The IRP: NHS needs better understanding and effective use of engagement and consultation

This week saw the latest instalment in the controversial saga of the Maternity service at Horton Hospital, Banbury.

When campaigners’ legal challenge failed in the High Court, the Institute predicted that the CCG’s plans might yet run into difficulty. Now the Independent Reconfiguration Panel (IRP) has advised the Minister that ‘further action is required locally before a final decision is made’[1]

It highlights a number of problems: –

  • Consultation with local authorities took insufficient account of patient flows and funnelled the scrutiny role through Oxfordshire’s JHOSC[2]
  • Though it was lawful to divide the consultation into two phases, in retrospect, it caused ‘confusion and suspicion’
  • Although the consultation identified alternative options, they were not adequately considered

Looking wider, this particular IRP Report needs to be viewed alongside other recent developments. They include: –

  • An equally critical IRP Report into service changes in Stoke-on-Trent & North Staffs in December, where it states ‘the NHS appears to have tied itself in knots about engagement and consultation.’
  • The Horton Hospital Judicial Review judgment[3] – also in December. Although Judge Mostyn found for the CCG, there are significant criticisms of the process, and lawyers believe it might be overturned if it went to appeal.
  • The February judgment in the Nascot Lawn[4] case, where Herts Valleys CCG was held not to have consulted properly over the closure of a respite centre for disabled children. Again, what was at issue is that the 2013 Regulations[5] about consulting local Authorities are not being properly observed.

It is therefore no wonder that the IRP is losing patience. In cautious, restrained language in the Horton hospital Report, it clearly sees that the larger areas covered by STPs, the range of partners needing to be involved and consulted, and the complex patient-flows that often cut across administrative boundaries requires the NHS to do better in public consultation.

Note its words:-

“The complexity of consulting on issues on this scale is not to be underestimated and requires a level of preparation, co-operation and exchange of information that many NHS bodies and their local authority counterparts may not previously have faced.”

Nevertheless, lack of knowledge or inexperience seems to be preventing this in some places. It is essential moving forward that all parties are aware of their responsibilities and follow the relevant regulations and associated guidance. The Department of Health and NHS England should consider whether the regulations and guidance are sufficiently understood and used effectively by all parties, particularly in the current context of STPs and “systems of care” rather than “organisations”.


The Institute acknowledges that some of these tasks make extraordinary demands on public engagement staff, and agrees that some clarification from the DoH and NHS England could be helpful. We already provide Executive Briefings and training for those embarking upon major service change, and our Quality assurance service is designed to minimise the risks of political or legal challenges.

We will offer more detailed Guidance in the light of recent IRP Reports and High Court cases in the coming weeks.

For further information, please contact the Institute on 01767 318350.


[1] Referral to the Secretary of State for Health re the permanent closure of consultant-led maternity services at the Horton General Hospital by Oxfordshire JHOSC – Letter to the Rt Hon Jeremy Hunt dated 9th February 2018

[2] Joint Health Overview & Scrutiny Committee

[3] Cherwell District Council v Oxfordshire CCG [2017] EWHC 3349 (Admin)

[4]  R (ex parte K, T & M ) v Hertfordshire Valleys CCG [2018] EWHC 267

[5] Regulation 23 of the Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013 (SI 2013 No 218)


The HSJ also comments on the IRP. Click here for the story.

About the Author

Rhion Jones is considered a leading authority on Public Engagement and Consultation. A founding Director of the Consultation Institute, he is co-author of “The Art of Consultation” (2009) and “The Politics of Consultation” (2018). He has delivered over 400 training courses and Masterclasses and is a prolific writer on the subject, having written over 300 different Topic papers and over 40 full Briefing Papers for the Institute. Since 2003 over 15,000 person-days of training based on courses he invented have been delivered. Rhion is in demand as an entertaining Keynote Speaker and Special Adviser, particularly on the Law of Consultation, and its implications for Government and other Public Bodies. In 2017, he was awarded the ‘Lifetime Achievement Award’.

Read more about Rhion

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