The well-respected IRP has just published its response to the October 2018 Referral form Dorset County Council’s Health Scrutiny Committee.

It contains strong criticism of the Council for having acquiesced in the controversial plans to make changes to the services provided by the NHS in Bournemouth and Poole, and subsequently changed its mind and referred the proposals to the Secretary of State. At this point, The Institute needs to declare an interest as it had conducted a Quality Assurance of the relevant consultation.

Local campaigners had never been convinced that Managers had properly taken account of the impact upon patients of longer travel times to the new designated A & E centre in Bournemouth. Neither were they persuaded that there would be adequate staffing for the proposed community services that underpinned the re-configuration of health and social care services. They took their case to the High Court and lost. Then they secured a further opportunity to argue before the Court of Appeal. As one who attended that hearing, I can confirm that they submitted a very weak case that was predictably rejected by Judges.

Nevertheless, reference to the Secretary of State is a quite separate process and a line of re-consideration that recognises the unique position of the NHS as being beyond directly local political influence. Health Scrutiny committees have been deliberately designed as one of those checks and balances that avoids unpopular changes being made to cherished services without opportunities to take special care in politically sensitive situations. As if to prove the point, recent years have seen a number of cases where the law may have arrived at one conclusion, but the IRP come to another. No better example exists than the successful defence of its consultation on changes to cardiac surgery in England for small children (per the Royal Brompton Hospital case at the Court of Appeal) and the (rightly) critical Report of the IRP into the same project a short while later!

These are, however, exceptions. More typically, Scrutiny Committees struggle to counter the arguments made by Managers, and there is growing pressure to look again at the process. The IRP seems to have chosen this referral to back calls for a Review. It says so quite specifically:-

“While some of the events recorded in the background above are undoubtedly unique to the Dorset CSR, this case provides further evidence for reviewing the purpose and processes for scrutiny of health services. When revising its existing guidance on health scrutiny the Department may wish to consider the need for a review of the performance of joint committees to ensure that they are operating as originally intended. Revisions to guidance might also make clearer that a referral depends upon scrutiny taking a view on proposals and making purposeful effort to resolve differences of view with the local NHS”.

In the Dorset case, not only do the experienced clinicians at the IRP find the service changes proposed for Dorset to be well-considered and appropriate to implement, but they criticise Councillors for failing to justify their change of position:-

“In the Panel’s view, the (Committee’s) subsequent change and referral in October 2018 cannot be explained by the evidence presented.”

And again

“The Panel is concerned that after four years of scrutiny, the HSC was either unable or unwilling to articulate a clear view on the NHS’s proposals or indeed put forward alternatives. As a consequence, valuable time and effort has been diverted from implementing and improving services.”

The NHS is not spared criticism. It suggests that Managers need to do more to communicate their forward path; it even says that “latterly the message about what is intended… seems to have been lost.”

But the main message is for councillors and campaigners. They need to be constructive and engage positively in problem solving rather than just object to change.

“That there remain issues and matters of local concern is to be expected but there is an opportunity now to inject new vigour into progressing the proposals to the next phase of implementation. ….”

 “That phase should involve greater co-production between interested parties than has hitherto been evident, not least in identifying the best ways of explaining to local people the rationale behind the changes and how they can influence the development of services. Those interested parties should include all arms of the NHS, local government for the area in its new guise as well as local Healthwatch and public and patient groups. In this regard, the Panel was struck, despite their evident interest, by the apparent lack of involvement to date of the Dorset Defend the NHS Residents Group in the development of proposals. Whatever the reasons behind this, it is to be hoped that a more constructive relationship can be built going forward.”

Building bridges, healing rifts, active listening etc.

All important and at the heart of best practice consultation and engagement. Here is a  cry for more better awareness, more training and more goodwill.

What are the chances?