NHS Consultation in Mental Health, Community and Maternity: Why Unresolved Challenges Cast Long Shadows

tCI believes the next period will bring significant change across mental health services, community services, and maternity provision. These changes are being driven by workforce pressure, financial constraint, and renewed expectations around care closer to home. As a result, consultation and engagement will move from the margins of service redesign to the centre of decision-making, not as a formality, but as a source of risk, assurance, and legitimacy.

In that context, past consultation challenges matter more, not less.

The 2023 Challenge

In 2023, Greater Manchester Mental Health NHS Foundation Trust faced judicial review proceedings over the redesign of its community mental health services. Service users argued that changes affecting their care had been developed without proper consultation. The claim was not marginal. It went to the heart of statutory duties around involvement and fairness, and it was serious enough to escalate into legal action.

Publicly, however, the story stops there. There has been no reported judgment, no published settlement, and no clear account of what happened next. Whether the case was withdrawn, resolved privately, or overtaken by events is not known. What is clear is that there is no public record explaining how the Trust responded.

Time has passed, but the absence still matters. Judicial review does not always end with a court ruling, but unresolved challenges do not disappear. They sit in the background, available to be cited by future claimants, scrutiny bodies, or regulators. What changed as a result of the claim? Whether the proposals were amended? Whether service users were subsequently involved in a different way? None of this has been set out publicly.

The 2026 Consultation

In January 2026, the Trust launched a new public consultation on the transformation of rehabilitation services. The proposals centre on community recovery provision and step down support. The consultation runs into February and is presented as a standard engagement exercise around service change. The consultation does not appear to be framed as a statutory exercise. The materials focus on gathering views rather than setting out a formal legal basis or prescribed process.

That in itself is not unusual, but it reinforces the sense that this is discretionary engagement shaped by context rather than statutory requirement. Taken in isolation, there is nothing unusual here. NHS organisations consult on service redesign frequently. But consultation does not exist in isolation. It sits within a wider pattern of behaviour, and context matters.

The Accountability Gap

The 2026 consultation does not refer to the earlier community mental health proposals. It does not explain how concerns raised through legal challenge were addressed. It does not describe what, if anything, changed in the Trust’s approach to consultation. That creates an accountability gap. When a public body moves into a new consultation cycle without closing out a contested one, stakeholders are left to draw their own conclusions. Consultation begins to look episodic rather than cumulative. Engagement appears to move forward even when underlying issues remain unresolved.

From a governance perspective, the risk is not that consultation is absent. It is that learning is invisible. Without an explicit account of what was taken from the 2023 challenge, the new consultation risks being read through the lens of the last one. Silence does not reset trust. It leaves uncertainty in place.

What Resolution Looks Like

The 2026 rehabilitation consultation may be well designed. It may involve people more effectively. It may lead to better decisions. None of that answers the underlying question: what happened after the Trust was challenged in 2023? Resolution does not require a court ruling. But it does require closure. That might mean publishing a statement setting out how the 2023 concerns were addressed. It might mean explaining what changed in the approach to consultation. It might mean acknowledging what was learned and how that learning has been applied.

Without that, the Trust is not consulting on a blank slate. It is consulting in the shadow of an unresolved past.

Why This Matters Now

Judicial review is rare. When it happens, it signals that something has broken down in the relationship between a public body and the people it serves. The legal process may resolve the immediate dispute, but the underlying issues often remain. How an organisation responds tells stakeholders whether lessons have been learned or whether the same patterns will repeat. For NHS organisations facing sustained pressure on services and resources, consultation will become more contested, not less. The temptation will be to move quickly, to focus on the next decision rather than accounting for the last one. That approach stores up risk rather than managing it.

Transparency is not just about what gets published during a consultation. It is about how you account for what came before. When past challenges go unresolved in the public domain, new consultations inherit that uncertainty. Stakeholders cannot assess whether their concerns will be taken seriously if they do not know what happened to concerns raised previously.

The Cost of Moving On

The Trust may have good reasons for not publishing a detailed account of the 2023 judicial review. Settlement agreements often include confidentiality clauses. Legal advice may have cautioned against public statements. Internal reviews may still be ongoing. But from the outside, none of that is visible. What is visible is a new consultation proceeding as though the previous challenge never happened. That is the cost when consultation moves on before it is resolved. Not that engagement stops, but that it loses credibility. Not that organisations stop asking for views, but that people stop believing their views will matter.

For organisations serious about consultation, the question is not just whether they are engaging now. It is whether they can demonstrate that past engagement led to change. Without that thread of accountability running through successive consultations, engagement becomes performative rather than purposeful.

Closing the Gap

The Trust still has the opportunity to address this. A clear statement about what happened in 2023, what was learned, and how that learning has shaped the 2026 consultation would do more for trust than any number of well designed engagement events. It need not be lengthy. It need not relitigate the legal arguments. It simply needs to acknowledge that the challenge happened, explain how the Trust responded, and set out what changed as a result.

That would connect the past to the present. It would show that consultation is cumulative, not episodic. It would demonstrate that when stakeholders raise serious concerns, even through legal channels, the organisation listens and learns.

Until that happens, the shadow remains. And with it, the risk that the next consultation will be read not on its own merits, but through the lens of an unresolved past.

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How tCI Can Help

Quality Assurance
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Early Assurance
Snapshot review during planning to Sense Check your evidence framework, codebook design and proportionality rationale before fieldwork begins. Helps you avoid costly missteps and strengthens your approach from the start.

Charter Workshops
Practical, interactive half day session introducing teams to good consultation principles. Grounded in the Consultation Charter and Gunning Principles, participants learn through expert input, case studies and group discussion. Build consistent approaches to engagement that are fair, transparent and defensible. Delivered online or in person, tailored to your sector.

Whether you’re preparing for a high stakes service change or building defensible evidence for complex decisions, we can help.

Contact tCI: hello@consultationinstitute.org