News Items About Public Voices

(comments welcome – bottom of page)

1st January 2017

URGENT – 13/1/17 – is the deadline for your views – by email – on NHS England’s decision about updating their ‘Transforming Participation in Health and Care’ guidelines, published in 2013.

Olivia Butterworth, NHS England’s Head of Public Voice, is inviting us to send our views in an email to her at   about updating the Guidelines.  Have a look at the website  article  to find out more about this.

She says that “Since ‘Transforming Participation’ was published, we’ve moved on; the guidance has become outdated and there’s now a wealth of new resources, tools and good practice available. Many of these resources are now on the NHS England website, on our Involvement hub.”

It is confusing – is this public involvement in her decision – or are we being consulted on the decision to change the statutory guidelines?  She says she wants our ‘feedback’ on:

  • “The features of the existing statutory guidance (Transforming Participation in Health and Care) that you would keep and include in the refreshed guidance.
  • What you would like to see in the refreshed guidance to meet current system needs.
  • Details of any good practice (public participation or patient involvement in care) that you want to share with others.”

It is all based on an assumption that the existing guidelines are no longer relevant. Why?

They could be strengthened in some areas but the basic principles are as relevant as they were when written.  These principles were promoted and endorsed by the NHS England Board consistently until fairly recently.

Our experience is that the way NHS England now involves the public has moved right away from, and no longer follows, the principles and ethical involvement practice promoted in the statutory guidelines ‘Tranforming Participation in Health and Care’.

Is this the reason they need ‘updating’?  Do principles, and ethical working practices, really become ‘outdated’?  Have the ‘new resources, tools and good practice’  come from management consultants posing as involvement experts, and basing their expertise around efficiency and control rather than principles and ethical practice?

What do you think?


16th December 2016

URGENT – 31/12/16 – NEW YEAR’S EVE – is the deadline for responses to NHS England’s Consultations on:

  • Patient and Public Involvement – the overall Policy about patient and public involvement in commissioning decisions (who provides NHS services)
  • The guidelines for involvement in Primary Care commissioning decisions

In November 2015 NHS England published their ‘Patient & Public Participation Policy’.  They also published a ‘Statement of Arrangements and Guidance on Patient and Public Participation in Commissioning’ for Clinical Commissioning Groups (who decide which organisation provides each NHS service) on how they should involve people in these decisions.

They say that these “documents set out our commitment to participation and outline how we will work with patients and the public to enable them to influence the health services they use. We would like to know more about how the documents are being used in practice and give you the opportunity to share your experiences of how well they are working.”

In March 2016 NHS England published their Framework for patient and public participation in primary care commissioning.  Primary Care includes GP services, Opticians, Chemists and Dentists and the commissioning decisions are made by both Clinical Commissioning Groups and by NHS England.

They say that “We would like to know what you think about the framework and to give you the opportunity to share your experiences of how well it is working in practice.  In addition, we are inviting comments about the related information for patients and the public about how they can get involved in primary care commissioning.”

They also say that their (NHS England’s) “ambition is for patients and the public to be at the heart of everything we do”.  

Please look at these consultations – BEFORE 2017:

Does NHS England’s Patient & Public Participation Policy work for me?

Does NHS England’s Framework for Involvement in Primary Care Commissioning, and the information, work for me?

& PLEASE tell us if you think these documents DON’T help to involve us in decisions


8th December 2016

We found a Consultation on “Work, health and disability: improving lives”.  This is a Government Consultation for the Department of Work & Pensions (DWP) and the Department of Health (DoH).  It started on 31st October 2016 and it closes on 17th February 2017. 

Damian Green MP (DWP) and Jeremy Hunt MP (DoH) say “We are seeking views on what it will take to transform employment prospects for disabled people and people with long term health conditions.”

The consultation page says This government wants to help everyone to be able to enjoy the independence, security and good health that being in work can bring.”  And also “We need to understand why disabled people and people with health conditions might be unable to get a job or keep one, and to recognise the wide range of conditions and circumstances they face.

The consultation page is rather patronising saying:

  • There are 45 questions in this consultation.
  • To make it easier for people to respond to the questions that are relevant for them we have split them into broad audience groups – please select the audience group that most closely applies to you.
  • If more than one audience group applies to you, you can return to the contents page and select another audience group.
  • When you select a group you will only see numbered questions that will be relevant to you.
  • It’s also possible to see all the questions should you wish to do so.
  • You don’t have to answer all the questions in any section. Please leave blank those questions you don’t have a view on.

It seems they want to limit general responses and fully answered responses.  It is to be hoped that the analysis of responses will not be skewed by the suggestion that responders only answer some questions.

Some of the questions are worrying – e.g. “What role should the insurance sector play in supporting the recruitment and retention of disabled people and people with health conditions?”

The survey questions are mainly in ‘management speak’ but there have now been different formats of the consultation produced.  An audio version, a BSL version and a Braille version can be provided on request.  There is no mention of an easy read version.

  Have a look   The consultation ends on 17th February 2017


1st December 2016

The KING’S FUND held a conference in LEEDS on 1/12/16 for senior managers working on the Sustainability & Transformation Plans, or STPs.  These plans were drawn up by groups of senior NHS managers working together in each of 44 sub-regions across England and are about how health and care services will be delivered over the next four years, without extra money from the government.

The Conference recognised that political decisions have been made about extra funding for health and care, and about balancing budgets, that are not negotiable – so all responsible for services have to deal with the consequences.

However some patients and members of the public attendedthe conference and were successful in getting the NHS leaders and senior managers to recognise the need for patient and public involvement in plans about changing their local services.  At least a quarter of the contributions from the floor were from the public.

The national campaigners’, and general public concerns, are being listened to with the NHS leaders in clear agreement that people need to be involved as equal partners in shaping the future of the NHS.

The key messages from the discussions were that there is a need for:

  • Meaningful involvement of the public to be sure services meet local need
  • The STPs need to involve front line staff and local authorities
  • Better collaboration and partnership working across agencies and populations
  • A focus on Out-of-Hospital Care – it’s not all about hospital reorganisation
  • To look at reducing the national bureaucracy which is costly and inefficient
  • To look at reducing procurement (contracting) which is wasteful and not always necessary
  • Changing the ‘top down’ culture in the NHS which prevents integrating services and partnership working across health and social care.

Phase 1 of the STP process was completed at the end of October with the plans being submitted for approval, to NHS England and NHS Improvement. The conference was told that Phase 2 will not start until later in January 2017. This will allow the NHS to prepare for the winter and to sort out the provider contracts for 2017-2019 before Xmas.  It was made clear that these contracts don’t need to reflect the content of the area’s STPs.

The delay in Phase 2 is also because there are many issues to be sorted, including more guidance from NHS England & NHS Improvement about governance and accountability, and to look at reducing bureaucracy and changing the ‘top down’ culture.

Also to make sure the public are fully informed and involved in decisions made by the STPs about how their local services will be delivered so that these services must meet the need for them.


26th November 2016

Yesterday Olivia Butterworth, the Head of Public Participation at NHS England, asked  how can we ensure that patients and the public are involved in their own care and decisions about how health services are provided?”

She has launched a ‘consultation’, or ‘involvement’, opportunity for people to suggest how to change the ‘Transforming participation in Health and Care’ guidance document that was created in 2013 to support Commissioners to involve local patients and the public in the decisions they make about local services.

She says “Since ‘Transforming Participation’ was published, we’ve moved on; the guidance has become outdated and there’s now a wealth of new resources, tools and good practice available.”   

And that In light of this, we think that now is the time to refresh the guidance and make sure it meets the needs of CCGs now and for the years to come, as we work to transform the NHS.”

She is inviting – not patients and the public who are what the guidance is about – but anyone who is “working in a CCG or are a healthcare provider, a patient, carer, volunteer or part of a community or voluntary sector group”.

The consultation is by email only, which is not best practice, and people have to give their ‘organisation’ which can exclude the general public – even though it is about THEIR involvement.

The ‘consultation’ lasts for exactly seven weeks, which is not best practice (at least twelve weeks), and includes two weeks over Xmas and New Year, which normally extends consultation periods to at least fourteen weeks.

If it is intended as ‘involvement’, and not a ‘consultation’, it should be for the whole time that changes are being considered and made, and should only involve those that the guidance is about – that is patients and the public.

This is what NHS England promotes in all it writes and says, and calls ‘co-production’, but they do not DO it themselves!

We ask:

  • Why does a three year old guidance need ‘updating’ NOW – ‘for the years to come’?
  • Is it to remove any direct involvement of people promoted in the existing guidance?
  • Is the ‘consultation’ period restricted to discourage direct involvement by the public?
  • Why are providers and commissioners involved – it is not about their involvement?
  • Why can NHS England not work WITH the public – openly, honestly & directly?
  • Why does NHS England not follow best practice in consultation or involvement?
  • Why is NHS England so determined to control, not to support, public involvement?

The link to the existing ‘Transforming Participation’ document is here.

The email to send suggested changes is

Have a look & see what you think

You all have until 13th January 2017 to respond to this ‘consultation’


20th November 2016

Professor Sir Bruce Keogh is the Medical Director of NHS England, and is responsible for the clinical effectiveness of the NHS in England. A few days ago he made a statement on the NHS England website news pages about some major changes that are about to be made to our healthcare services.

The changes he is talking about are in ‘local plans called Sustainability and Transformation Plans’, and they are also known as STPs.  There will be 44 of these plans across England and they are for changing how our healthcare services will be delivered over the next five years.

He starts his statement by saying that The NHS needs to make common-sense and overdue changes that will improve care for patients”. 

He then goes on to say that Over the last six months, health and care leaders up and down the country have been working together to identify where sensible changes to services can deliver real improvements for patients.”

He says that Around one third of the 44 proposals are already published, with the remainder set to be shared with the public to kick off local discussion over the coming weeks.”

 “To help our NHS staff make the changes they know work, we need the public, and their elected representatives to work with us.”

We have to ask:

  • WHY didn’t these ‘health and care leaders’ include patients and the public in their work to identify these ‘sensible’ changes?
  • WHY wait until the proposals are written before working with us?
  • WHY didn’t they involve us at the start so they don’t waste our time by ‘sharing’ proposals with us that we know ‘won’t work’?

He finishes by saying “Claims of secrecy have been overtaken by the fact that we’ve asked that all STPs are now published over the next few weeks. And the extra time this has provided has given local hospitals, GPs and mental health service leaders the time they need to develop a starting-point for local conversations.”

We say:

  • NO you only want to ask us what we think of the plans you have already made
  • NOT to have local conversations about what should be in them
  • NOR to really and honestly ‘work with us’

If you have a chance to look at his statement –  please tell us what YOU think.

15th November 2016

The Kings Fund published a report yesterday about the STP (Sustainability and Transformation Plan) process so far.

The report highlights the lack of involvement by patients, the public and others in the development of the plans.  These were submitted for approval, on 21st October 2016, by NHS Improvement and NHS England, who are responsible for the NHS in England and will allocate the Transformation fund to support the changes.

It says in the conclusion that “it is clear from our research that STPs have been developed at significant speed and without the meaningful involvement of frontline staff or the patients they serve. The plans are also being developed in an NHS policy environment that was not designed to support collaboration between organisations.”

The report makes recommendations – “to strengthen the STP process as it moves from planning to implementation:

  • secure the meaningful involvement of patients and the public, alongside clinicians, other frontline staff and local authorities
  • develop governance arrangements that allow organisations to make collective decisions and share accountability
  • improve national co-ordination and leadership of the STP process
  • consider whether statutory changes are needed to support collaboration through STPs
  • focus on the skills and resources needed to implement STPs, as well as the cultural aspects of making change happen.

It also says national and local leaders should “be realistic about what can be achieved within the time and funding available, and honest in communicating this to politicians and the public.”

But concludes that “STPs offer an important opportunity to improve health and care services in England.” !

10th November 2016

Today was the deadline for people to apply to become a Patient Advisor, or a Patient Chair, on the new NHS Citizen Programme Board, that will oversee the involvement of patients and the public in the work of NHS England (NHSE).

NHSE is responsible for the NHS in England and has a legal duty to involve the public in its work.  It agreed some major changes in the NHS Citizen programme at their last Board meeting six weeks ago. NHS Citizen is NHSE’s service that enables patients and the public to be involved.  See the application pack to be on the NHS Citizen Programme Board – citizen-prog-board-info-pack

The agreed changes include a People Bank of 800 appointed patient representatives, who are selected by NHS England but have no way of reporting back to the public and patients they ‘represent’.  There are about 55 million people in England.

There will be closer working with Healthwatch, and other NHS funded bodies such as NHS Digital, to “maximise the successful brand” (they mean NHS Citizen).  There will also be an outreach programme visiting organisations from communities ‘of interest’ and a new digital space to collect all the ‘feedback’ they gather.  However this outreach work will focus on NHS England’s national ‘priority areas’.

There will be a new Involvement Hub on the NHS England website to inform people about training opportunities that help them to understand the ‘new’ NHS and to become skilled in being ‘engaged’ with (asked by the NHS establishment what they think of decisions already made)!

There is nothing in the plans to involve ordinary people directly, or collectively, about all the changes happening in Our NHS.

4th November 2016

Health Campaigns Together (HCT) enables many separate campaigns to liaise together, share experiences and lessons, and where possible work together on issues of common concern. Recently HCT sent a briefing pack to all those public NHS activists who attended two recent conferences to discuss what people can do about the STPs.

These STPs, or Sustainability & Transformation Plans, are 5 year plans for providing health and care services in each of the 44 so-called ‘footprint’ areas of England. They were pulled together over the summer, and most of the people living in each ‘footprint’ area, including GPs, local councillors, patients and the public, have no idea what’s in them

The plans are expected to deliver NHS England’s Five Year Forward View, written in 2014, by reorganising how, and where, services are delivered by creating ‘new models of care’.  These ‘new models of care’ include centralising specialist services into ‘hubs’, closing or downgrading local services and reducing the number of hospital beds and NHS staff.

John Lister (HCT) said that “Health Campaigns Together agreed to prioritise a campaign targeted at local councils and councillors aiming to pressure them to

  1. demand publication of local Sustainability & Transformation Plans which have now been submitted to NHS England and
  2. to refuse to sign or withdraw support from any plans which involve any loss of local access to health services without adequate and satisfactory alternative services already in place.”

HCT are compiling information about all the STPs across England on their website

Here  you can find the Health Campaigns Together STP Briefing Pack..

1st November 2016

People campaigning in Shropshire scored a victory on Tuesday night for the NHS.

‘Around 80 members of the public went to an ‘Extraordinary Joint CCG Board Meeting’ where health bosses were planning to sign off the blueprint for closing an A&E. The meeting, at Shrewsbury Town Football Club, was packed. People stood at the back of the room because there weren’t enough chairs.’

Of the two CCG Boards, that needed to ‘sign off’ the proposals, called ‘Future Fit’. One CCG Board voted against the changes, persuaded by the campaigners, and although the other CCG Board voted in favour,  the plans needed support from both CCG Boards so they cannot now go forward.

The campaigners worked really hard to make the case against the plans with 80 people attending the meeting.  These plans were to close an A&E service, downgrade a hospital and shift services on to GPs and community services, but with no funding to support the extra need for services in the community.

The campaigners remain vigilant as this is one battle with more to come, but it shows how people making sure their voices are heard can make a difference.

See their meeting report Another nail in the FutureFit coffin

20th October 2016

In West Yorkshire the decision was made to move A&E services from Huddersfield to Halifax, to expand the hospital in Halifax but demolish two hospitals in Huddersfield and replace them both with one smaller hospital.  This decision was made despite 60% of the people responding to a formal public consultation opposing this action. 

The Greater Huddersfield CCG and the Calderdale CCG ignored the fact that 60% of responses to their formal public consultation did NOT support their proposals and had also showed their opposition at some angry public consultation meetings during the summer.

Local, and parliamentary petitions against the CCG proposals have a joint total of more than 100,000 signatures compared to the formal consultatiuon responses of only 7,582.  The Consultation Report does however include a list of eight petitions that they received and shows their text, all opposing the proposals, and the number of signatures on each, a joint total of 85,824!

There is much anger in Huddersfield, which is in the borough of Kirklees, a semi rural area with a population of just under half a million people.  The other A&E in the borough, in Deswbury, is being downgraded next Spring to an Urgent Care centre.  So after April 2017 all 999 calls in the large , and semi rural Pennine Kirklees borough will be taken by Ambulance an average extra 22 minutes travel time, out of the borough.

The people of Huddersfield will be taking legal action – see the campaign website at

15th October 2016

Public NHS campaigners gathered in Leeds for the Yorkshire Health Campaigns Together Conference, today.  The conference included updates on the crisis in the NHS but focused on what people could do about the lack of public awareness, or influence, on the new STPs (Sustainability & Transformation Plans).

People attending listened to updates, from Dr David Wigley on the increasing pressure on Doctors working in GP practices, and from Dr James Chan on pressures Junior Doctors are facing. Specific areas of the NHS were concentrated on in the morning, mental health and the STPs, by looking at sharing what people across the north are already doing to challenge and raise awareness and also discussing new ideas.

In the afternoon three areas were looked at and people’s ideas shared.  These were how to work with MPs and Councillors, how to work with, and to challenge, NHS commissioners and providers, and how to raise public awareness of the imminent danger to the future of our NHS. The conference closed with a motivating speerch from John Lister, of Health Campaigns Together and a discussion on final conclusions.

Health Campaigns Together, have made available an STP Resource Pack  on their website and are gathering informnation from around England on the STPs on an STP Watch page.

10th October 2016

People from across England had their voices heard at a rally in London today against the closure, and downgrading, of many local hospitals.

See the video on the Newsflare website :


‘Footage has emerged from London, UK, of hundreds of people protesting against the government’s NHS policies.’

‘The video, shot on Monday, shows a huge crowd gathering in Central London after participating in a 300-mile march across the country to protest the privatisation of the UK’s public health services.’

‘Hundreds from the Hospital campaigns from around the country gather in Trafalgar Square to oppose any further closures, and to oppose the appalling STP (Sustainability and Transformation Plans), march and protests to Downing Street, Department of Health and Parliament, London,UK.’

5th October 2016

MHAGS (Mental Health Action Group Sheffield), the only user-led mental health service in Sheffield, lobbied Sheffield City Council on 5th October after hearing that their £10,500 funding would be withdrawn at the end of March 2017, after 25 years of support.

 MHAGS began as a group of mental health service users who were campaigning in the 1980s for mobility passes on buses for people with mental health issues.  These didn’t exist at the time, but were piloted in Sheffield and later became nationwide.

In the 1990s, when NHS Trusts were created, many mental health services became casualties and MHAGS campaigned to keep day centres open across Sheffield.  In 1995 they became a charity, running a user-led day centre offering meals, activities, trips and a friendly non-judgemental atmosphere.

The group are concerned that ‘a whole community will be dispersed into isolation’ when the day centre closes next spring.  Check their website

29th September 2016

NHS England’s Board approved their new plans for involving Patients and the Public in their work  ‘Improving the quality of customer insight through NHS Citizen’

The Board discussed the NHS England Patient & Public Participation Team’s plans for meeting NHS England’s legal duty to involve the public in it’s work. The new NHS Citizen will collect more patient ‘feedback’ from all NHS ‘engagement’, have a ‘citizen online’ tool to hold this ‘data’ (feedback), and online Involvement Hub to support and inform involvement.

There will be outreach, such as the Youth Forum and a new ‘People Bank’ including 800 Patient Representatives (selected by NHS England), and NHS Citizen will work with Healthwatch England and help the STP ‘footprints’ to involve the public.

The Board were told that the NHS Citizen workshop on September 12th, gave ‘some widespread support’ for the plans (even though they weren’t discussed) and came up with the idea of a ‘steering group’ involving the public. This steering group became an NHS Citizen Programme Board, in the plans, involving Patient Advisors (selected by NHS England and ‘managed’ by the Director of the Patient & Public Voice and Insight.)

Lord Victor Adebowale, an NHS England Board Non-Executive Director, said he’d had communication from people who were at the workshop (from National NHS Public Voice with our concerns) and that NHS England should be prepared to listen to some uncomfortable challenges and to learn from them.

See our blog post on what really happened at the 12th September NHS Citizen Workshop

28th September 2016

STPs –‘I haven’t seen any genuine patient and public engagement yet.’  said Julia Simon (a former senior manager at NHS England) 

A month ago, on 28th September 2016, Julia Simon the recently ex-head of NHS England’s commissioning policy unit and its co-commissioning of primary care programme director, spoke to GPonline.   Julia Simon speaks to GPonline in September 2016

She said ‘I think it (the lack of public involvement) is entirely driven by the speed that NHS England has imposed on this (STP) process which is, frankly, kind of mad.  It’s mad. I think we will see a lot of catching up on that end, but to do that right, to do a statutory consultation – it’s three months. They don’t have three months.’

Referring to the speed at which STPs were being asked to draw up plans, she said it was:

  • ‘actually shameful, the way we have done it’ 
  • ‘forcing health and care organisations to come together so quickly to draw up the complex plans was likely to backfire’
  • ‘up against tight deadlines, organisations were likely to make unrealistic financial forecasts and claims about benefits to patient care’
  • ‘hastily drawn-up plans would lead to financial problems’
  • ‘it means there is a lot of blue sky thinking and then you have a lot of lies in the system about the financial position, benefits that will be delivered’
  • ‘it’s just a construct, not a reality.’
  • ‘ultimately it means bankruptcy in some areas’

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