Public Consultation Policy
Approval Committee Board of Directors
Review Date Document Author(s)
Public Consultation Policy, January 2012 Page 1 of 17
Tracey Hall, Head of Communications and Fundraising
Version Control Version Date 3
Principle Amendment Changes
5 5, Annexe A 7
• Inclusion of Monitor guidance and DH regulations • Update to joint protocol elements • Inclusion of SoS four tests
Consultation process Those listed opposite have been consulted and comments/actions incorporated as required.
List Groups and/or Individuals Consulted • Patient Engagement and Communications Committee • Executive Directors • Governors
Contents Public Consultation Policy, January 2012 Page 2 of 17
Health Scrutiny Committees
3.1 The role of HSCs
3.2 Principles of communications
Defining substantial variation and developments
When we will consult
5.1 Formal public consultation
5.2 Stakeholder communications
5.3 Exemptions from public consultation
5.4 Organisation reconfiguration
Who we will consult
How we will consult
7.1 Prior to consultation
7.2 During public consultation
7.3 Promoting public consultation
Monitoring compliance with the policy
Approval, implementation and Review
Appendices Annexe A: HSC report template Annexe B: Formal public consultation stakeholder list Annexe C: Stakeholder consultation list
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Introduction Public and stakeholder consultation is an essential part of service reconfiguration (change). To do this well requires planned communication and engagement at an early stage to ensure all groups have the opportunity to give their views and help shape services. As well as the positive attributes that result from consultation, there is a statutory and legal obligation on public sector organisations to consult. Section 242 of the NHS Act 2006 sets out the NHS organisations required to involve and engage patients and the public more widely in: • The planning and provision of services. • The development and consideration for changes in the way those services are provided. • Decisions affecting the operating of services. Under Section 244 of the NHS Act 2006, NHS Trusts also have a duty to consult health scrutiny committees where a proposal constitutes a substantial development of health services or variation in the provision of these services. The Secretary of State for Health also sets out four key tests of which reconfiguration processes need to demonstrate achieving.
Policy Statement This Policy aims to set out: • • •
The Foundation Trust’s responsibilities in informing and responding to Health Scrutiny Committees. The process for determining what is a substantial service variation. When and how the Foundation Trust will carry out formal public consultation when substantial service variation is agreed.
The main objective for any public consultation is for: “a well planned and managed event that is accessible and encourages engagement with key stakeholders that leads to better decision making and effective implementation.” This does not mean that proposals will not be controversial but it does mean that open and productive consultation can be achieved. There are four key areas, set out by the Secretary of State for Health, of which the reconfiguration process will need to evidence: • Support from GP commissioners will be essential. • Arrangements for public and patient engagement, including local authorities should be further strengthened. • There should be greater clarity around the clinical evidence base underpinning proposals. Public Consultation Policy, January 2012 Page 4 of 17
That proposals should take into account the need to develop and support patient choice.
Health Scrutiny Committees (HSCs) A protocol for joint scrutiny in Bournemouth, Poole and Dorset has been set out by local authorities, and agreed to by the Foundation Trust. That protocol is incorporated within this policy. The protocol does not include Hampshire but the same principles of openness apply.
3.1 The role of HSCs Local authorities with social services functions are able, via HSCs, to ‘review and scrutinise matters relating to the health service in the local authority’s area, and to make reports and recommendations on such matters.’ These powers are set out in Section 244 of the NHS Act 2006. The Foundation Trust has relationships with HSCs in Bournemouth, Poole, Dorset and Hampshire. Bournemouth HSC is considered the lead committee. The Trust will also consult with the Scrutiny Committee at Christchurch Borough Council (not a HSC but with a wider scrutiny remit). 3.2 Principles of communication with HSCs and NHS Trusts The Foundation Trust must: • Provide early notice to the Chair of the HSC, via the appropriate council officer, of potential substantial variations and/or developments. • Attend HSCs when requested to answer questions. • Send the Chair of the HSC all Trust Board agendas and papers and the Annual Report. • Respond to requests for written information and to scrutiny committee reports and recommendations within 28 days. HSCs will: • Give adequate notice of requests for information and attendance at meetings. (HSCs must give adequate notice. In urgent circumstances there is a minimum of 10 working days notice for requesting written information and 20 working days notice for attendance at meetings). • Send HSC agendas and papers to the Chair and Chief Executives of Trusts, plus other health officers who request them. • Send draft scrutiny report on matters relating to the Foundation Trust for opportunity to comment on the recommendation before the report is finalised. • Send scrutiny recommendation in writing to the Chief Executive of the Foundation Trust.
Defining substantial variations and/or developments There is no definition of a substantial variation and this must, therefore, be agreed locally between the HSC and the Foundation Trust. The following factors should be taken into account when considering if a
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proposal is a substantial change (further details can be found in Appendix A): • • • •
changes in accessibility of service impact of proposal on the wider community patients affected methods of service delivery
The Foundation Trust must notify the Chair of each relevant HSC of any proposals for service change at an early stage by submitting the templates found in Annexe A. The report should also be copied to the Chief Executive of the relevant PCT. A section of this report must be completed by a group of people affected by the potential change, e.g. patient group or local LINks. This process is set out in a joint protocol agreed by HSC and NHS bodies in Dorset. Once submitted the HSC can request additional information to reach a decision on whether the proposal is substantial.
When will we consult? The duty to involve and/or consult patients and the public still applies whether or not a proposal constitutes a ‘substantial variation or development.’ Ultimately, it is for the local authority (via the HSC) that is being consulted upon to decide if it considers a proposal to be substantial and wishes to scrutinise that proposal. What is important is that involvement and consultation is adequate both in terms of time and content and appropriate to the scale of the issue being considered.
5.1 Formal Public consultation Formal public consultation will be carried at all times when the service reconfiguration is considered a ‘substantial variation’ by the HSC. This level of consultation involves a 12 week statutory consultation period with the wider public. The Foundation Trust will expect to carry out formal public consultation on the following occasions, subject to agreement by the Health Scrutiny Committee: • The closure of a complete service • A substantial variation in services – defined as affecting a large number of patients or a small number of patients significantly, and/or changes in accessibility of services (e.g. site change) • Reduction in the number of referrals to a service, through demand management proposals • Transfer of patients services to another provider of healthcare • The moving of a service from one site to another • Organisational reconfiguration (see 5.4) The Foundation Trust’s Annual Strategy sets out proposals for future developments and changes in services provided over the short, medium and long term. Each year the Annual Strategy will be subject to formal public
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consultation to ensure as many people as possible are able to comment on the future direction of local health services. 5.2 Stakeholder consultation There may be occasions when although the HSC does not consider a proposal to be a substantial variation, some consultation would be beneficial. On these occasions the Foundation Trust will consult with the stakeholders set out in Annexe C. The consultation period will be shorter than the 12 weeks carried out during formal public consultation. The Foundation Trust anticipates that this form of consultation will be carried out on occasions such as: • Providing the same service but in a different way • Significant changes to clinic opening hours – i.e. reducing or increasing a service that would lead to a significant effect on patient care 5.3 Exemptions from public consultation The Foundation Trust would not consider consultation necessary in the following circumstances: • If it is a proposed pilot scheme. • If the withdrawal of a service is genuinely only temporary (i.e. less than six months) and there is an agreed date for reinstatement of services. • The Foundation Trust wishes to introduce a new service – this is an agreement between the Foundation Trust and the Commissioner. • The Foundation Trust stops undertaking a procedure for reasons of patient safety or where there is a new way of undertaking the procedure. • The change is so urgent that it is not practical to consult, for e.g. in the interest of clinical safety such as unsafe staffing levels or infection on wards. • Changes in clinical practice in line with national policy (for example NICE) or up to date good practice. • If the change does not involve a direct clinical or patient care service, for example corporate functions. • Minor changes to the opening hours of clinics. An HSC can of course scrutinise any aspect of healthcare delivery. The Foundation Trust will fully co-operate with those scrutiny discussions. 5.4 Organisational reconfiguration On occasions of organisational reconfiguration (including proposed merger), 12 weeks formal consultation will be carried out in accordance with Monitor guidance and DH regulations. The Trust will specifically seek the views of: • Patient forums • Staff • Local residents • Local authorities • FT members • Commissioners
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Who we will consult with Consultation means effectively consulting with those who are representative of the local community and those who use local health services. This includes hard-to-reach groups in line with the Foundation Trust’s Single Equality Scheme. Specific efforts will be needed to ensure the consultation reaches groups in the format that best meets their needs, for example different languages or larger print. A comprehensive stakeholder list has been established and forms the basis for all formal public consultation. During formal public consultation the Foundation Trust will seek to engage and consult the stakeholders identified in Annexe B. During stakeholder consultation the Foundation Trust will see the views of those groups set out in Annexe C.
6.1. Staff consultation Public consultation will always include Trust staff. This is separate to the Foundation Trust’s statutory requirement to consult with staff on any type of organisational change that affects them or their working conditions. (This form of staff consultation, including staff side representatives, will continue to be led by the Human Resources Directorate and staff should seek advice when necessary). There will be a need to carry out staff consultation first where a service change does affect staff.
How we will consult
7.1 Prior to consultation While it is the Foundation Trust’s legal and statutory obligation to formally consult with the public, Governors will play a key role in any public consultation exercise, including: • Having an opportunity to input into key messages and planned consultation events. • Giving the views of patients, members and the public to the Trust The draft consultation document will be circulated to the full Council of Governors prior to the public consultation. Feedback of which will be sought through the Chairs’ Group*, rather then from each individual Governor. The Trust will also provide a brief to the Council on the consultation process and a draft communications plan. (*The Chairs’ Group is an informal group of the Chairs from each formal Governor Committee that meets regularly with the Trust’s Chairman).
7.2 During public consultation 7.2.1Any public consultation exercise will follow the key principles of the Cabinet Office Code of Practice on Consultation. They are to: • Consult widely throughout the process, allowing a minimum of 12 weeks for written consultation at least once during the development of policy • Be clear about what the proposals are, who may be affected, what questions are being asked and the timescale for responses • Ensure that the consultation is clear, concise and widely accessible Public Consultation Policy, January 2012 Page 8 of 17
• • •
Give feedback regarding the responses received and how the consultation process influenced the policy Monitor the effectiveness of consultation, including through the use of a designated Consultation Co-ordinator. Ensure that the consultation follows better regulation best practice, including carrying out a Regulatory Impact Assessment if necessary
7.2.2 The Secretary of State for Health sets our four key areas of which any service configuration must demonstrate achieving. These are: Support from GP commissioners • Outcome of dialogue with GP consortia and other bodies such as Professional Executive Committee and Clinical Commissioning Groups as appropriate, with relevant extracts of minutes showing dates and who was present. • Evidence that GPs have been involved in designing the care pathway, for example membership of a project group. Public and patient engagement: • Summary of discussions with LINks, HSCs, patient groups and public (post legislation this will be Health watch and Health & Wellbeing Boards) • Public-facing report that shows what was said by patients and the public and how the proposals have been adapted to take account of their views – as required by Section 242 - and an Equality Impact Assessment. Clinical evidence base • Outcome of dialogue with medical directors, GPs etc. reviewing evidence base and proposals against best practice, with meeting report and/or statement of confidence in the evidence base from lead clinician. Patient choice • Statement by local commissioners on how the proposals affect choice of provider, setting, and intervention, and how this compares with choice in current service. • Where impact on competition under Principles and Rules of Cooperation and Competition applies, informal advice from Cooperation and Competition Panel should be provided. 7.2.3 Governors play a key role during any public consultation in terms of: • Representing the views of members and the public to the Trust • Supporting the communication of key messages to members and the public • Commenting on public communications material • Supporting public meetings 7.3 Promoting consultation The consultation exercise will be publicised as widely as possible, both internally and externally, to ensure all interested groups have the opportunity to Public Consultation Policy, January 2012 Page 9 of 17
have their say and share their views. A Communications Plan will form part of each formal public consultation exercise. 7.3.1 Media relations All media relations during the consultation exercise will be planned and coordinated by the Head of Communications and approved as part of the overall Communications Plan by the Director of Service Development. Strong links with the media will be encouraged from the outset with, for example, patient case studies, key facts and other information to demonstrate the benefits to patients and the local community and make the case for change. Key media spokespeople that have been identified may need media training in giving radio or TV interviews. 7.3.2Methods of Promotion During all formal public consultation the following promotional methods will be used: • Written consultation document • News releases to all local media – print, TV and radio • Website page with the opportunity to leave feedback • Information on the Trust’s intranet site for all staff • Global email to all staff • Governors’ constituencies events where appropriate • Understanding Health events (consultant talks to the public) • Public meeting – where appropriate • Foundation Trust members’ newsletter • Staff newsletter • Staff briefings – Ask the Exec In addition to the above methods, there are a range of promotional methods that can be considered. These include: • Information boards displayed in key public areas • Press conference to launch the consultation • Local authority publications where appropriate e.g. BH Life • Focus Groups • Pro-active letter writing to local newspapers • Exhibitions • Leaflet drops • Posters • Local media – adverts, advertorials, press packs • Via Parish Council publications
Monitoring Compliance with the Policy
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The Communications Department will monitor compliance of the policy, in liaison with the Director of Service Development, and will co-ordinate all formal public consultation carried out by the Trust.
Regular reporting throughout the consultation period will be provided to the Trust’s Patient Engagement and Communications Committee and Board of Directors. Governors will also receive regular updates during the consultation period. A post consultation report will be produced following each formal public consultation exercise providing a summary of the responses received from the public and stakeholders and how the Trust demonstrates achieving the four key tests.
Approval, Implementation and Review The policy is approved by the Board of Directors but will be implemented by the Communications Department. An Equality Impact Assessment has been completed which, together with the policy, will be reviewed every two years.
References • • • • • • • • • • •
Draft Protocol for Joint Health Scrutiny in Bournemouth, Poole and Dorset Code of Conduct on Consultation, Cabinet Office, January 2004 Consultation Strategy, Ashton, Leigh and Wigan Primary Care Trust, 2004 Public Consultation Strategy, Christchurch Borough Council Strengthening Accountability: Involving Patients and the Public, February, 2003 When do NHS Bodies have a legal duty of consultation?, Mills and Reeves, September, 2006 Service Development or Redesign: A Good Practice Toolkit for Involvement, Communications and Consultation, February, 2006, v.1 The Consultation Charter, Consultation Institute, March 2005, v.3 A Stronger Local Voice, Department of Health Service Improvement: Quality Assurance of Major Changes to Service Provision, Sir Ian Caruthers, March, 2007 Applying for a merger involving an NHS foundation trust, Monitor, 2006.
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Annexe B Formal Public Consultation (12 week) Stakeholder List During formal public consultation exercise (i.e. when there is a substantial variation), the Foundation Trust will consult the following stakeholder groups depending on the nature and circumstances of the particular consultation. • Governors • Foundation Trust Members (c14,000) • Staff via the Partnership Panel and other internal communication networks • Patients – Via the Foundation Trust’s Patients’ Panel, LINks (via Help and Care), Help and Care, the Patient Advice and Liaison Service (PALS) and via patient panels that exist within service areas • Relevant Health Scrutiny Panels - Bournemouth, Poole, Dorset and Hampshire • Dorset and Hampshire MPs • GPs • Minority ethnic groups • Voluntary groups • Primary Care Trusts • Mental health organisations (via Dorset Healthcare NHS Trust) • Social Services – Dorset, Hampshire, Poole and Bournemouth • Local strategic partnerships – Dorset, Bournemouth, Poole, Christchurch and Hampshire • Older people via Help and Care, Age UK and Older People’s Forums • Young people via the Youth Service at Bournemouth Borough Council, Christchurch Borough Council, Hampshire County Council, Dorset Country Council and Borough of Poole (if appropriate to the issue) • People with care responsibilities via carer groups • Resident Associations when changes directly affect them • Hospital charities, • Trust Volunteers – via the Voluntary Services Manager • The wider public • Town and Parish Councils • Disease specific groups, e.g. British Diabetics Association local branch – depending on the issue being consulted. Note: The above list aims to define some of the different groups and agencies that the Trust will consult. An individual list of each organisation is available from the Trust’s Communications Department on request. The Foundation Trust will also inform both Monitor and the Foundation Trust Network of any public consultation exercise.
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Annexe C Stakeholder consultation During stakeholder consultation exercise the Foundation Trust will seek the views of the following groups: The following stakeholders will be consulted during a public consultation exercise (i.e. not a substantial variation but when limited consultation is carried out): • • • • • • • •
Foundation Trust’s Council of Governors Relevant Health Scrutiny Committee – Bournemouth, Poole, Dorset and Hampshire Primary Care Trusts – Bournemouth and Poole, Dorset and Hampshire Foundation Trust members Staff affected by the issue GPs Other specific groups as identified Wider public via a news release to local media and Trust’s website only
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