The BBC report that Unison, a large public sector union (disclaimer – I’m a member), is challenging the government’s plans to ‘shake up the NHS’ as proposed by the ‘Equity and Excellence : Liberating the NHS’ White Paper that was much discussed a few weeks ago.

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Initially I scoffed at the thought that this challenge would be going anywhere, but I think they have a fair point.

Basically, the issue on which the challenge is being made is an interpretation of  what a ‘consultation’ involves.

The Constitution of the NHS states that the public, staff and unions have a right to be consulted over changes made within the NHS and on the other hand, the Chief Executive of the NHS has sent letters out to all NHS chief executives telling them to implement the changes immediately.

Do I think the challenge will make any difference whatsoever? No.

I’ve been involved in a few NHS consultations around service reconfigurations in the past as a ‘member of staff’ and to term them ‘consultations’ has almost been an insult to ones intelligence. They have never been anything other than paper exercises in which the ‘men in suits’ have produced shiny documents about changes they want to make and have made no attempt to listen or consult.

Oh, there might be a 2 hour meeting in a hospital at the other end of the borough of which you are given less than a weeks’ notice or a page or two on the website with no structured form but just a free form invitation to ‘respond’ but never has the result of the consultation been anything other than what was proposed from the outset.

In fact, I’d venture a guess that the cost of the consultations and the associated consultants/project managers are wasting resources when a decision has already been made.

The truth is that there is no core wish or desire to know what ‘people’ want – whether those people are staff or patients within the service. On the most recent occasion, we were told about the ‘consultation’ which apparently had been going on for months, about a week before it finished and it was a matter that intrinsically involved every one of us (I use us to mean employees in the team in which I work).

It’s easy to be cynical until I was reminded of the constitution’s statement that this is an obligation. I wonder that it has been so flippant in its implementation.

Good luck to Unison though – I don’t expect them to have any long term success. The changes are coming but there does need to be a lawful implementation of these changes and if they need to consult, we have a duty to respond.

The consultation document is here.

For the record, the ‘local HealthWatch’ referred to is described in the document as that body

‘which will act as local consumer champions across health and care. Local Involvement Networks (LINks) will become the local HealthWatch.

Like LINks, their services will continue to be contracted by local authorities and they will promote patient and public involvement and seek views on local health and social care services. We propose that local HealthWatch be given additional functions and funding, so that they become more like a “citizen’s advice bureau” for health and social care – the local consumer champion’

So I thought ‘I don’t know what ‘LINks’ are – I’ll look it up. LINks (which currently exist) are

Local Involvement Networks (LINks) are made up of individuals and community groups, such as faith groups and residents’ associations, working together to improve health and social care services.

There is a proposal that they will have a greater influence and maybe it’s a part of the ‘big society’ and ‘consulting’ process but I do wonder and worry as to whether specific interest groups can position themselves in these bodies. It was the ‘faith groups’ part that worried me to be honest. I have nothing against faith groups – some of my best friends are very religious (true!) but I don’t want them trying to monitor or make decisions about how health care is delivered in my local area, thank you very much. I may have to do more LINk investigation at a later date because, for now, I want to concentrate on the discussion document.

These are the questions asked in the document

The Government would welcome views on the following questions:

‘Q1 Should local HealthWatch have a formal role in seeking patients’ views
on whether local providers and commissioners of NHS services are
taking account of the NHS Constitution?

Q2 Should local HealthWatch take on the wider role outlined in paragraph
17, with responsibility for complaints advocacy and supporting
individuals to exercise choice and control?

Q3 What needs to be done to enable local authorities to be the most effective
commissioners of local HealthWatch?

Q4 What more, if anything, could and should the Department do to free up
the use of flexibilities to support integrated working?

Q5 What further freedoms and flexibilities would support and incentivise
integrated working?

Q6 Should the responsibility for local authorities to support joint working
on health and wellbeing be underpinned by statutory powers?

Q7 Do you agree with the proposal to create a statutory health and
wellbeing board or should it be left to local authorities to decide how to
take forward joint working arrangements

Q8 Do you agree that the proposed health and wellbeing board should have
the main functions described in paragraph 30?

Q9 Is there a need for further support to the proposed health and wellbeing
boards in carrying out aspects of these functions, for example
information on best practice in undertaking joint strategic needs

Q10 If a health and wellbeing board was created, how do you see the
proposals fitting with the current duty to cooperate through children’s

Q11 How should local health and wellbeing boards operate where there are
arrangements in place to work across local authority areas, for example
building on the work done in Greater Manchester or in London with the
link to the Mayor?

Q12 Do you agree with our proposals for membership requirements set out in
paragraph 38 – 41?

Q13 What support might commissioners and local authorities need to
empower them to resolve disputes locally, when they arise?

Q14 Do you agree that the scrutiny and referral function of the current
health OSC should be subsumed within the health and wellbeing board
(if boards are created)?

Q15 How best can we ensure that arrangements for scrutiny and referral
maximise local resolution of disputes and minimise escalation to the
national level?

Q16 What arrangements should the local authority put in place to ensure that
there is effective scrutiny of the health and wellbeing board’s functions?
To what extent should this be prescribed?

Q17 What action needs to be taken to ensure that no-one is disadvantaged by
the proposals, and how do you think they can promote equality of
opportunity and outcome for all patients, the public and, where
appropriate, staff?

Q18 Do you have any other comments on this document?’

I may spend some time now reading the document and formulating a response – at least to those questions that I have an interest in – particularly Q17, I think. I’ll probably print the responses. The problem with consultations is that they can be done with little fuss or fanfare and the legal obligation is fulfilled. Often the decisions have been made in advance and would be best made as a group response rather than individuals responsing – indeed, some organisations make a business of it – but if it is a way of having voices heard at least, even if they don’t end up going anywhere, it is a chance that someone might stop and think about some of the implications.

One thought on “Consultations

  1. Hmmm, I see you have met our provincial government. Their favourite trick is to do the consultations (starting on a Friday) during the summer holidays when, at best it’s a skeleton staff. And at worse, you are far too busy to even think about responding. (Colour me cynical.)

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