changes will affect the extent or way in which these services are delivered. (https://www.england.nhs.uk/wp-content/uploads/2016/09/engag-local-people-stps.pdf). However, this has not happened.
Footprints began to publish their STPs from 21st October 2016 onwards, and all were supposed to be published by December 15th 2016. However, CCGs’ draft operational plans for the years 2017/18 and 2018/19 (which, among other things, must show how CCGs and providers will support the delivery of STPs) had to be submitted to NHS England by 24th November. And the deadline for NHS England to sign off CCGs’ final operational plans (aligned with the signing of contracts for services for the years 2017/18 to 2018/19) was 23rd December 2016. In other words, there was no time for meaningful public consultation between the publishing of STPs and the first step towards putting these plans into effect. This may leave STPs open to legal challenge.
What you can do
- Sign the government petition calling for the NHS to be properly funded, and for the STP programme to be scrapped: https://petition.parliament.uk/petitions/165948 .
- Visit http://www.stopthestps.org.uk/home/4593142849 for up-to-date-information and resources for those wanting to take action against their local STP,
- Visit http://www.healthcampaignstogether.com/pdf/Resource%20pack.pdf for a resource pack giving information on how to find out what your local STP proposes, or how to make a Freedom of Information request. If you belong to a political party, this resource pack also provides the wording for a motion to submit to your local branch.