The tension in relationships between councillors and health commissioners is never more evident than in the run up to local elections. We can hardly blame politicians for acting politically, so it’s no surprise that as elections approach in England we see a flurry of calls for local health scrutiny committees to refer commissioners’ decisions for review by the Secretary of State for Health.

Lots is made of these referrals by campaigners and local media, but what is a referral and what happens when one is made?

The power to make a referral is given to local authorities by regulations the Secretary of State issues. A local authority (or group of local authorities under section 30 of the regulations) can make referrals on three grounds:

1. It is not satisfied with the adequacy of content or time allowed for consultation with itself (not wider consultation with patients, the public and stakeholders).
2. It has not been consulted, and it is not satisfied that the reasons given for not carrying out consultation are adequate.
3. It considers that the proposal would not be in the interests of the health service in its area.

There are several hurdles for a local authority to jump before it makes a referral. The regulations require that where the local authority has made a formal recommendation to the commissioner on the matter in hand and after due consideration the commissioner disagrees with that recommendation, both parties must take ‘such steps as are reasonably practicable’ to reach agreement. If agreement is not reached, the local authority is required to present a long list of evidence to support its referral.

The Secretary of State for Health receives the referral and passes it to IRP (Independent Reconfiguration Panel), which is appointed to review each case and advise the Secretary of State. The panel is made up of experts in the area of health service reconfiguration and representatives of the public. The reports IRP issues in response to referrals are an excellent source of insight and information for anyone planning for public involvement on health service changes in England.

The IRP process has two stages: initial assessment, and full review. Though few referrals make it even to the initial assessment stage (IRP issued just two initial assessment reports in 2016), the reports give us great insight into the considerations IRP makes of the evidence it is presented with. The reports issued in 2016 and the one issued so far in 2017 all have notes on public involvement that are useful to consider when planning involvement exercises:

• They point out the need to get off to a good start, which didn’t happen in the Torrington referral;
• The report on the Hartlepool referral highlights the importance of making sure the quality of engagement and consultation matches the quantity and of fully involving those who will use the services in planning and developing healthcare services;
• The lessons from the Redbridge referral include that NHS bodies planning reconfigurations need to understand the detail of the regulations, and the importance of obtaining – and being seen to obtain – independent validation of consultation processes.
• And both the Redbridge and Torrington reports point out that there is still work to be done to convince the public of the benefits of new service configurations even after the changes have been made.

IRP has set out the learning from the reviews it has completed in a series of documents available on its website. Its independent eye and expertise have improved and continue to improve the practice of involving patients and the public in planning and making decisions about health service changes. And whether they offer an initial assessment report or a full review, the lessons they highlight are valuable to all of us. After all, as they say themselves in the report on the Redbridge referral, “it is probably true that any public consultation could be improved upon in some regard”.