Input into the Consultation Policy

Closed 8 Jul 2011

Opened 7 Jul 2011

Results Updated 11 Jun 2012

Input into the Consultation Policy

 

Background

 

The NHS has a duty to involve local people when they take decisions, make policies and plan changes which are likely to affect the range of services available or the way in which services are delivered.

 

NHS Stockport’s consultation policy is up for its three-yearly review.

 

NHS Stockport’s Pathfinder Commissioning Group is working towards authorisation, which will require evidence of good engagement and strong processes for consultation.

 

Recent decisions taken on funding cuts, undertaken without consultation, have made this a priority area and a real risk – both financially, due to the legal costs associated with judicial reviews and the potential need to reinstate cut contracts, but also in terms of the organisation’s reputation and its relationships with local groups.

 

Review Stage

 

Review of past consultation work revealed that:

  • Many local groups want to have more of a say on how NHS money is spent and what services we commission with it
  • Many groups don’t know how to engage with the PCT
  • Others have difficulty taking part in consultations due to work or caring responsibilities
  • People don’t know what happens to their views after consultations
  • There is little confidence that when people are consulted their views are actually used in decision making
  • Commissioners felt there is no systematic approach to consultation
  • Different teams across the PCT don’t know what engagement is happening in other team
  • As a result the same questions are asked again and again
  • Local groups are frustrated that their time is being wasted going over the same questions
  • This leads to a lack of transparency, unwillingness to take part in consultations, perception that local people cannot influence change.

 

On the positive side, it was also clear that:

  • When the PCT takes time to involve groups in decisions it is done very well
  • There is a lot of talent in the PCT for engaging people
  • The PCT maintains strong links with a wide network of groups and regularly informs them about changes and issues.

 

NHS Stockport & Stockport Managed Care want to build on the experience, skills, local knowledge and community links to develop a consistent, effective consultation and engagement system which uses local views to influence change.

 

Stakeholders

 

The following groups were identified as key stakeholders for this policy revision:

  • The Local Involvement Network
  • Local voluntary groups (including specific patient groups)
  • Community groups
  • Commissioning & Service Delivery Partners (including GPs, the FT & the Council)
  • Commissioners

 

Initial Survey

 

An initial survey was sent to commissioners, engagement teams in organisations across the borough, local community groups and voluntary organisations representing patient groups and communities. These groups were specifically chosen for their roles in representing the views of key stakeholders and a wide range of local groups.

 

Results showed a real desire to influence decisions on how NHS money is spent and how services are run. However, there was not a great demand for people to be involved in taking decisions or having rights of veto over decisions. Instead, most people wanted to be able to comments on plans and make suggestions.

 

Of the 30 people who responded, most already actively engage with the PCT. However, 41.4% felt that their views were not listened to by the local NHS, 34.5% were not sure and only 24.1% felt that the views they had given to the PCT influenced its decision making.

 

There is an increasing desire to widen consultation methods to include more technology, such as use of online surveys, virtual discussions on websites and use of social networking tools. Traditional information stalls, letters, and phone surveys were less popular. For face to face discussions, the preferred option was to use focus groups rather than larger open events.

 

In terms of who should have a say, most people felt that this should be widened systematically to enable most local groups, patients, carers, voluntary organisations and the general public the chance to make suggestions. However, the majority thought that clinicians such as doctors and dentists and decision makers at the local council should have more power to also approve plans.

 

The following principles emerged as key to local people:

  • Local people are the experts on their personal health needs and should be listened to in decisions on health services – particularly any cuts to services
  • Experiences and views should be actively sought from ALL community groups, not just those who volunteer their views and are able to attend NHS events
  • Patient experience is vital to identifying good practice
  • But views on services should be balanced by data
  • Clinicians should be involved in planning services
  • Every service review should be based on local needs
  • But local involvement in decisions should be cost effective
  • In some cases, it is enough to ask for views from expert groups, rather than doing a large-scale consultation
  • The bigger the change, the more groups should be consulted
  • People should be given 12 weeks to comment on each service review
  • And feedback should be published on what people said and how that influenced decisions

 

Focus Groups

 

To build on the views already given in past engagement exercises and through the initial survey, workshops were planned with:

 

  • The Local Involvement Network, representing local people, patients and special interest groups
  • Lead commissioners across the PCT who will be undertaking consultation work
  • The PCT engagement team
  • PCT Directors & GP representatives

 

LINks Session:

 

Feedback from the Local Involvement Network was extremely constructive.

 

Examples were given of some great consultation work undertaken by the PCT and it was genuinely felt that there is valuable knowledge and expertise in the organisation. But despite this, it there is a real need for improvement to make NHS Stockport’s public involvement systematic.

 

LINks members felt that current consultation work is very much ad hoc and, in some decisions almost non-existent. The group felt that it is difficult for many people to take part in our consultations and, as a result, it is always the same people whose voices are heard by the PCT.

 

While the staff undertaking engagement are helpful and talented, the end product is not always used within the organisation making engagement work at best ok, but at times verging on ineffective. When asked how well local views were used in local decision making, there were some examples where it was felt that local consultation influenced decisions a little, but the majority of people felt their views were never listened to.

 

What was very clear is that local people are keen to take part in consultations and help the PCT, but that the PCT must make more of an effort to feed back to local people how their views were used and what impact that had made on the decisions.  Even when ideas or suggestions aren’t used, the NHS should let people know why that decision was taken.

 

In terms of where we want to get to, LINks welcomed efforts by NHS Stockport to involve them in discussions at this early stage. A strong case was made for the incorporation of a consistent consultation process in commissioning and decision-making. It was noted that good consultation and local involvement can help improve services and make them more user-friendly, which would reduce complaints and improve patient satisfaction levels. Asking for views from an early stage would help highlight potential issues and allow the PCT to make changes before the service is launched – “getting the service right from the start” would reduce waste and improve take-up of services locally.

 

The group were conscious, however, of some of the problems the NHS faces when trying to consult like the lack of money to do consultation, lack of time to fit consultation into the work cycle, and shortages of staff to undertake engagement. LINks also noted that many of the people taking part in traditional consultations are those people who have enough time to take part (mainly over 60s) and those with a specific interest: “pressure groups are biased and can the skew the direction of the service.”

 

When asked about the principles NHS Stockport should work to in their consultation, LINks suggested that our public involvement should be:

  • Open - making it clear what we want to do and why and publicising events well so lots of people can take part
  • Inclusive - engaging a broad section of the community, not just the same people
  • Flexible - to handle the different needs of different groups
  • Timely - taking place early on in the process to have a real influence on changes
  • Regular – ongoing throughout changes to keep people up to date
  • Proportional – the amount of time and effort spent on consultation should relate to the scale of change and impact on communities
  • Informed – with changes explained clearly, giving people the information required to help take decisions
  • Consistent – done at every level of the organisation (including GPs)
  • Influential – consultation should not just be paying lip service to the public, but views should be listened to
  • Two-way – NHS Stockport should consistently feedback how views were used and what difference they made.

 

The group was very clear that everyone should have the opportunity to take part in engagement and to have their voices heard in the decision making process – not just those who are influential or have easy access to the NHS. Care should be taken to reach groups who are less connected to the PCT and to assist people whose voices are not heard in taking part.

 

However, the level of involvement and the level of influence these groups should have was seen as variable:

  • LINks felt that the views of people with a vested interest in a service (such as journalists trying to get a story or private companies trying to win a contract and make money out of the NHS) should not be considered in decision making
  • The General Public should always be informed of changes, but their views should only be actively sought when a change is likely to impact on them as individuals
  • A wide range of groups should be involved in inputting ideas into the commissioning process: patients, carers, local people, service providers, social care staff, the complaints team, commissioners and clinical or professional experts with specific information or knowledge on the topic
  • Representative groups, such as charities and pressure groups, and minority groups should also be involved in approving plans which will affect them
  • Staff in the service should be able to input ideas and have a say on the plans – but this should be at all levels – receptionists, community teams, district nurses, GPs, surgeons
  • Carers were also seen as a key group in providing knowledge and information
  • In terms of the final decision, it was felt that clinicians, with the support of one or two patient and public representatives, should have the final say.

 

A wide range of suggestions were given about how to engage and what different methods should be used. The general consensus was that NHS Stockport should use as wide a range of engagement methods as possible and tailor them to the specific groups they are consulting. Examples included:

  • Holding three open meetings a year with the general public
  • Town Hall Events
  • Open days for Clinics / Practices / Hospitals
  • Focus groups to get views from people who are most likely to be affected by changes
  • Questionnaires
  • Surveys (by phone, paper, email, online)
  • Direct contact and regular meetings with voluntary groups
  • Using social networking sites like Twitter to engage with younger people
  • Consulting younger people at schools and colleges
  • Advertising events widely and in plenty of time to increase participation
  • Church venues for religious groups
  • Information in Pubs to reach people who are less likely to come to health events
  • Surveys about medication to be left in pharmacies
  • Surveys about a service to be left in the waiting room

 

What was clear is that strong planning should be used to make sure plenty of notice is given, as many people as possible are made aware of events, the correct venue is chosen for the target group so that people are not excluded, and engagement methods are varied to attract a wider range of opinions.

 

On a final point, the group looked at the commissioning work cycle at the PCT and agreed that a lot of information is passed to the NHS, but that some central database needs to be used to link views given at one event to decisions made on a similar topic. The group felt that this could really improve the use of consultation feedback and reduce waste.

Overview

We have a legal duty to involve patients and the public in changes to services that will impact on them.

We asked the Local involvement Network and local people to give us their views on how we should consult.

Areas

  • All Areas

Audiences

  • GP
  • Practice Manager
  • Commissioner
  • Manager
  • Men
  • Women
  • Older people
  • Younger people
  • Young adults
  • Patients
  • Carers

Interests

  • Input into decision making