Learning from the NHS! - NHS Reconfigurations are very challenging for public engagement – but hold lessons for many others in public service and beyond

When the NHS tries to bring about significant change, it often faces a storm of public protest and frequently becomes a political football as one side or another seeks an electoral advantage from the ensuing debate.

As often as not, that debate takes the form of a public consultation – for that is what Parliament has laid down as the proper process of engagement before local people suffer change by unaccountable Managers.

Last week, the Institute published a Briefing Paper entitled *“The role of consultation in NHS & Social Care reconfigurations in England”. It is an attempt to bring together our thoughts on a massive challenge in as comprehensive a way as we can; it also proposes some Critical Success Factors* we hope might be useful to those who either have to organise these consultations – or who have to interact with them in some way.

In preparing the paper, however, it became clear that much of our analysis and many of the learning points apply equally well outside the NHS – indeed anywhere in the public services. They apply wider still for many private Companies, or third sector organisations work in what can loosely be called the ‘public realm’ where the norms of public engagement and change management are similar.

So here are three lessons we believe can be drawn from our recent work in Health & Social Care and which may apply to others who may need to consult the public

Tell people the problem

The public is rightly suspicious of experts who know best and who come to a consultation with solutions asking that they be rubber-stamped. The NHS is rapidly learning that it is better to involve a range of key stakeholders in a pre-consultation process to seek out new ways of working and to think through the basis upon which new solutions can be developed. This is why co-production is finding increasing favour – especially in Wales and Scotland, where there is rather more reluctance to hand over the problem-solving to the big consultancy houses.

A good way to proceed is to publish a discussion paper or an Issues paper that sets out the problems that need to be tackled, and to seek public and stakeholder views – telling them that these will help inform the development of options that may be presented in a forthcoming consultation.

Welcome the debate

A year ago, the NHS had to abandon a £6m reconfiguration of children’s cardiac surgery, following a very critical report on the process by the Independent Reconfiguration Panel. Among the many mistakes committed by the consultation organisers was creating a feeling that the views of campaigning parents were not welcome. There were echoes of the previous Francis Report on the scandal in Mid-Staffordshire where once again the NHS had sought to suppress rather than welcome debate.

There are other public services which give the impression that debating their policies is an irksome chore that they would prefer to avoid. It always ultimately rebounds upon them. It will also rebound on infrastructure builders and other developers who are naturally keen to get on and build rather than spend time and treasure talking. The NHS is hopefully learning the lesson they should all observe that a robust debate will validate their arguments and that they need to win those debates if they are to command public support for their projects

Promote an independent element in the process

The British are keen on fair play. That is one way to explain why we get so upset when powerful interests are perceived to be cheating, or cutting corners. It may also explain the procession of legal challenges where campaigners allege that pubic bodies are not consulting them properly. In the recent case concerning the closure of a day centre, Shropshire

Council tried to argue that whilst it agreed it should consult, it should have carte blanche as to how to consult. The Judge rejected this, but it may be the tip of an iceberg whereby thousands of community groups and other interests feel that public bodies are going about consultation in a way that suits themselves – rather than properly seeking out consultee views.

Not everyone can go to Court, so who can confirm whether best practice is actually being observed? It needs to be someone independent, who knows enough about the complexities of public engagement but who also understand the pressures facing managements trying to cope the change. The NHS is a case in point and probably explains why the Institute’s QA service is being used so extensively for the current batch of reconfigurations. The same logic should apply elsewhere.

TRIGGER POINTS

• Briefing Paper 33: “The role of consultation in NHS & Social Care reconfigurations in England” is available on request from the Institute (01767 318350) and is currently a draft for Comment. Opinions are welcome before its finalisation in early June
• The Institute’s Quality Assurance accreditation using our well-developed Compliance Assessment process can be applied to most controversial consultations. Contact Jan Warner for details on hello@consultationinstitute.org
• The recent High Court case was R(ex parte LH) v Shropshire County Council [2014] EWCA Civ 40; this is covered in some depth in the Law of Consultation course – next on in London on 19th June

This is the 260th Tuesday Topic; a full list of subjects covered is available for Institute members and is a valuable resource covering so many aspects of consultation and engagement