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Annex 3 Informing, engaging and consulting the public in developing health and community care services

Background

1. NHS Boards are required to involve patients, carers and the public in designing, developing and delivering the health care services they provide for them. Boards' responsibilities in this area were initially set out in the document, Patient Focus and Public Involvement ( PFPI)¹¹.

2. To reflect the importance of this agenda, duties of public involvement and equal opportunities were placed on NHS Boards in the NHS Reform (Scotland) Act 2004¹².

3. The Scottish Health Council ¹³ was established in April 2005 to ensure NHS Boards deliver their patient focus and public involvement responsibilities.

Community Engagement

4. To fulfil their responsibilities for public involvement, NHS Boards should routinely communicate with and involve the people ¹⁴ and communities they serve to inform them about their plans and performance. This everyday involvement should follow principles and practice endorsed by the Scottish Health Council ¹⁵.

5. Public Partnership Forums ¹⁶ provide an important way of promoting the routine involvement of local people in the design and delivery of the health services they use. NHS Boards should also work with their Community Planning partners to minimise duplication in their community engagement mechanisms.

Consulting the Public

6. Proposals for service change should, as far as possible, emerge naturally from a Board's day-to-day engagement with the people and communities it serves.

7. However, where a proposed service change will have a major impact on a patient or carer group, or on a geographical community, a formal public consultation process must be carried out. The scale of the public consultation should be proportionate to the scale of the proposed service development or change.

8. Boards should involve potentially affected people and communities in assessing and agreeing the scale of the consultation process required. The Scottish Health Council should be involved in these discussions and can advise on what was considered appropriate in similar cases.

9. It is also good practice to inform patients, carers and the public about changes to management or organisational structures, even if they do not directly affect service users.

Ministerial Approval

10. Where a Board's judgement is that a service change will have a major impact, for example where it involves closure or re-provisioning of a service, they should seek advice from Healthcare Policy and Strategy Directorate on whether Ministerial approval will be required for their decision.

NHS Board responsibilities

11. Where a Board is considering consulting the public about a service development or change, it is responsible for:

• informing potentially affected people, staff ¹⁷ and communities of their proposal and the timetable for:
  • involving them in the development and appraisal of options.
  • involving them in a proportionate consultation on the agreed options.
  • reaching a decision.
• ensuring that the process is subject to an Equality and Diversity Impact Assessment¹⁸.
• ensuring that any potentially adverse impact of the proposed service change on, for example, the travel arrangements of patients, carers, visitors and staff have been taken account of in the final proposal.
• providing evidence of the impact of this public involvement on the final agreed service development or change.

12. Where a proposed service change would impact on the public in another area, the Boards concerned must ensure that all affected individuals and communities are involved in the process. Proposed changes to regional or national services must similarly be the subject of a co-ordinated engagement process.

The Process of Informing, Engaging and Consulting the Public

13. A public consultation about a service change should grow naturally out of a Board's everyday communication and dialogue with the people it serves. It should offer potentially affected people and communities a real opportunity to influence the Board's decision-making about the design and delivery of the service through their involvement in:

• developing and appraising possible options to decide which should be the subject of a full public consultation; and
• the formal public consultation on the agreed option(s).

14. The public involvement process outlined below should be applied in a realistic, manageable and proportionate way to any service development or change which will have an impact on the way in which people access or use NHS services.

Planning

15. As soon as a Board is aware of a need to consider a change to a service they should develop an involvement and communication plan which details how the engagement process will be carried out.

16. This plan should be developed with advice from the Scottish Health Council, and should 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. Boards should seek from the Scottish Health Council:

• views on the type of involvement they would expect to see for the proposed service development or change.
• views on similar work and good practice elsewhere.
• co-operation in quality assuring each step of the process as it develops.

Informing

17. The people and communities who may be affected by a proposed service development or change should be given information about the:

• clinical, financial and other reasons why change is needed and which may limit possible choices, including reference to any relevant legislation or Scottish Executive policies.
• benefits that are expected to flow from the proposed change.
• processes, such as carrying out a transport needs assessment, that will be put in place to assess the impact of the proposal.

Engaging

18. There should be an open, transparent and accessible process of developing the choices or options which can be delivered within the available resources, in which potentially affected people and communities should be proactively engaged. The Scottish Health Council should be consulted about the communication and involvement techniques to be used which will vary depending on the issue involved, and the people and groups the Board is trying to reach.

Option development

19. The Board should work with local people to develop options which are robust, evidence-based, patient-centred, sustainable and consistent with clinical standards and national policy. Where this happens, the subsequent consultation process will have greater credibility and authority.

20. Clinical and professional staff who work in the service should be involved in developing the options and can have an important role in presenting them at meetings and other public involvement events.

21. Although every effort should be made to develop more than one option, there will be occasions where options are limited, for example, by requirements to comply with national policy or legislation, and there may only be one feasible course of action. If so, the option development process should still be used to involve potentially affected people and communities, and to seek to achieve a consensus that there are no other viable options.

Option appraisal

22. The Scottish Health Council's advice should be sought about establishing an open and transparent process to determine which options should proceed to the public consultation stage.

23. In publicising the outcome of the option appraisal process the NHS Board should take care to:

• ensure they accurately incorporate clinical views, financial implications and the views of patients and the public; and
• clearly explain why each option is considered viable, particularly so if a 'preferred' option has emerged from the option appraisal process.

Consulting

24. Boards should not move to the formal consultation stage until they have the Scottish Health Council's confirmation that public involvement in the option development and appraisal process has been satisfactory.

The consultation document

25. A consultation document will need to be produced. This must:

• be easy to understand.
• be readily available and accessible.
• outline how the options offered for consultation were developed and agreed.
• balance any argument offered in support of an option with any relevant counter argument.
• contain sufficient information for the reader to be able to understand the reasons for the proposal(s) and come to an informed conclusion.
• outline the factors which will be taken into account in arriving at a formal decision.
• contain information about contacts for further information or clarification and direct consultees to public access points in libraries etc.
• allow sufficient time, normally 3 months, for those consulted to consider and respond to the proposal.

26. Innovative and creative methodologies and technologies should be used to enable people who might otherwise be excluded from the consultation process to be involved and provide a response.

The consultation process

27. Potentially affected people and communities should be consulted on the agreed option(s) for the proposed service development or change. The advice of the Scottish Health Council should be sought about the consultation methodologies ¹⁹ to be used in the consultation process.

28. An inclusive process should encourage and stimulate discussion and debate. While it may not result in agreement and support for a proposal from all individuals and groups, it should demonstrate that the NHS listens, is supportive and genuinely takes account of views and suggestions.

29. It may not possible to obtain agreement from all stakeholders about a proposed service development or change. In these cases, the support of the Scottish Health Council in confirming that there has been a wide ranging consultation, which has taken all reasonable steps to take account of differences of view, will be essential.

Seeking Ministerial approval

30. In submitting a final proposal to the Minister for approval, the Board must enclose a report from the Scottish Health Council which confirms that potentially affected people and communities have been appropriately supported and involved in the consultation process.

31. It should be noted that Ministers:

• will not consider a Board's submission unless it gives evidence of how potentially adverse impacts for the affected people and communities will be taken into account.
• reserve the right to ask a Board to carry out a consultation process again in whole or in part if the Council's assessment is that the public involvement did not meet the required standard.

Feedback

32. NHS Boards must provide feedback to the stakeholders who took part in a consultation to:

• inform them of the outcome of the consultation process and the final agreed development or change.
• provide a full and open explanation of how views were taken into account in arriving at the final decision.
• provide reasons for not accepting any widely expressed views.
• outline how people can be involved in the implementation of the agreed change.

The feedback stage is of vital importance in maintaining public confidence and trust in the integrity of the involvement process.

Evaluation

33. Evaluation is an appraisal of how the informing, engaging and consulting activities undertaken worked; the impact they had on the service change; and the lessons to be learned for future involvement work to be carried out by the organisation.

34. The evaluation process should be a positive and constructive one designed to highlight areas which may need to be strengthened or developed. It need not be a lengthy or time-consuming process. Its purpose is to help the Board communicate to the public on how their involvement influenced and supported the development of the service. The Scottish Health Council can provide information and guidance on how to evaluate the consultation process.

35. The evaluation report should be made available to interested parties.

The Scottish Health Council's role

36. The Scottish Health Council was established to ensure NHS Boards deliver their PFPI responsibilities. The Minister's annual review meeting is informed by the Council's report on whether the Board has demonstrated year-on-year improvements in involving patients and the public in service developments and delivery, and in individual decisions about their personal health care ²⁰.

37. 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 have the information and support they need to play a full part in the consultation process.

38. As the Council is required to quality assure the process as it develops, Boards should engage with it at the earliest possible stage and ensure any issues identified by it are acted upon.

39. The Council will look to the Board to provide evidence that the views of potentially affected people and communities have been "actively sought, listened to and acted on; and treated with the same priority as clinical standards and financial performance" ²¹.

Healthcare Policy and Strategy Directorate
October 2007

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