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Editor’s blog Thursday 22 July 2010: Reconfig Panel supports SW GI cancer service change, but backs critics of consultation

Advice On The Reconfiguration Of The  Upper Gastro-Intestinal Cancer Surgical Service In The South West Peninsula has now been published by the Independent Reconfiguration Panel.

Firstly and rightly, it supports the reconfiguration of services to improve clinical quality and safety for patients. That is unmitigatedly to be welcomed.

It says,
“Overall, the Panel supports the view that the changes that have been implemented are in the best interests of patients and will provide safe, sustainable and accessible services for the population. The service is focussed on improving patient outcomes by providing the capability and expertise to deliver high quality care that can be sustained and improved into the future whilst more can be done to improve accessibility.”

Secondly, it supports critics of the lack of public consultation as part of the process.

The report later states of the non-consultation:
“The NHS confirmed to the Panel that they had not carried out a formal public consultation on the service change on the grounds that in their discussions with the Cornwall HAOSC (and before that with Cornwall H&ASCOSC) and other scrutiny committees involved, these committees had generally – though not consistently - agreed that the proposal to consolidate the oesophago-gastric cancer surgical service for the south west peninsula onto a single site did not constitute a substantial change.

“The Panel heard from those opposed to the proposals that they believed formal public consultation was required and were aware that HAOSC members had seen legal opinion received by RCHT to this effect. However, they indicated they had not seen the legal advice provided to CIOSPCT. The Panel had previously been made aware that some councillors considered the decision not to undertake a formal public consultation could be unlawful. In discussions with councillors, it was confirmed that they had seen the legal advice provided to RCHT but they also had not seen the advice provided to CIOSPCT.”

It later adds,
““Formal consultation” is a term used by many people in the NHS to describe the statutory requirement imposed on NHS bodies by the Local Authority (Overview and Scrutiny Committee Health Scrutiny Functions) Regulations 2002. These regulations require NHS organisations to consult with overview and scrutiny committees (OSCs) when they are considering a proposal for a substantial development of the health service in the area of the local authority, or for a substantial variation in the provision of service.

“What is often misunderstood is that the duty to involve users, set out in section 242 (1B) of the NHS Act 2006, is also formal as it is a legal requirement. There is a common misconception that if the OSC is not consulted, because a proposal is not deemed to be a substantial variation or development to a health service, users do not have to be involved. This is not the case. NHS organisations must involve users where section 242 (1B) requires arrangements to be made for involvement activity (whether by being consulted, or provided with information, or in other ways), irrespective of whether the OSC is consulted or not”.

It then adds,
“The Panel received no evidence that patients, carers and the public were fully involved in discussing the case for change and development of the patient pathway. The Panel considers that the PCN should have done more to engage with patients, carers and the wider community during the development of the proposals. The Panel would expect to see the PCN and CIOSPCT involvement processes significantly strengthened. The NCAT Service User Involvement in Cancer Care – Policy, Principles, Practice (2009) document addresses many of the „foundation stones‟ of user involvement which would result in a strong base for future engagement and consultations around other cancers. The Panel considers it essential that the PCN capture and evidence the patient experience as the starting point for any future work on service development. The Ipsos MORI work undertaken by CIOSPCT is a model for this type of approach. Engagement needs to be embedded and mainstreamed into all the work to develop and reconfigure services that takes place within the PCN area.

“The Panel accepts the view that patients and user representatives were not adequately involved in the development of the proposals and that public engagement and involvement mechanisms were not fully used. This led to the public having little opportunity for their voice to be heard or to influence or express their concerns especially during the early part of the process. As a result of this experience, local people felt disenfranchised by the way the service change was handled and became suspicious of the whole process. In the Panel‟s opinion, this understandable suspicion was exacerbated by the mixed messages at various times from different sections of the NHS community”.

It concludes,
“The history of this service change is long and, over the relevant period, both expectations and requirements to involve people through effective processes have changed. Inadequate community and stakeholder involvement in the early stages of planning change is, in the IRP‟s experience, a major cause of disputed service changes. With hindsight, the involvement of users and patient representatives in the PCN work leading up to and through the independent clinical review process was insufficient. This, combined with the absence of effective processes and agreements between the NHS and the HAOSC to manage service change, led to a breakdown in some key relationships.”

Where credit is due
This story has been closely monitored by Dr Phil Hammond and friends over a prolonged period, in Private Eye and elsewhere.

Phil has generously given me his permission to get this into the public domain quickly. This scoop (such as it is) is due to Phil and friends in the south west including Daphne Havercroft, for analysis, FOI requests, persistence and indomitability. All the credit is theirs.

Consulting the local population is not a panacea. It is, however, a clear legal duty.

Saving lives through better care is the goal of everybody. Going about it by inappropriate and over-forceful means which could be deemed tantamount to bullying should not be anyone's goal.

This matters hugely, because there will have to be many such reconfigurations. If the NHS approaches them without understanding and responding to genuine local concerns, it will antagonise and may fail every time. Lawyers will be most happy if that happens. Patients will not.

This looks very much like another vindication for John Watkinson. Credit to him, too.