Written Statement - Lessons Learned Review into NHS Service Change Engagement and Consultation Exercises by Health Boards

A review of the engagement and consultation exercises undertaken by the health boards during the first phase of service reconfiguration in NHS Wales is today being published by its author Ann Lloyd CBE.

The Welsh Government commissioned the review in June 2014, fulfilling a commitment to undertake such an exercise when all three consultations were complete. Mrs Lloyd, supported by a small reference group with experience of major service change in the NHS, was asked to provide an assessment of the effectiveness of the current processes and guidance and consider what improvements may be necessary.

The review also considered and assessed the role community health councils (CHCs) played in the process. Mrs Lloyd was asked to provide advice about both the role CHCs are asked to play and their ability to discharge these responsibilities effectively.

I welcome Mrs Lloyd’s comprehensive report and wish to place on record my sincere thanks for the meticulous way in which she conducted the review.  More than 70 representatives of 30 organisations were interviewed, including NHS organisations, CHCs, local authorities and members of public campaign groups involved in the consultation exercises.

The review identifies a number of key strengths in the three engagement and consultation exercises undertaken by Betsi Cadwaladr University Health Board, Hywel Dda University Health Board and the five health boards and the Welsh Ambulance Services NHS Trust which were involved in the South Wales Programme.

All parties demonstrated significant levels of ‘honest endeavour’ in the service change process, and devoted much time and effort to ensuring the engagement and consultation processes were extensive, genuine and conscientious.

The review highlighted comprehensive engagement with clinicians, which was seen as a major step forward and proved invaluable to the final results. It also said good use was made of equality impact assessments in ensuring the processes remained dynamic and that plans and strategies were reviewed and adjusted accordingly.

Decisions to engage external validation organisations - such as the Consultation Institute and Opinion Research Services (ORS) - during each of the three consultations, were seen as sensible and helpful in providing added assurance to health board processes and the review said good use was made of third sector networks in involving hard-to-reach groups.

However, there was evidence the existing guidance underpinning the service change process was not interpreted or applied consistently by health boards across Wales.  

Public interest in the service change process varied and appeared to be limited to those people who were directly affected by the proposed changes. The absence of expert patients in the process and the detailed knowledge these key groups gained from their extensive use of health services was highlighted as a missed opportunity.  

Mrs Lloyd makes a number of recommendations to reform the current engagement and consultation arrangements, including the national guidance on major health service change in Wales. Her principal recommendation is that effective and continuous engagement by health boards should become the main vehicle for service change in the future; formal consultation should only be used for ”fundamental” service change where large numbers of people are affected or a significant local asset is proposed to be moved.

I can see the merit in this as a means of enabling and accelerating the pace of much-needed service change in Wales in the future. I have asked my officials to investigate this further.

Mrs Lloyd also recommends removing CHCs’ unique power to refer a health board’s proposals to Welsh Ministers for determination if they consider they are not in the best interests of local communities. She advises that CHCs, as presently constituted, have neither the resource nor the expertise to exercise this function effectively. At the very least, the power of referral should not remain the sole prerogative of CHCs and they should be required to seek and secure the agreement of their local services boards before referring service change proposals to Welsh Ministers.         

I understand the points being made and have asked officials to explore the role the proposed new public services boards would play in the service change process as part of the collaboration duties to be placed on them by the Future Generations Bill.

I have also asked for more detailed advice about Mrs Lloyd’s recommendation that an expert panel should be introduced into the  process to advise Welsh Ministers in cases where service change proposals are referred following consultation.

For the time being, however, I have decided that CHCs’ power of referral should remain, strengthened by the new functions proposed for the Board of CHCs as part of the ongoing implementation of the recommendations of the Marcus Longley review in 2012 (see below). I have been greatly encouraged by recent High Court rulings in relation to the Hywel Dda University Health Board service change plans, which have consistently found that all aspects and procedures adopted by the health board and Welsh Ministers were both fair and lawful.

Ongoing work to implement the recommendations of the Williams Commission and the current independent review of Healthcare Inspectorate Wales by Ruth Marks will also have implications for the future role of CHCs.

However, health boards and CHCs should move as swiftly as possible in the direction proposed by Mrs Lloyd in her report. In particular, I expect health boards to   improve continuous engagement with their local communities.

CHCs, for their part, should immediately begin forging closer links with their respective local service boards to discuss matters of mutual interest and concern. CHCs are required to have regard to the need for systematic, continuous engagement with the local population and community groups within their area in order to appropriately represent the public’s view. In future, this should include their local services boards, particularly when they are considering major service change proposals.

I will update Members as progress is made against the recommendations.
 

Consultation on Changes to Community Health Councils’ Regulations and Establishment Order

The Longley review in 2012 set out a series of recommendations for the future of community health councils in Wales. An eight-week consultation will today be launched into a set of draft Amendment Regulations and draft Establishment Order for CHCs arising from the review’s recommendations.

The main changes proposed include:

• Power for Board of Community Health Councils in Wales to set standards for a the way in which individual CHCs carry out functions, including, in particular, advocacy; inspection and monitoring; service change and the process of engagement;
• The appointment of an independent chair and two non-executive directors to the Board through the Public Appointments process;
• A change of title for the CHC Board Director and Chief Officers to reflect a more integrated management structure;
• More flexibility in the management/staffing arrangements for CHCs;
• Various amendments to clarify performance management and membership issues including compliance with code of conduct, indemnity; new maximum term for co-opted members;
• The establishment of a single CHC for Powys.