Our approach to public involvement

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Our approach to service change

We are responsible for commissioning (planning and buying) local healthcare services. Service improvement is central to this work, which usually occurs within an existing configuration of services.

However, there are also times when the scale of improvement that can be achieved and the benefits that can be delivered, warrant a major service change.  It is for these large scale changes that the NHS England Good Practice Guide has been produced.

It takes into account national guidance published by NHS England on “Planning and Delivering Service Changes for Patients” and also on the role of Clinical Senates in providing clinical advice to inform NHS England’s service change assurance process.

NHS England Good Practice Guide

Our committment to patient and public involvement

We are committed to patient and public involvement (PPI) across all our work. This approach is set out in our Patient and Public Involvement Strategy.

The strategy sets out our principles for good involvement and how people can get involved – whether this is in identifying health needs, developing priorities and strategies, in procuring services or in monitoring service delivery.

Cover for Patient and Public Involvement Strategy 2016-2019

Patient and Public Involvement Strategy 2016-2019

How South Gloucestershire CCG will improve the services it commissions and provides by involving people at every stage of the commissioning cycle.

The principles contained in this strategy are just as relevant for when we approach major service change. 

There is no fixed way of involving people in our work, and we are committed to ensuring that our approach is appropriate and proportionate to any service change being considered. 

However, when we approach major service change, there are other aspects – not least assurance and scrutiny – which need to be an integral part when developing proposals.

Putting the needs of patients first

In line National guidance from NHS ENgland and our PPI strategy, we will put the needs of patients and the public first when developing proposals for major service change. 

Change will be clinically-led and underpinned by a clear evidence base. We will involve the local clinical community and health and social care partners, ensuring that we take advantage of the opportunities for integrating services.

We believe that involving patients and the wider public is essential for the design of high quality services.

People with specific health needs, or people who care for them, are experts in that area, and we are committed to using their expertise in shaping the health services they use. 

This does not mean that our service change proposals will always prove to be uncontroversial.  Rather it means that decisions will be reached through open and transparent discussions, where people are able to influence decisions and see how their feedback has been acted upon.

Involving people in our work will also help address health inequalities, aiming to ensure that services are available and accessible to all sections of our diverse community.

If we genuinely succeed in reaching all groups, we will have better opportunities to understand and respond to their needs. 

Our principles for service change

We aim to follow these principles when planning and developing proposals for significant service changes:

Evidence

When developing service change proposals, these will be:

  • based on available evidence about how best to meet local health needs and deliver good quality services within available resources;
  • informed by the health needs specified in the Joint Strategic Needs Assessment and the priorities agreed in the Joint Health and Wellbeing Strategy; and
  • take into account patient feedback received by the CCG.

For all major service change proposals, we will conduct and make available publicly an assessment of the evidence when measured against the Government’s four tests for reconfiguration.

Engagement

The views of patients and their carers, members of the public and key stakeholders, including South Gloucestershire Council, will be proactively sought and used in developing service change proposals.

Leadership and Clinical Involvement

  • The development of service change proposals will be led by the CCG’s clinical leads, and will be formally agreed by the CCG’s clinical leadership team at the CCG’s Clinical Operational Executive meetings.
  • Clinicians in member practices and provider organisations will be given opportunities to contribute to the development of significant service change proposals.
  • The CCG’s Clinical Operational Executive will consider whether or not external clinical advice, which could include a peer review or an independent evaluation of clinical best practice, is required for the development of service change proposals.

Major Service Changes

There may be times in the future when the CCG needs to consider major service changes.

The decision made in 2004 to close Frenchay hospital and redevelop Southmead is a good example of a major service change.

Such decisions require additional checks, as well as continuous engagement and communication to which we are committed. The formal assurance processes and best practice guidance for major service change are complex, even for people who work in the NHS.

This diagram contains a flow chart which provides a guide for how we would approach the development of proposals for major service change.

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Our approach to service change diagram

This diagram shows the process for involving patients and public in shaping health services.

We’re publishing this document with the aim of improving transparency about NHS decision making and set within our overall approach to PPI.

We have tried to keep it clear and concise, whilst recognising that major service change proposals need to developed carefully with good governance, external assurance and extensive patient involvement.

For more information contact:

Louise Rickitt, Head of Strategy and Service Redesign
Email: louise.rickitt@nhs.net