It may be a mistake; it may be an oversight. Or just sloppy drafting. But deep inside the Welsh Government consultation on new arrangements for public and patient involvement lies a potential threat to people’s rights to be consulted on significant changes to the NHS. The exercise ends today and the Institute has submitted its views on plans to abolish Community Health Councils (CHCs) and to make other changes to the way in which the NHS listens to the views of local communities.

Many of the ideas are perfectly sound. The integration of health with social care suggests there is a case for replacing CHCs with a single body covering both aspects of wellbeing. A firm commitment to co-production is also a positive move and the Institute recommends setting up a Co-production Fund so that the Welsh emulate the Scots and invest seriously in capacity-building for public engagement. We think this should be around £300k per annum for the next three years.

It looks like Wales will have a new national public/patient voice body broadly on the lines of the Scottish Health Council, but will need to find ways of ensuring its independence – something that proved difficult north of the border. Far too little is known of the details of the proposed new body, so the Institute is calling for further public dialogue before the plans are tabled in new legislation before the Senedd.

We are far less convinced about withdrawing the right to refer controversial service changes to Government. Its current thinking is to leave the initiative with Ministers to ‘call in ’ a proposal for further consideration. We think it must be up to the public to decide whether it wishes to escalate the situation; in England, Health Overview & Scrutiny Committees have this right, and it is difficult to imagine that the Welsh will willingly abandon a right which their English neighbours enjoy.

More serious is anxiety that the Government would like to eliminate the right to public consultation. It does not mention any proposed amendment to the legislation, but, either by accident or design, it has published (Fig 1, Page 34 of the consultation paper) a table outlining the proposed process for service change with all references to the legal right of consultation airbrushed out. We know that management optimists hope that high-quality co-production may reduce the level of controversy surrounding some changes to NHS services. But unless the statutory requirement to ‘involve and consult’, per S.183 of the NHS (Wales) Act is amended, Health Boards would still need to Welsh Government consultation response organise a public consultation for substantial changes.

We realise that Ministers wish to make changes and would love to avoid the delays and controversies that sometimes arise. And their commitment to ‘continuous engagement’ will definitely help. But ‘engagement’ is a very unspecific obligation, and it is difficult to enforce best practice standards. Consultation, in contrast, is subject to clear rules and these can be enforced by a Court of Law.

For that reason, the right to a consultation matters, and the Institute urges the Cabinet Secretary in Wales to make an early announcement to clarify that there is no intention to withdraw this aspect of the process as part of his planned package of reforms.

A full copy of the Institute’s response to the ‘Services Fit for the Future’ consultation can be found here.

Rhion can be contacted at rhion@rhion.com OR 07966446450