Evidence submitted by TwoCan Associates
(PPI 162)
This submission relates to the Committee's question:
In what circumstances should wider public consultation
be carried out and what form should it take?
1. TwoCan Associates is a small company
that specialises in promoting the active involvement of patients
and the public in health and social care. We work with the voluntary
sector and the NHS, both locally and nationally.
2. In July 2006 we were commissioned by
Surrey and Sussex Strategic Health Authority to analyse responses
made to a discussion document issued by the SHA, entitled Creating
an NHS fit for the future. This was seen by the SHA as a "discussion
document", rather than a piece of formal consultation under
Section 11 of the Health and Social Care Act 2001.
3. Creating an NHS fit for the future
looks at why changes to health care are needed, and considered
some of the things that could be done to improve health services
in Surrey and Sussex. More specific information about plans for
the future within Surrey, East Sussex, West Sussex and Brighton
and Hove are also given.
4. The Strategic Health Authority sought
the views of patients, carers, NHS staff and the wider community
about the changes proposed within Creating an NHS fit for the
future, and the reasons for these changes. As well as distributing
the document widely to these stakeholders, a variety of groups
and organisations attended meetings in their local area to discuss
the issues. Specific stakeholder events were also organised to
enable members of local groups and organisations to participate
in more detailed discussion.
5. A total of 6,226 people responded to
the discussion document, 3,651 signed a petition or campaign letter
to protest against the perceived closure or downgrading of a local
hospital and 2,575 wrote in with a more detailed response to the
issues raised in the discussion document. Of these responses,
the majority (81%) were about concerns at the possible closure
of St Richards Hospital in Chichester, and most were sent by members
of the public (87%).
6. Overall, people agreed with the reasons
for change outlined in the document, and the desire to improve
health services. However, they were concerned that the changes
would not need to any improvements in the quality of health care,
and felt that the real reason for the proposed changes was to
save money. Many did not seem to trust that the SHA was telling
them the truth.
7. By far the majority of people who responded
to Creating an NHS fit for the future were extremely concerned
about possible closures of local hospitals or departments within
hospitals. They were worried that increased journey times could
cause delay to treatment; that people would need to travel further
to hospitals; that there would be an impact for visitors and that
any plans to close departments or hospitals did not take into
account plans to build large numbers of homes in the South East
over the next 20 years. Overall, the discussion document seemed
to frighten many people—perhaps needlessly.
8. Respondents made detailed comments about
each of the reasons for change. We have not described these in
this paper, but would be happy to forward this information if
required. Below, we have summarised respondents' views on the
consultation process. Quotes from responses are in italic type.
Consultation Fatigue
9. Both staff and members of the public
felt they were being "inundated" with consultations
that seem to overlap and are all being carried out in a hurry.
There were questions about how Creating an NHS fit for the
Future fitted in with other recent consultation documents.
A number of respondents observed that in spite of these consultations
no one felt any better informed.
10. These discussions were thought to have
had a very negative impact on staff morale and caused distress
to the public. Overall the community felt let down and shared
a great deal of cynicism regarding the whole process.
11. Others were concerned about how proposals
would be implemented, given the imminent restructuring of PCTs
and the SHA, particularly as local plans did not seem to reflect
the regional strategy.
"Will PCT's plans be reversed to fit
with proposals in this document? Will this create requirement
for further consultations and reviews once restructuring is complete—a
further waste of resources. When will final plans for the region
be agreed and proposed?" (Member of NHS staff)
Criticism of the Consultation Document
12. Many people said they found it difficult
to make specific comments in response to the document as it was
very broad in coverage, and the ideas too vague to give constructive
feedback. Some people saw this as a period of "buttering
up" and were frustrated that the consultation process was
not helping to move the debate on, as illustrated by the following
comments from members of the public:
"What are the conclusions? What changes
are proposed?"
"Poor quality consultation."
"Inspirational statements rather than
proposals."
13. There was also a great deal of concern
about wasting money on producing the brochure:
"Consultation is urgent but it is maddening
to see all this money being spent on `glossy magazines' when we
have no budget for training, nor sufficient stationery to do our
jobs." (member of NHS staff)
"The glossy brochure and lack of space
to return comments creates the impression this is a publicity
stunt and not a genuine consultation." (Member of the
public)
Was this Genuine Consultation?
14. Many people questioned the value of
this consultation and were sceptical that their views would be
listened to. Some believed that decisions had already been made,
since the timescales seemed to suggest that the SHA does not have
an open mind. Some asked what would happen if the discussion phase
showed that most people rejected the proposals:
"The ludicrously short time frame imposed
on the whole process... reflect the little regard the SHA actually
has for proper consultation and that... there is no desire to
genuinely improve and coordinate services across the region".
(Member of NHS staff)
Suggestions for Further Consultation
15. Many people asked that the next consultation
document provide more concrete information on proposals and details
of where costs savings are to be achieved. This would need to
include a detailed breakdown of the type of services provided
by local care centres, local general hospitals, major acute hospitals
and critical care hospitals. The proposals would also need to
be backed up by a business case, covering timescales for implementing
change, initial costs to set up community services and projected
long term savings.
"It is our view that many of the alarming
scenarios being played out in the press are a direct result of
poor communication ... and the Committee seeks reassurance that
an honest, transparent and meaningful public consultation exercise
will take place at the earliest opportunity". (West Sussex
County Council Health Scrutiny Select Committee)
16. Others commented that large, formal
and potentially intimidating public meetings are not the right
way to consult a wide range of people, nor the right format to
encourage meaningful debate and discussion. It was suggested that
other formats should be developed specifically to engage with
hard to reach groups in the community including:
— making use of the local community
and voluntary sector networks, Citizen's Advice Bureaux and specific
interest forums;
— going out to meet people to
ask specific questions;
— using very small groups for
hard to reach people;
— working with intermediaries
who have been able to build trust with hard to reach groups and
individuals; and
— consulting people with physical,
sensory and cognitive disabilities in ways that suit their needs.
17. It was also felt there needed to be
better engagement with a wider range of stakeholders including
clinicians, specialist commissioners and networks, adult services,
children's services and the voluntary sector.
18. Overall, people wanted more advance
warning of the consultation and the details to be clear and widely
publicised:
"A document alone will not do the trick
... visits/events/more targeted communications ... would be required
in order to get this message out there". (Member of NHS
staff)
Bec Hanley and Kristina
Staley
TwoCan Associates
February 2007
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