Paul Parsons has a lot of relevant experience with patient and public involvement in the NHS. He is also active in working with Institute clients considering how best to implement Sustainability & Transformation Plans (STPs). 

We asked him for his latest view of where we stand right now.

Just six weeks after the October submission date for sustainability and transformation plans, STPs are, unsurprisingly, still the hot topic in the NHS. Some common themes are emerging from conversations with commissioning leaders since the first STPs started to seep into the public domain.

• Commissioners aren’t yet won over to the principle of an open public dialogue about the principles and objectives contained in the plans they’ve published;
• Each appears to be concerned with the extent to which they have met their legal responsibilities on public involvement in developing the plans; and
• There is a range of acceptance of, or resistance to the concept of formally giving the public a chance to comment on the plans at this stage.

Each of the 44 commissioning partnerships are at different stages in their change process and have different challenges in their area. NHS England recognises that and is keen the plans involve a range of stakeholders and are all led locally. So it’s understandable that the guidance issued in September doesn’t provide a paint-by-numbers approach to the public engagement requirements of these exercises.

And for commissioners who can find confidence in conforming to actions others are taking, a lack of specific guidance can create some inertia in the system that prevents organisations being one of the first to commit to a course of action; in this case a consultation on the plan itself.

But we’re not in limbo.

The Consultation Institute has issued a briefing on public engagement for STPs that outlines the risk of simply deferring consultation to the point at which commissioning partnerships publish specific proposals.

We know the courts have found deficiencies in process where decisions to implement a programme of change have been consulted on without inviting views on the proposal to undertake that programme. (Nash v London Borough of Barnet, 2013)

Formally engaging on the plan at this stage:

• gives STP partnerships the chance to fine-tune its content and understand the priorities key stakeholders would apply;
• will help identify people and groups who want to have a say;
• meets ministerial commitments that “When the STPs come back in October after being signed off, they will be consulted on”; and
• gives the partnerships an opportunity to reduce the risks of challenge later in the processes by documenting that they’ve met the requirements for public involvement that NHS England placed on them in its September publication Engaging local people – A guide for local areas developing Sustainability and Transformation Plans.

In a programme of changes that is reliant on swift implementation to achieve sometimes ambitious financial savings, getting off on the right foot is critical to success overall. And while the odd misstep and stumble might be inevitable, Institute Director Rhion Jones has pointed out that, as a process, “consultation is not very fault tolerant.”

In general, the benefits of formally involving stakeholders and the public with opportunities to comment on the plan and its implications will significantly outweigh any cost or delay the activity causes. The time and resources invested in in a well-run consultation on the plan now will be recouped several times over by reducing the work that will have to be done further down the line.

We can point Institute members and supporters to a whole range of support and resources available to plan and run an effective involvement exercise to meet these objectives. If interested, please get in touch.