Back in August while many of us were on our summer holidays, IRP (the Independent Reconfiguration Panel) published its assessment of the Grantham A&E case referred to Secretary of State for Health by Lincolnshire County Council’s health scrutiny committee.

As always, the assessment is full of insight that can help the Consultation Institute’s NHS clients preparing for service changes.

A hospital trust was struggling to staff A&Es at three hospital sites to safe levels. The Trust board decided to operate 24/7 A&E at two of those sites and change provision at a third (Grantham) to an urgent care service open 8am-8pm for a three-month ‘temporary’ period. Understandably lots of local people were angry at the changes.

When the trust extended the three-month temporary closure to six months, councillors on Lincolnshire’s health scrutiny committee (HSC) deemed the change substantial and, in effect, permanent. In its view, the matter was therefore, one on which it should have been consulted under the 2013 local health scrutiny regulations and referred it to the Secretary of State on the basis that the closure is not in the interests of [the] health service in the area.

IRP concluded that a full review would add no value and stated that further local action by the NHS with the Council can address the issues raised. So what are the key learning points from the assessment?

1 – Be clear what services are actually being provided
“Patients, the public and stakeholders need to know what to expect from their local health services.” IRP Grantham assessment, June 2017

The service provided at Grantham had been called A&E by everyone, but IRP says the service was already more like an urgent care centre. IRP said that may have led to unrealistic expectations and misunderstanding about the level of service that can and should be provided.

Starting points for dialogue about changes to public services differ. Patients and the public need to understand the realities of current service configuration to understand the impact of proposed changes. In a planned change, there is time before change proposals are developed to correct the differences you identify. When it’s a short-notice change to service, it’s harder. Too often dialogue on important changes is clouded, confused and even derailed by misunderstandings that needn’t ever have existed.

2 – Share the problem early
“Clearly the crisis did not arise overnight…. Elected representatives have a right to be kept advised of developments, including potential pressures that may affect the provision of services.” IRP Grantham

The trust knew about the staffing challenges for months before its board made the decision to close Grantham A&E temporarily, but it hadn’t talked to HSC about them.

IRP said it would have expected HSC to have been advised of the situation earlier.

It’s hard to think of a situation where local politicians wouldn’t view a change from 24/7 A&E to 8am-8pm urgent care as a substantial change. Surprise magnifies the impact of change, so the NHS hampered itself by keeping the problem from HSC.

3 – Six months isn’t temporary
“After six months, the closure can no longer be regarded as a temporary measure”

Patient safety comes first without question and legislation allows for temporary emergency changes. But what is temporary? It’s hard to argue that changes made for ‘emergency’ reasons that runs into months, or in some cases years, are in any common sense of the word ‘temporary’.

In this referral assessment, IRP gives NHS providers and commissioners in England a clear indicator that its indefinite use of temporary powers is not acceptable. It is certainly not a solid basis for constructive dialogue with patients and the public.

The common themes in these learning points underline the value of transparency and integrity in public dialogue. Using honesty as a starting point brings dividends later in the process, no matter how hard the first step is. Dialogue about service change needs an open and honest basis to be successful.

IRP concludes that the time has come for an open and honest appraisal of the future for emergency care at Grantham and across Lincolnshire. That’s a generous conclusion; it’s evident that that time came a long while ago. But it’s not too late. However difficult the first step, the best time for open and honest dialogue with patients and the public is, as always: now.

Image taken from BBC