Building Your Case for Change: Why Consultation Is Your Strategic Foundation

The Challenge: Making Change That Sticks

You need to transform services. The financial pressures are real, the quality imperatives are clear, and doing nothing isn’t an option. But here’s the problem: a technically sound Case for Change can still fail spectacularly if it hasn’t earned legitimacy with the people it affects.

NHS England’s 2025 reforms, the Medium Term Planning Guidance, and the revised ICB Operating Model have raised the stakes. They demand transformation while simultaneously insisting it happens with communities, not to them. For ICB leaders building a Case for Change, this creates a critical insight: consultation isn’t what you do after you’ve made your case – it’s how you build a case that will survive contact with reality.

What Makes a Case for Change Defensible?

A defensible Case for Change has three legs: it’s evidence-based, legally sound, and publicly legitimate. Most ICB teams excel at the first marshalling of clinical evidence, financial data, and outcome projections. Many understand the statutory consultation requirements for the second meeting. But the third is where cases succeed or fail.

Public legitimacy means stakeholders understand why change is necessary, have influenced how it happens, and trust the decision-making process was fair. Without it, even watertight proposals face implementation gridlock, judicial review, or community campaigns that force costly backtracking.

The 2025 policy framework makes this explicit. The Medium Term Plan demands ICBs “truly listen to their communities and drive the change they want and need.” The ICB Operating Model emphasises accountability at the place level, where decisions are made in partnership forums with councils, patient groups, and representatives from the voluntary sector. There’s no bureaucratic cover anymore you own these decisions, and you’re accountable to the communities affected.

The insight for Case for Change development: Consultation isn’t a final validation step. It’s the process through which you discover what change is actually possible, identify where your assumptions are wrong, and build the coalition needed for implementation.

The Risks of Getting It Wrong

Legal Risk: The Gunning Principles Aren’t Optional
Public bodies must consult lawfully on significant service changes. The Gunning Principles set the standard: proposals must be formative (still shapeable), information must be adequate, time must be sufficient, and responses must be conscientiously considered.

Cases for Change that fail these tests face:

• Judicial review that delays implementation by months or years
• Reputational damage when trust is already fragile
• Wasted resources on proposals that must be withdrawn and redesigned
• Lost credibility for future change initiatives

One unlawful consultation can undermine an entire transformation program. The planning guidance promises “future freedoms” for systems that maintain financial discipline, but legal challenges destroy those freedoms.

Strategic Risk: Communities Remember Being Ignored
Even if your consultation is technically lawful, a process that feels like box-ticking generates long-term damage. When communities believe they were consulted at rather than with, they:

• Resist implementation through every available channel
• Challenge decisions through local media and political pressure
• Withdraw cooperation from future initiatives
• Force leaders into defensive, reactive positions

The Medium Term Plan acknowledges the NHS must “win back the public’s faith.” Poorly handled consultation achieves the opposite. Your Case for Change might be clinically impeccable, but if the process that produced it felt like a fait accompli, implementation will be painful and protracted.

Building Consultation Into Your Case for Change: Practical Steps

1. Start With the Problem, Not the Solution
Your Case for Change should begin with a shared understanding of the problem: workforce shortages, financial unsustainability, quality concerns, and unmet needs. Could you explain this clearly and back it with data? The Medium Term Plan encourages honesty about constraints. When stakeholders understand why the status quo isn’t viable, they’re more likely to engage constructively on what to do about it.

Use national policy as your anchor: show how local challenges connect to the Planning Guidance’s transformation priorities (cutting waits, shifting care closer to home, financial sustainability). This frames your case as addressing recognized needs, not arbitrary preferences.

2. Engage Before You Have Answers
The first Gunning principle consulting at a formative stage is your strategic asset. Use pre-consultation engagement to:

• Test whether your problem definition resonates with lived experience
• Co-develop options with clinicians, patient groups, and local partners
• Identify which solutions are politically or practically unworkable
• Surface local knowledge that improves proposals

This isn’t a delay, it’s insurance. Early engagement identifies fatal flaws before you’ve invested heavily in a preferred option. The national emphasis on co-production gives you permission to spend time here. Call it co-design, call it option development, but do it before formal consultation.

3. Make the Case for Change Transparent
When you move to formal consultation, provide clear, accessible information on:

• The problem and its evidence base
• Options considered (including doing nothing)
• Assessment criteria you’ll use to decide
• Likely impacts on different communities
• How the decision will be made and by whom

Avoid jargon. Remember the public can only give “intelligent consideration” if they have the facts. If your Case for Change requires three pages of clinical acronyms to understand, it will fail the accessibility test.

4. Demonstrate You’re Listening
The hardest part: proving you’ve conscientiously considered responses. Your Case for Change must show how consultation input influenced the outcome:

• If feedback changes your proposal, explain what shifted and why
• If you proceed despite objections, explain what factors outweighed them (clinical safety, value for money, legal duties)
• If responses raised implementation concerns, show how you’ve addressed them

Document this rigorously. “We considered all responses” isn’t enough—you must demonstrate how they shaped your thinking. This is what makes decisions resilient to challenge.

5. Use Place-Based Partnerships as Co-Creators
The ICB Operating Model emphasises Place-Based working. Leverage it. Bring Place-Based Partnerships, local councils, and the local voluntary sector in place of Healthwatch as partners in developing your Case for Change, not just recipients of finished proposals. They understand local context and can help you navigate political and practical realities.

When place partners feel ownership of the case, they become advocates rather than obstacles. They can explain to their communities why change is necessary and help identify solutions that work locally.

Why This Matters for Your Case for Change

A Case for Change built through robust consultation has strategic advantages:

It’s More Accurate
Stakeholder engagement surfaces operational realities and patient impacts you might miss from your desk. Front-line staff know which proposed efficiencies won’t work in practice. Patient groups identify access barriers your data doesn’t capture. Local councils flag implementation dependencies. This intelligence makes your case stronger and more implementable.

It’s More Resilient
When difficult decisions are made transparently, with genuine consideration of input, they’re harder to overturn. You have an audit trail showing the process was fair and lawful. You can demonstrate that objections were weighed and either addressed or explained. This resilience matters when facing scrutiny from regulators, politicians, or courts.

It Builds Your Coalition
Change requires implementation partners, GPs who’ll work differently, voluntary sector organisations who’ll take on new roles, and councils who’ll align their services. If these partners helped shape your Case for Change, they’re invested in making it work. If they learned about it from a press release, they’ll be defensive and difficult.

It Creates Permission for Tough Decisions
Paradoxically, honest engagement makes hard choices easier. When you’ve been transparent about financial constraints, shown you’ve genuinely explored alternatives, and demonstrated that the status quo carries unacceptable risks, stakeholders often accept that difficult decisions are necessary even if they don’t like them. Legitimacy doesn’t mean everyone agrees; it means everyone accepts the decision was made fairly.

The new policy framework reinforces this: the Medium Term Plan was “influenced by what the public told us they wanted.” Service standards will be “co-designed with people with lived experience.” This isn’t just policy rhetoric—it’s recognition that transformation succeeds when it’s co-created, not imposed.

The Bottom Line

Your Case for Change will be judged on three criteria: Is the evidence compelling? Is the process lawful? Does it have legitimacy with those affected?

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How tCI Can Help

Quality Assurance: Independent review at critical stages, from evidence protocol design through to final reporting, ensuring your approach to qualitative data meets legal and good practice standards. Our seven-stage QA process includes assessment of analysis methods, interpretation fairness, and compliance with Gunning, PSED and ICO requirements.

Early Assurance: A snapshot review during planning to sense-check your evidence framework, codebook design, and proportionality rationale before fieldwork begins.

Charter Workshops: Half-day sessions helping your team understand good practice standards for handling qualitative consultation data, including rigorous analysis and defensible interpretation.

Whether you’re preparing for a high-stakes service change or need confidence that your evidence approach will stand up to scrutiny, we can help. Contact tCI for Quality Assurance at hello@consultationinstitute.org