Shh! It’s a secret! The NHS involved us, the public, in its decisions – but they didn’t tell us how or when!

Well – NHS England has just re-written their guidance document saying how the public should be involved in decisions about the NHS. But – they kept this a SECRET! They only involved a few ‘select’ members of the public – in deciding how the NHS will involve ALL of us, the public, in NHS decisions in the future!

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But – N NHS PV found out.  So we’re telling you.cropped-megaphone.jpg

(We were not included in the list of the ‘select’ few – who were invited to a workshop and sent some draft documents to comment on – but we have some new members who DID know – and they thought the Public SHOULD know!)

So – What is this all about?

In April 2013 the Health & Social Care Act became law.

This Act created both NHS England, the national organisation responsible for all NHS services in England, and Clinical Commissioning Groups, or CCGs, which are local organisations responsible for our local NHS services.

(There are 209 CCGs across England – Northern Ireland, Scotland & Wales are each responsible for their own NHS services).

The Act includes a legal duty for Public Involvement in the ‘commissioning arrangements’ of NHS services, (how they are planned and delivered) for both NHS England, in Section 23 13Q, and the CCGs, in Section 26 14Z2.

In September 2013 NHS England published a guidance document called ‘Transforming Participation in Health and Care for Clinical Commissioning Groups, CCGs.’

 This document has now been removed from the NHS website as it was replaced, on 6/4/17 by a new version , which is still the Statutory Guidance explaining the legal duty in the Act that CCGs MUST ‘have regard to’! 

This guidance shows CCGs how, and when, to involve both patients and the public in the decisions they make about how local NHS services are commissioned (planned and delivered).

The guidance is a legal document, intended to explain the wording of the Act.

It is the CCGs’ responsibility to make sure the NHS services local people need are made available to them, and they ‘must have regard to any guidance published‘ by NHS England about public involvement in decisions about these services. This requirement is also stated in Section 14Z2 of the Act.

In 2013, the original guidance explaining this legal duty was designed and written jointly, by NHS England working together with members of the public.  These were people who had used the NHS in England, and many gave their stories and described how they were often involved in improving the NHS services they relied on.

However in November 2016 Olivia Butterworth, who is the Head of Public Voice at NHS England, said she wanted people to help her make changes to the original guidance document.  She did this in a news blog, OB news blog 25.11.16, on the NHS England website News page, saying that this original guidance “has become outdated”  as “we’ve moved on” now.

Sincere apologies – the original link to her blog now takes the reader to another page on NHS England’s website as they have removed her blog from the website – completely!  

So we have inserted, instead, a copy we made and saved of her news blog – in case such a thing ever happened.

How were the public involved in ‘updating’ the guidance about involving them?

Olivia invited anyone to send in, by email to her, their ideas about how this guidance should be ‘updated’ before Friday 13th January 2017.  But this was a general invitation, for anyone, not just for the public.

And it only gave people seven weeks to respond, which included the Christmas and New Year holidays, so it was not likely to attract lots of responses.

She gave many reasons in her blog post for the urgent need to change this document.  But there were a number of people who wrote comments on her post and were not impressed.

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You can see these comments by clicking on this link – comments-on-olivias-blog-post.  

They were at the bottom of her blog page, but have now been removed (in early March 2017).  

The blog post itself has also now been removed (mid-March 2017).

(They moved her blog post weeks ago from its original November position on the general News pages and put it on the Involvement Hub News pages. But there was NO information showing where it had been moved to –  in case anyone who had seen it originally wanted to revisit it.)

It makes you wonder – Did they want us to see it – or did they mean to hide it? 

We don’t know whether all these comments made on her blog post page were included, or taken account of, in the ‘updating’ of the original guidance.

This ‘send all your ideas to me’ method of ‘involving people’ meant that the ideas people sent in were only seen by her  – and those she chose to share them with.

That was not very ‘transparent‘!

There was no open discussion possible for people to share their ideas, and develop them together, other than all the blog post comments – which are no longer online for all to see!

We don’t know:

  • how many people sent ideas to her,
  • what they said, and
  • what was recorded,
  • which contributions were accepted, and
  • which were rejected
  • or why.

This is not an inclusive, meaningful or respectful way to involve the public.

It is certainly NOT ‘transparent’.

It shows a controlled, disempowering, tokenistic, and ‘managed’ approach to involving people in decisions.

What happened next?

We, the general public, haven’t heard anything since the general invitation to suggest ideas for ‘updating’ the guidance.  We haven’t been informed about what has happened.

But we now know that Olivia, on behalf of NHS England, had been busy in the meantime – behind closed doors!

Now – we can ‘show’ you the work that has been done – behind those closed doors.

Our new members include some on the list of the ‘select few’ who have been given ‘inside information’ and we thank them for sharing this with us.

We are able to reproduce it here for you, the general public, to make sure you are no longer completely ‘left out’ – not knowing what these draft plans are to involve us in decisions about our NHS.

Here is the ‘inside information’:

What happens now?

We haven’t been informed.

But the workshop slides suggest that a final version of both the Draft Guidance documents, above, will be published at the end of March 2017.  It is not clear if this will be after being approved by the the NHS England Board, or not!

We think that you, the public, should know about a decision soon to be made by NHS England about how you, the public, are to be involved in NHS decisions!

Unfortunately the deadline for comments was 23rd February 2017.  So we have all missed the deadline.  We sincerely apologise for not being able to share this with you earlier.

We can only hope that when the final version of the Statutory Guidance for Public Involvement is published, maybe at the end of March, NHS England will decide to formally consult us all before the new guidance is set in stone.

What N-NHS-PV thinks!

That NHS England is proposing to move far away from its original declared promise, and legal duty, of ‘transparency‘ and ‘participation‘:

This promise was clearly stated on P2 of the minutes of the inaugural meeting of the NHS Commissioning Board, later called NHS England, in October 2012 in the description of the role of the NHS Commissioning Board, which is now called NHS England.

But NHS England demonstrates this move away from the original promise:

  • in the content of their new draft Guidance document for involving the public
  • and in the way they seemed to rule out actually involving the public in ‘updating’ the one that was published in 2013 – about how to involve the public

NHS England has ignored ‘transparency’ in developing the draft guidance for Public Involvement which has been:

  • changed in a way that was developed and written in secret
  • changed by involving very few ‘selected’ people in its development
  • controlled by NOT ensuring these people actually ‘represented’ the wider public view
  • developed with the timescales for feedback too short to involve the wider public

We respect our new members who actually shared the drafts with lots of people.

NHS England’s new guidance gives no recognition of the tradition of user-led, inclusive Patient & Public Participation in the NHS:

  • This was still practiced when the minutes of the first meeting of the organisation later called NHS England, were written in October 2012
  • Public involvement was then still ‘facilitated’ (supported and enabled)
  • Rather than being ‘managed’ and ‘controlled’ as it is now, and as the draft guidance document suggests it should be in the future

NHS England’s new guidance does a U turn on the time when people:

  • were ‘supported’ and ‘enabled’ to be involved in decisions about the NHS
  • had individual differences recognised and any barriers to being involved removed or addressed to allow everyone an equal voice
  • had experience and understanding respected and valued
  • were treated with respect and offered an inclusive and equal model of involvement
  • were NOT segregated into ‘silos’ based on ‘need’ in a way that masquerades as equality

But that’s not the end of this down-sizing of the Public’s role in the future of Our=NHS – GONE is the accountability of:

  • NHS service planners to the Public for their decisions about the NHS
  • NHS commissioners to the Public for their Public Involvement arrangements
  • NHS-chosen ‘patient representatives’ to the Public for all they say & do ‘on our behalf’

In fact we, the public, won’t be told who these Patient representatives are, how they act and what they say as they ‘represent’ us, or even how they ‘consult’ us.

NHS England are making decisions  FOR us – the people who use, and pay for, Our=NHS

The guidance does NOT describe how to meet the actual wording of the relevant parts of the Health & Social Care Act 2012, which is its purpose: 

  • The actual wording of the Act, in both Section 23 13Q, (for NHS England) and Section 26,14Z2, (for CCGs) states clearly the legal duty to involve the public requires them to involve ‘individuals to whom the services are being or may be provided
  • The draft guidance promotes a ‘top down’, management-led approach to Public Involvement through NHS managers selecting a few people to involve in the decisions about service planning and delivery
  • It introduces a targeted approach to equality, making assumptions about people, even suggesting that voluntary organsations can speak for the people they provide services for

Individuals should decide who they want to speak, or advocate, for them:

  • The draft guidance is NOT describing the involvement of the ‘individuals to whom services are being or may be provided
  • To do this the NHS should be aiming to involve all the individuals within the general public, to hear all their views, and allow them to choose their own representatives

The new document gives Statutory Guidance and should match the requirements in the Act, which refers to ‘individuals‘:  

It should NOT substitute the people that the NHS chooses to act as ‘patient representatives’ for The Real Thing, members of the Public:

  • Members of the public mean just that – individuals
  • Individual members of the public should all select the individuals to represent US
  • We should all be informed and involved in decisions about Our=NHS

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We will look at how the NHS England officers are advising CCGs to involve us, the public , in future decisions in a new post:

  • WHEN the new Statutory Guidance is published – end of March 2017 (maybe)
  • As a NEW document ABOUT INVOLVING US – that DIDN’T INVOLVE US in writing it!

Please tell us what YOU think – about this undermining of the role that the Public used to have in decisions about the future of Our=NHS.

Are they restricting Public Involvement in the STP* in your area?

The local STPs – (*now called ‘Local Plans to Improve Health & Care’) – are NOT letting local people know what’s being planned, or to say what they think about it. The STP people should be involving ALL of us in ‘shaping’ our local services. IT’S THE LAW!

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What are we talking about?

  • England has been split into 44 areas each had to write an STP, Sustainability & Transformation Plan, to reorganise local NHS & care services
  • The STP has to deliver NHS & care services more cheaply (to save money) and also to make them more effective and safer and they have to do all this very quickly
  • (The STPs have to SAVE money as the Treasury refuses to give the NHS more money to meet the growing need for its services – so we are to have CHEAPER NHS services)
  • The local organisations responsible for planning local services are Clinical Commissioning Groups (CCGs) there are 209 of these in England
  • BUT CCGs have had to come together, in the 44 new areas, to plan these changes

Please be patient – it is very complicated

  • Each CCG has a LEGAL DUTY to involve the public in their area in any plans to change how services are made available to them
  • The Act (Health & Social Care Act 2012) says they ‘must make arrangements to secure that individuals to whom the services are being or may be provided are involved (a) in the planning of the commissioning arrangements by the group (b) in the development and consideration of proposals by the group for change in the  commissioning arrangements where the implementation of the proposals would have an impact on the manner in which the services are delivered to the individuals or the range of health services available to them,
  • By ‘commissioning arrangements’ the Act means that ‘CCGs must arrange for the provision of the services and facilities …. as they consider necessary to meet the reasonable requirements of the persons for whom they have responsibility‘ (Explanatory Notes of the Act)

So when we say it is THE LAW – we mean that the law requires that:

  • All CCGs  MUST involve the public in their decisions about OUR local NHS services
  • That means each CCG – working in each STP – MUST involve the public in their decisions about the ‘development and consideration‘ of the STP ‘proposals
  • And that they MUST be involving ‘individuals to whom the services are being or may be provided’  
  • That does NOT mean a chosen few who are not accountable to the rest of us

The Patient Activists in Barnsley Save Our NHS (BSONHS) have shared with us how involved the Barnsley public have been, so far, in the South Yorkshire & Bassetlaw (SY&B) STP:

BSONHS asked Barnsley CCG, last summer, how the South Yorkshire & Bassetlaw (SY&B) STP was going to involve the public – according to the CCG’s legal duty to involve the public in decisions about changing services.

We were told that the local Healthwatch would represent the public in developing the plans.

In November 2016 we were told there would be a big conversation with staff and the public – to be done by partners, by voluntary organisations and by Healthwatch.  And that it would include a number of face to face discussions with people.

In February 2017 BSONHS were contacted by the SY&BSTP to say that ‘conversations’ with the public, run by the local Healthwatch, would start on 13th February and end at the end of March.  We were told any feedback, from the public, would go to the Collaborative Partnership Board (STP) to be discussed before taking the (STP) plans any further.

They also sent us a link to a simple online survey that had an introduction giving some basic STP information.

A visit to a BSONHS meeting was offered, to discuss the STP and ‘capture’ our views.  We asked if they could visit an open meeting, with our wider membership, but were told no, it would be a focus group, that would be repeated if many members wished to attend.

So BSONHS decided to send an email to the STP officer saying we would not want a focus group but would welcome a visit to our meeting, for a discussion.

In the email we reminded them of national guidance and the legal duty to involve the public in plans to make service changes.

The email is lengthy – but includes links to, and quotes from, the LAW and the many NHS documents that state clearly that the public MUST be involved in STPs ‘at the early stages’

  • CCGs and Trusts, and NHS England are ignoring their duty to involve us
  • Challenging bad practice needs to give reasons why it is bad practice (evidence)

We share two extracts from this email.  

Both extracts include information about public involvement rights that may be useful to others: 

First Extract:

“BSONHS members discussed the offer of ‘conversations’ with the public at our meeting on Monday, 27th February, and have agreed the following response:

BSONHS members are not aware of any arrangements for such ‘conversations’ that have been made in Barnsley to involve the general public and are concerned that it is now two weeks into the seven week period.

However:

  • We are aware that individual VCS (Voulntary and Community Sector) organisations may have put arrangements in place for the people who use the services they provide – but not for the general public
  • We are also aware that Healthwatch Barnsley, as a local healthwatch service, is required to act as a social enterprise, and therefore to abide by Regulation 36 (1) (b) (that is included in the Statutory Instrument 2012 No 3094) which states they are unable to act in any way that can be interpreted as ‘the promotion of, or opposition (including the promotion of changes) to, the policy which any governmental or public authority proposes to adopt in relation to any matter;’
  • We feel this requirement will limit their (HwBarnsley’s) ability to formally report the genuine concerns of the public about the STP and the significant restructure of services it proposes, or that our members may have about the decision by HM Treasury not to increase the funds to meet the growing need for both the NHS and Social Care services, in effect cutting the resources available
  • We also have concerns that Healthwatch Barnsley is not accountable to the people of Barnsley, nor representing more than about 2% of them – (we expand on this below*)
  • We note that you offer to run numerous focus groups for the people in Barnsley we are in touch with, but we do not feel a focus group enables meaningful public involvement
  • We feel that focus groups are recognised tools for market research, academic research and for pollsters, but not as a participation or involvement technique
  • We are very aware of the general lack of understanding lately, within the NHS, of the recognised skills and techniques for enabling and faciltating meaningful and inclusive public involvement in decisions about services in the NHS
  • We are also aware that all guidance documentation about New Models of Care and STPs from NHS England and NHS Improvement require meaningful involvement of the public, and that recent publications by the Kings Fund (Delivering STPs proposals to plans – Ps 31 & 32) and the House of Commons Public Accounts Committee ( Financial Sustainability of the NHS – Recommendation 4.) both say this is not happening
  • We remember discussing with you, in September 2016, the newly published NHS England guidance about public involvement in the STPs called  Engaging Local People, which clearly states on P8 that: ‘All footprints should be engaging with local people via Healthwatch and other patient and public groups, to discuss and shape their proposals’ – it doesn’t say to just work with Healthwatch who have been the only ones involved so far, by the SY&B STP Collaborative Partnership Board, to ‘represent’ the public – but without involving or informing the public
  • BSONHS, is a ‘public group’, and is in touch with other public groups that exist across the STP area, and further afield; and we have also been represented at a number of national events about the STPs and the New Models of Care and we keep ourselves informed about the central NHS bodies’ current thinking
  • We note that the Engaging Local People document repeatedly refers to terms such as ‘ongoing dialogue‘ and ‘ongoing involvement‘  saying that ‘ jargon free and accessible language that is appropriate to the audience will be essential to ensuring that people can participate meaningfully’  and that ‘ Effective communication and involvement throughout the process will help to build ownership and support for proposals to transform health and care and will also help identify potential areas of concern’
  • We are aware that the initial engagement (in February and June 2016) was NOT jargon free; that the general public have been excluded from the process since; that the people of Barnsley feel no ‘ownership’ in the SY&B STP and that they feel that these changes are being imposed on them, with none of their concerns and fears being heard or taken account of
  • We are also conscious that the Engaging Local People guidance warns that ‘Service change must be evidence-based, and this evidence should be publicly available during the …… decision-making stages’; that ‘public bodies with responsibility for STPs have a variety of legal duties including to involve the public in the exercise of their statutory functions’  and not ‘doing so effectively is likely to cause legal challenge and lengthy delay’; and also that  ‘failure to appropriately involve patients and the public in plans may lead to judicial review and criticism’ , and ‘could lead to proposals that do not adequately meet the needs of the local community’
  • We are very aware that the Collaborative Partnership Board is not a legally constituted organisation with powers to make decisions about service change, but that each constituent CCG carries the legal duty for public involvement, under the Health & Social Care Act 2012 Section 26 14Z2 Public involvement and consultation by clinical commissioning groups, which states:

(2)  The clinical commissioning group must make arrangements to secure that individuals to whom the services are being or may be provided are involved (whether by being consulted or provided with information or in other ways)— 

(a) in the planning of the commissioning arrangements by the group,

 (b) in the development and consideration of proposals by the group for changes in the  commissioning arrangements where the implementation of the proposals would have an impact on the manner in which the services are delivered to the individuals or the range of health services available to them,

and

(c) in decisions of the group affecting the operation of the commissioning arrangements

where the implementation of the decisions would (if made) have such an impact. 

and

(6) The reference in subsection (2)(b) to the delivery of services is a reference to their delivery at the point when they are received by users.”

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Second Extract:

“In a seven week period there is only 4 hours of public information/conversation offered by Healthwatch Barnsley, which is the statutory service with the sole purpose to gather the views of patients and the public around the health and social care services available to them, but in Barnsley they reach less than 2% of the local population.

A local healthwatch service is also required to be accountable to the population it serves – this is not the case in Barnsley as they have repeatedly withheld any information about their involvement in the SY&B STP development, and have told us that what they say ‘on our behalf’ is confidential.

We note that:

Healthwatch England produced a summary of the five key things that communities should expect in getting involved in decisions that affect them, particularly about service changes –     http://www.healthwatch.co.uk/reports/5-things-communities-should-expect-getting-involved.  These are not happening in Barnsley.

The Local Government Association describes the purpose of healthwatch as: ‘    The aim of local Healthwatch is to give citizens and communities a stronger voice to influence and challenge how health and social care services are provided within their locality.’  (Delivering Effective local Healthwatch – Key Success Factors 2013 P8 – Local Healthwatch purpose – engagement and relationships) This is not happening in Barnsley.

NHS England says that ‘ It is important that there is an ‘intelligent customer’ in the STP communications and engagement team who has skills and experience in public involvement and the associated legal duties’ on P 13  in their Engaging Local People document refered to above.

We do not feel that the apparent delegation of the required public involvement function to Healthwatch Barnsley, and other local healthwatches, ensures that the STP Collaborative Partnership Board is giving due regard to the guidance provided, or the expectations of them and of their constituent statutory bodies, regarding patient and public involvement.

We are aware that this email is lengthy and contains a substantial amount of material but this signifies the seriousness of our concerns about the level of public involvement that has been offered so far in the development of the SY&B STP, and that is proposed to be offered in its future development, its governance, any commissioning arrangements and, in particular, the accountability to the public it is intended to serve.

We would therefore like to invite you, and/or other representatives of the Collaborative Partnership Board, to come to our next BSONHS open meeting, that will be open to our wider membership, in the week commencing 27th March 2017.  We usually meet on a Monday in the evening but will confirm the time and venue to allow some flexibility, as we really do hope it is possible for yourself, or team members to join us.

  • We will be chairing the meeting, but you are welcome to give a brief, Plain English explanation of the STP’s purpose, content and decision making structures
  • We will then invite you to hear the concerns of our membership and to answer their questions.
  • We will ensure that the dialogue is respectful and around the issues, and not the people or personalities involved in the Collaborative Partnership”

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BSONHS has now received a reply – which we share below.

From the SY&B STP Associate Director of Engagement and Communication to BSONHS:

Many thanks for your email and your comments on the current public and staff engagement exercise underway to gather views on the ambition and ideas in the South Yorkshire and Bassetlaw’s Sustainability and Transformation Plan.

We are in the very early stages of looking at how we can achieve our ambitions of improving our health and care services and are beginning to explore what is possible. At this stage, we are taking account of public and staff views on the STP’s direction of travel and see this very much as the start of ongoing involvement in discussions to shape the future of services. There are currently no plans to change any services, other than those that existed pre-STP – which are hyper acute stroke services and children’s surgery and anaesthesia services and on which we recently consulted the public.

Our methodology to take account of views looks at gathering feedback from both quantitative and qualitative approaches. This includes:

  • Commissioning Healthwatch and the voluntary sector across SYB to engage with groups and communities, with a particular emphasis on the seldom heard to capture and report their feedback on the plans. They are doing this through a variety of methods, of which focus groups are one. Their role is to put the plans forward as they stand and gather feedback, it is not to promote the plan. Their strong links into communities and with patient groups will help to ensure we reach audiences with an interest in the Plan and also those who are less likely to be heard
  • Media release distributed at the launch – we will also send a ‘two weeks to go’ media release  – signposting people to how they can get involved
  • Social media activity via CWT account, amounting to more than 1,700 reached via Twitter and almost 600 people have so far clicked onto the survey via social media. STP partners are also carrying out social media activity which we will include in the final report on the exercise
  • E-bulletin to all those who signed up to the Commissioners Working Together distribution list
  • Between 13-20 March, all bus tickets across all journeys in South Yorkshire and Bassetlaw will alert people to the opportunity to have their say
  • STP partners are also raising awareness of the survey and holding discussions in their organisations to gather qualitative feedback

At the end of the exercise, we will analyse the survey responses, along with themes that develop from conversations, and report these back to the Collaborative Partnership Board. The Board is very keen to hear the findings and will discuss them before any next steps are agreed.

I note your comments about Healthwatch. The team at Healthwatch Barnsley is aware that the conversations need to encompass as many view points as is possible and are visiting groups individually to gather feedback, as well as holding two focus groups on March 21 in partnership with Voluntary Action Barnsley. To ensure accessibility, one is being held in the morning and in the evening and the team is also providing access support such as care cover where it is requested.  In addition to the two focus groups arranged, they are also facilitating discussion sessions for the following groups:

  • Carers workshop
  • Buckingham House care home, Penistone
  • Springvale Community Gardens, Penistone
  • Barnsley Independent Alzheimer’s and Dementia Support
  • Supporting safe and independent living in Barnsley
  • Barnsley MIND – LBGT group
  • Wednesday Voice – learning disabilities group
  • Parkinson’s District Branch Meeting
  • Goldthorpe Development Group
  • Wombwell cricket club
  • ROMERO coffee morning – the group provides many forms of support for local people marginalized by social inequality
  • Salvation Army, Goldthorpe
  • Conversation Club

They are also attending a Core tenant’s breakfast meeting where the following organisations are represented:

  • Plus Me
  • TADS
  • Creative Recovery
  • Barnsley Sexual Abuse & Rape Crisis Services
  • 360 Engagement
  • The Well
  • Care2Care
  • Academics

I understand Healthwatch has had some technical issues with their website, which have now been resolved and the information is available.  See http://healthwatchbarnsley.co.uk/get-involved/south-yorkshire-and-bassettlaw-stp/ The team has also been using social media to raise awareness of the opportunities for Barnsley people to have their say, as well as adverts in the Barnsley Chronicle.

Thank you too for your offer to attend the next Barnsley Save Our NHS meeting, which will be held in the week of 27 March. Unfortunately, I am on leave for much of this week and have commitments on the evening I am not. Can I therefore suggest that myself and the STP Programme Director arrange to meet a delegation of Barnsley Save Our NHS the week after. This would allow us to hear the group’s concerns and address questions. I would also encourage your members to complete the online survey (hard copies and alternative formats of the survey are also available) so that we can ensure their views are captured. Dates and times we could make are:” – (possible dates were given)

_____________________

BSONHS are arranging to meet with them in April –

(if it is confirmed that issues we raise in the ‘conversation’ issues will be included in the feedback to the Board.)  

We have two main concerns about how this ‘involvement’ is happening:  

Firstly that having a few targeted ‘conversations’ excludes ‘individuals’ within the wider general public, and prevents a collective, and informed, public voice.  

Secondly that the ‘conversations’, and the survey, ONLY focus on the information provided, which is ONLY telling people that the STP aims to improve services.

  • There is NO public information about changes to where, when or how services will be available to patients and the public in the future.  
  • There is NOTHING explaining to the public about how the ‘commissioning arrangements’ are changing, including the governance and accountability of local commissioning and how the decisions about services will NOW be made.

By not telling the public ALL the information means that any public involvement is not fully informed nor is it about ‘commissioning arrangements’ – as the LAW  requires.

______________________

National NHS Public Voice (N-NHS-PV) is keen to hear how other areas are experiencing ‘public involvement’ in their local STP – general comments welcome too.

Please share with us either:

  • VIA our contact page
  • OR as a comment on this post (we don’t put these online straight away)
  • OR by email to n.nhs.pv@gmail.com

We will ONLY post your information online if you ASK us to – however you send it to us.

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