The NHS Long Term Plan is ambitious; it involves significant changes to the way health services are delivered so the trend for service reconfiguration arising, in part as a result of the NHS Five Year Forward View, looks set to continue.
Under the LTP, Sustainability and Transformation Partnerships (STPs) will evolve into Integrated Care Systems (ICSs). The target in the LTP is for all of England to be part of an ICS by 2021 – involving one clinical commissioning group per ICS. Inevitably, we will see a reduction in the number of CCGs. ICSs will have a key role in working with local authorities at ‘place’ level, and through ICSs, commissioners will be the drivers of change, making shared decisions with providers on service redesign and LTP implementation.
Amongst the many considerations commissioners will need to plan for while implementing the LTP are the various engagement and equality duties that must be discharged during the course of the process. There is, of course, the statutory duty to engage the public in decisions about how health services are delivered. Where the change to health services under consideration are significant or substantial, NHS bodies have a separate, but no less important, duty to consult with the local authority in whose area health services will be affected. NHS bodies will also need to turn their mind to the public sector equality duty and the duty to have regard to the need to reduce inequalities in terms of access and outcomes.
Managing these legal duties alongside the complex process of comprehensive and ongoing service reconfiguration can be challenging, but it is important to ensure effective commissioning and to avoid legal challenges. Service reconfiguration is often contentious and opposition to proposals is common, particularly where the proposed change is perceived as a reduction in services, or where it involves the closure of a much loved local health facility.
In recent years, failures by NHS commissioners and providers to discharge one or more engagement or equality duties has been used as grounds in judicial review to challenge the process or decision-making, in many cases successfully. The judgments from these cases demonstrate the fatal nature of such failings for well organised and timely service development.
Ongoing community interaction, with clinical teams and local patient groups and third sector groups, enhances service transformation and provides for a better base for services. NHS England guidance is clear that service users must be involved not just in the consideration of proposals to change services, but also in the development of any proposals: the days of plans being developed behind closed doors by health professionals and managers has long gone.
Avoiding the pitfalls around engagement and equality duties is vital to ensure a diligent approach from the outset, so consider how best to go about it early and be sure to build an effective involvement strategy into your development plan.
If you are involved in implementing the LTP and would like support or advice regarding engagement and equality duties or wider relevant commissioning issues, please do not hesitate to get in touch. We have some handy guides which might be of interest to you.
Samuel Lindsay, Associate
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