Sadly, we have yet another tale of flawed engagement and consultation as the NHS seeks to implement cost-saving measures at a Community Hospital.

This conclusion is not from the Consultation Institute. These are the findings of the authoritative and rigorous Independent Reconfiguration Panel (IRP) which advises the Secretary of State for Health when Council Overview & Scrutiny Committees refer proposed service changes to the Government.

In the advice published this week, the IRP considered a decision of Northumberland CCG – working under NHS England direction, to make a temporary closure of 12 in-patient beds at the purpose-built, PFI-funded community hospital permanent. Local Councillors and a vigorous campaigning body argued that there had not been adequate consultation, and that impact assessments and the ‘bed closure’ test had not been properly undertaken.

The IRP Report is highly critical.
• Although the CCG undertook an options appraisal process, it consulted on only one of the five identified options.
• It confirms that ‘no publicly available equality impact assessment was carried out prior to public consultation’.
• There was a lack of dialogue between the CCG and the local Health Overview & Scrutiny Committee: – ‘The Panel has seen no evidence that any discussion took place between the two bodies about whether or not the matter was deemed to be a substantial development or variation …’
• It notes, in particular that there was no discussion in advance of the launch of the consultation, and states:- ‘The reasons for this are difficult to understand.’
• It seems that the CCG (or maybe was it the Hospitals Trust?) did not regard the Department of Health’s fifth ‘test’ on bed closures as being applicable.

For these and other reasons, the CCG has been encouraged to work hard to remedy the deficiencies in a clearly flawed change management project.

From an Institute perspective, it is clear that:-
• Something is seriously wrong when a CCG, working so closely under the direction of NHS England (because of a serious financial situation) could so disregard its own NHSE Guidance.
• Relationships between the Overview and Scrutiny Committee and NHS Managers had clearly deteriorated. The IRP mentions the fractious tone of some of the evidence – but this excuses no-one from observing prescribed best practice.
• Community hospitals arouse strong local feelings and NHS Managers have to take care to engage and consult with local people on both the development and consideration of proposals for change. Here, those impacted included frail elderly and those needing end-of-life care and inadequate attention had been given to assessing the impact of proposals on families that might be affected.

Finally, in all this there is more than a whiff of buck-passing. CCGs may be the Commissioners – and this one was seriously in deficit. But the Hospital Foundation Trust that actually ran the hospital was in healthy surplus, and it seems strange that cherished services like these could be withdrawn without more and better dialogue between Managers in accountable public bodies and their local populations.