NHS Coventry and Rugby CCG is committed to involving patients, the public and wider stakeholders in the planning, prioritisation and buying of NHS services for our population.
What is involvement?
Involvement is about giving patients, the public and wider stakeholders influence over commissioning. This can take many forms and be done through many different approaches, the most common of which are listed below:
- Informing – this might involve leaflets, radio adverts and public meetings
- Engagement – this might involve surveys, interviews and focus groups
- Participation – this might be inviting an expert service user or carer to sit on a recurring project group
- Consultation – this could be done via workshops, public meetings or drop-in events.
These methods are not mutually exclusive and some service changes or developments will incorporate a number of these techniques depending on the issue under consideration.
How we involve patients and the public
Under the National Health Service Act 2006 (as amended by the Health and Social Care Act 2012), CCGs and NHS England have duties to involve the public in commissioning, (under sections 14Z2 and 13Q respectively).
As outlined in the NHS England’s Patient and public participation in commissioning health and care: Statutory guidance for clinical commissioning groups and NHS England, section 5, the CCG must assess the benefits of, and the legal requirement for, public involvement and plan and carry out involvement activity. Decision making and the rationale for decisions should be clearly documented at all stages.
Understanding the impact on services
When considering potential commissioning decisions, we must also consider the impact of that decision on services; this might be in the way a service is delivered to individuals or in the range of services available to individuals. The CCG will always seek to involve patients and the public in this process where appropriate.
Impact on service should be considered from the perspective of the patient, not just the clinical service. Accessibility, transport links and ambulance availability are examples of issues that need to be reviewed when considering the impact on service.
Where the CCG has a legal duty to involve, it will follow the processes outlined in the Communications and Engagement strategy, and will include a review of existing information and previous involvement activities at the start of the process, to ensure commissioning decisions are based on evidence where available.
How we will involve people
The CCG may involve patients and the public in a variety of different ways, such as:
- In the planning of commissioning arrangements
- In the development and consideration of proposals for changes in the commissioning arrangements where the implementation of the proposals would have an impact on service, as outlined above
- In decisions affecting the operation of the commissioning arrangements, where the implementation of the decisions would, if made, have such an impact
Involvement can take a number of forms including but not limited to:
- Designing the approach to engagement
- Developing options
- Refining options
- Formal consultation on a limited range of options
- Being informed about the outcome of the consultation and the decision taken.
Involvement may be delivered through
- Face to face sessions, either one to one, in focus groups or large workshops or presentations
- Via survey, either online or paper-based
- Via telephone
- Via email
- Via social media
If your involvement requires specialist knowledge or training, we will provide that for you in order for you to feel informed and confident in having your say. For example, if we ask you to take part in an exercise to procure (buy) a new service, we will provide you with training and give ongoing support on how to access the system, score and evaluate the bids and provide feedback.
Who we will involve
The CCG will engage directly with those affected by the commissioning activity wherever possible but, in some circumstances, some aspects of public involvement will take place via representatives with appropriate expertise and representation of those affected and where that representation offers a fair and balanced reflection of the views of others. This approach should complement, not substitute, opportunities for direct engagement. Where available and appropriate, a patient/public representative acting as an “expert by experience” will be appointed as the chair of a patient reference group or similar.
When we will consult
Where proposals for commissioning decisions require formal consultation, and following pre-consultation engagement, the CCG will follow the Gunning principles to ensure the consultation is fair:
- Consultation must take place when the proposal is still at a formative stage
- Sufficient information and reasons must be put forward for the proposal to allow for intelligent and informed consideration and response
- Adequate time must be given for consideration and response
- The product of the consultation must be conscientiously take into account
Involving patients and the public as early as possible
It is important to note, involving patients and the public as early as possible is preferred, but it is not expected they will be involved from day one of any proposal: instead, they will be involved when it is most appropriate to meet the principles above. The CCG may first develop a proposal, a shortlist of options or even a preferred option before involving patients and the public, as long as involvement can still make a meaningful difference to the approach being taken.
If we need to make a decision urgently
In the event that a decision needs to be taken urgently, the CCG will consider the duty to involve the public alongside the public interest of maintaining continuity of care and protecting the health, safety and welfare of patients or staff.
Understanding judicial review
We understand that the risk of not following this guidance could result in judicial review, wherein a judge will decide whether the CCG has followed the law and legal duty to involve. It is important to note, however, that a judge will not comment on whether the decision being made is right or wrong, and may not change the outcome of the decision, merely delay it and ensure the CCG makes the decision properly aligned to the guidance above.