The Scottish Government

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Annex 1 Background Information

The role of the Scottish Health Council

1. The Scottish Health Council ⁸ ( SHC) was established in April 2005 to ensure NHS Boards deliver their Patient Focus and Public Involvement ( PFPI) commitments ⁹. The Minister's annual review meeting with an NHS Board is informed by the Council's report on whether they have achieved year-on-year improvements in involving patients and the public in service developments and delivery, and in individual decisions about their personal health care.

2. More specifically, when an NHS Board proposes a major change in a local NHS service, its staff should work in partnership with the Council to ensure that potentially affected people and communities are provided with the information and support they need to play a full part in the consultation process. At the end of the consultation process the Council presents the Board with its assessment of the quality of the public involvement in the process.

What are the stages in the public consultation process?

3. The current guidance on Informing, Engaging and Consulting the Public in Developing Health and Community Care Services¹⁰ requires an NHS Board to involve potentially affected people and communities in:

• developing the initial plan for service change
• developing and appraising possible options to decide which should be the subject of a full public consultation
• a formal public consultation on agreed option(s)

Thereafter the Board considers the outcome of the consultation and the SHC's report on the quality of the public involvement. The Board's decision is then conveyed to Ministers. Ministers reserve the right to ask the Board to carry out the consultation again in whole or in part if the Council's assessment is that the involvement did not meet the requirements of the national guidance on public involvement.

What lessons can we learn from the Scottish Health Council's experience?

4. A number of lessons emerge from the Scottish Health Council reports on the involvement of the public in recent consultations on major changes in NHS services:

• proposals for service change should, as far as possible, emerge naturally from a Board's day-to-day engagement with the people and communities they serve
• the people and communities who use a service should be involved in developing and appraising the options for change
• the Board should not move to formal consultation until a robust and transparent option appraisal process has been completed satisfactorily.

And to be effective, the option appraisal stage must ensure that:

• clinical factors have been fully considered
• there are clear and robust costings of alternative options
• the public and local communities have been fully and proactively involved in the development and appraisal of options
• clinical and financial issues, and the views of the public, receive the same consideration.

5. The Council's experience suggests that where these criteria are met, the subsequent consultation process will have greater credibility and authority.

6. However, the Council has no remit to comment on the quality of the options presented, or whether all possible options have been considered. It focuses on the quality of a Board's public involvement, not on the quality of the evidence presented for that service change. The proposed arrangements for independent scrutiny would allow for robust and rigorous scrutiny of the information and evidence available, and ensure that decisions are informed by a strong and appropriate evidence base. The NHS, in proposing changes to services, needs to develop plans which are robust, evidence-based, patient-centred and consistent with clinical best practice and national policy, and to take account of local circumstances and the views of local communities.

7. The Scottish Government therefore wishes to complement the Scottish Health Council's assurance of the quality of Boards' public involvement, with a process which will assess the quality of the evidence in support of a Board's proposal(s) for a major service change.

What factors should be taken into account in establishing a system of independent, external scrutiny?

8. The purpose of an extra stage of independent scrutiny in considering proposals for changes to NHS services is to introduce a scrutiny element in the decision-making process that focuses on assessment of the information and evidence. This involves the capability to challenge and examine the available information and evidence impartially and to publish a commentary and conclusions. This will ensure that the subsequent consultation process has a transparent information base, and greater credibility and authority.

9. The Scottish Health Council's experience suggests that the credibility and authority of public consultation depends on a well planned, thorough and transparent process of option development and appraisal. This suggests that the extra stage of independent scrutiny should be undertaken before there is wider public consultation, and should focus on the quality of the evidence base for the options developed. The Scottish Government believes that this type of independent scrutiny of proposals would strengthen the ability of Boards to progress to the public consultation stage in the knowledge that a transparent and thorough exploration of options had been conducted.

10. This should result in greater public assurance about the quality of the consultation process. Equally, there will be cases where difficult choices are necessary which will not command complete public support.

Would independent Scrutiny be required for every service change proposal?

11. Independent scrutiny will be required where there are proposals for service change which will have a major impact on the way services are delivered. The national guidance on public involvement requires a formal public consultation process to be carried out in cases where a proposed service change will have a major impact on a patient or carer group or on a geographical community.

12. In the future, there will need to be independent scrutiny of the proposed options in these cases in advance of consultation. The Scottish Health Council is developing a set of criteria to help to judge whether a proposed service change is major. The final decision on whether independent scrutiny is required will be a matter for Ministers, taking into account the impact of the proposed changes on different groups and communities, and any concerns expressed by patient or carer groups, communities or stakeholders locally.

How would independent scrutiny work?

13. The independent scrutiny process would be required to:

• scrutinise, independently, proposals brought forward by NHS Boards to establish that all the possible service change options have been identified;
• assess the safety, sustainability, evidence-base and value for money of the proposals,
• ensure the proposals are robust, patient centred and consistent with clinical best practice and national policy.
• provide a clear, comprehensive and accessible commentary on the evidence presented in support of proposals for service change which the NHS Board would be able to reflect in the final proposal for public consultation.

The independent scrutiny process would not reach a view on a preferred option. This would remain a decision for the NHS Board to take as part of the option appraisal process.

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