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An open letter to the incoming Chief Executive of NHS England

Dear Ms Pritchard,

You take office at a challenging and interesting time for the NHS. The body has been rightfully lauded for its key role tackling the coronavirus pandemic and continues to maintain its revered place in society. The pandemic however is regrettably not over, and with the potential for further surges or more harmful variants emerging the NHS will no doubt continue to face challenges. The pandemic is not the only place where challenges might emerge, especially with the Government’s reform proposals in the Health and Care Bill.

Although the pandemic provides the greater clinical challenge, the greater long-term challenge may prove to be reform, reorganisation and reconfiguration. Although the NHS remains one of the most respected national institutions, the public’s affections can be fickle, particularly when service reconfigurations are concerned. As the leading best-practice body dealing with public engagement and consultation in the United Kingdom, we see controversies in respect of many different public services, but rarely more frequently than in the reconfiguration of NHS services.

The best way that the NHS can avoid legal challenges and ensure a solid ongoing relationship with the public it serves is to ensure that it properly and robustly discharges its public engagement obligations. This means involving the public in service change and making sure that they are thoroughly engaged at all points of the process. The new legislation, though it moves them around, does not substantively alter the pre-existing involvement obligations with which your colleagues have familiarised themselves over the years. The one area that concerns is that the Bill, as currently drafted, injects an element of potential Ministerial interference in even small-scale service changes (due to the wide definition of ‘reconfiguration’) and we believe this is an unwelcome politicisation of many improvements. It will also cause delay and potential legal challenges.

The Bill also places certain new consultation requirements on the NHS, most notably around the establishment of the new Integrated Care Boards. Although discretion is given to clinical commissioning groups to decide who to consult, we would encourage a comprehensive and consistent approach being taken, not only to ensure a wide range of views being represented, but also to demonstrate a renewed commitment after the reorganisation to the principles of good involvement and engagement.

We also advocate that the NHS continues to go beyond the strict legal requirements of involvement and enhance a best practice approach to public involvement. In our view, the legal requirements should be a baseline, and professionals should seek to go beyond it. Over the course of the pandemic, we have seen brilliant and innovative methods of engagement being used in the NHS and beyond – and we should further develop these to ensure ever more effective public involvement.

We wish you well in your new role, and we are sure you will rise to the occasion. And if you need any assistance on your involvement and consultation activities? We stand ready to help.

Kind regards,

The Consultation Institute

About the Author

Stephen serves as the Institute’s Legal and Parliamentary Officer. Before joining the Institute Stephen studied Law at Bangor University and pursued a Masters’ degree in Aviation and Space Law at McGill University in Montreal. After this, he returned to London and was called to the bar in 2016 at the Honorable Society of Gray’s Inn, before deciding not to go into practice and move towards public policy work instead. Within the Institute, Stephen provides legal, political and policy analysis of UK and global current affairs of interest to consultors and consultees.

Read more about Stephen

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