There’s a phrase that seems to have come with the publication of every recent NHS service change proposal. We hear it from senior doctors and nurses in local television interviews. NHS commissioners utter it on the radio and at public governance meetings. And we see it in the statements issued to the local press.

“Doing nothing is not an option”

Those who use it believe it helps with one of the hardest bits of change management: convincing the public that change is necessary. Former BBC journalist Mark Brealey has provided media training to hundreds of public sector leaders ahead of consultation exercises involving controversial change.

“When clients are about to face the media on controversial change,” he says, “I stress the need to be really clear about the current problems using strong statements with powerful messages that hammer home the positive benefits change will bring for patients, carers and communities.”

So having a simple statement that underlines the need for change helps launch the debate and ‘doing nothing is not an option’ meets that objective. It says “I’m convinced, you should be too.” Say it loud enough, earnestly enough, and often enough and local people might just accept that their local services have to change as the starting point for a debate.

They might, but it’s unlikely if you’re involving communities for the first time like with most STPs. So whether doing nothing is in fact an option or not can quickly become the front line in the battle between commissioners and local people campaigning under banners like “Save Our Services” and “Hands Off Our Hospital”.

That’s difficult ground for public sector bodies, because it’s easy to confuse the important public relations elements of a formal consultation with the requirements of fair process.

“Do nothing” has become shorthand in options development for making no specific substantial changes to a service. And despite their statements to the contrary, some consultors still include ‘do nothing’ as an option on which they are genuinely consulting. Whether consultors specifically state ‘doing nothing is not an option’, or not, campaigners are using their ever increasing awareness of the rules that govern public consultation, and the support of crowd-funded lawyers, to claim that the absence of a ‘do nothing’ option is evidence that decision makers have broken the law by having already made up their minds.

So what do you need to think about if you’re a consultor setting out options?

• Consultors don’t need a ‘do nothing’ option to do nothing. If a public body were to discover evidence in the course of its consultation that makes the case for no change, it can simply set aside the decision and leave arrangements as they are.
• Is doing nothing really an option? Public bodies have a responsibility to present options that are viable. Most change proposals are developed to address shortcomings in current arrangements that have been identified and quantified. And if you have hundreds of pages of evidence and analysis that clearly identifies why services aren’t safe or affordable, or not meeting patient needs, it’s hard to make a logical argument that not making changes is viable.
• Offering ‘do nothing’ can be disingenuous and weaken the integrity of the consultation exercise in front of an already sceptical audience. It makes it easier for participants to discount evidence for change, meaning information the public provides is likely to be much less effective at influencing the decision than it would otherwise have been. That could mean the whole exercise is a waste of public money.
• There are other ways for respondents to be heard if they object to change. In good consultations public bodies provide the opportunity to hear about alternative options and if a respondent wants to argue for no service change, they can use that facility to present their evidence and it will be taken into account.

So we can argue that considering and logically discounting the ‘do nothing’ option in a transparent manner before publishing viable alternative proposals is good consultation practice.

The reality is that the whole ‘do nothing’ debate is a distraction. It’s unlikely that anyone would seriously argue that our NHS services shouldn’t improve and adapt to deal with the population’s changing health needs. The questions are what change is acceptable? What impact will proposed changes have? Are the proposals the best answer? And did commissioners choose the right questions? Those questions and others should be the focus of our consultation dialogues.

Thanks to @QuintinOliver, @EAGammell, @jontybradley @AmandaMAssocand others for their thoughts on doing nothing as an option.

Originally posted on Medium