There are different ways of taking action to try and protect the NHS, from joining a pressure group, giving donations to national campaigning groups such as KONP, keeping friends and relatives updated, writing letters to the local and national newspapers about your concerns, to joining local or national demonstrations. You can join a local campaign group (see, e.g. https://keepournhspublic.com/local-groups/) or set one up yourself. And don’t forget social media for news or to learn about information about events.
Many proposals for fundamentally changing the NHS, such as Sustainability and Transformation Plans, appear to place considerable emphasis on ‘public engagement’ or ‘consultation’.
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. Guidance on public engagement from NHS England states that “Particular emphasis should be given to engagement with people who are less frequently heard and who experience the greatest inequalities in health outcomes.” (https://www.england.nhs.uk/wp-content/uploads/2016/09/engag-local-people-stps.pdf) 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 publicly 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 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.
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.
There are different ways of becoming engaged but for most, it’s worth knowing the grounds on which you can hold planners to account. For example,
The NHS Mandate
Each year, the Department of Health produces a mandate for the NHS which has to be laid before Parliament and sets out the government’s objectives and any requirements for NHS England, as well as its budget. (The Mandate for 2016/17 can be found here.) NHS England is legally required to follow the mandate: it’s one of the ways in which the NHS is accountable to Parliament and to the public. Clinical commissioning groups are also expected to play an important role in delivering the mandate. Although the most recent mandate is clearly in line with the current governments’ plan for the NHS, there may still be ways of using it to hold NHS England to account on some issues.
The NHS Constitution
The NHS Constitution is the main document that outlines the core principles and values on which the NHS is based. It clarifies what we can expect from the NHS, and what is expected from us in return. It states our legal rights and the pledges that the NHS is committed to achieve.
The NHS Constitution is revised every 10 years. According to the current version (2015), our rights include
A good way of finding out about – and challenging – local plans is to attend the board meetings of your local Clinical Commissioning Group, NHS Trust, or Health Scrutiny Committee. These are usually open to the public and you may be able to put questions to them, generally if submitted in advance. You should be able to find out about these meetings by searching on line, going to the CCG’s, Trust’s or local authority’s web page and looking for information about their meetings.
You can also find out what is happening from your local Healthwatch (http://www.healthwatch.co.uk/find-local-healthwatch).
If you are concerned about what is happening to local services, you can also write to your MP at The House of Commons, Westminster, London SW1A OAA (letters are more effective than emails), or meet him/her at their constituency surgery (see local paper for surgery times). To find out who your MP is, visit www.theyworkforyou.com. There is usually no point in writing to an MP if you are not one of their constituents. You can try writing to Ministers and there are instances when you can write to MPs or members of the House of Lords if they act as the Chair or are members of relevant committees, such as the Health Select Committee.
Signing petitions is useful, particularly when they are one part of a broader campaign. However, because the use of petitions has grown hugely and they are easy to sign, they are beginning to have less impact.
Supporting legal action
Several campaign groups are turning to legal action, such as calling for a Judicial Review, to try to stop further dismantling of the NHS.
Campaigners under the banner “999 Call for the NHS” are awaiting the outcome of a judicial review that they sought to test whether new contracts being drawn up for ACOs are unlawful, not least because the system for paying these organisations induces rationing of treatment.
In Dorset, campaigners have been granted a judicial review (due to be heard 17th & 18th July 2018) to challenge local CCG plans to move A&E and maternity services.
In Lincolnshire, the Save Our Urgent Care Action Group has sought a judicial review of Corby CCG’s plans to downgrade the town’s Urgent Care Centre without consulting patients. Instead of a walk-in service, patients would undergo telephone triage by someone with no medical qualifications before being given an appointment (a change that would circumvent the 4 hour A&E target).
Many of these campaigns would appreciate donations towards legal costs, and support outside court during hearings
For more information of action you can take, see: