Archived decisions

Appendix Four

Potential functions, structure and process -

The Independent Reconfiguration Panel

DRAFT

IRP

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This document outlines a draft set of potential functions, structures and processes for the IRP to utilise and operate.

1. 0 The Functions of the IRP

1.1 The overall role is to provide the Secretary of State for Health (SoS), on request, with an independent assessment and review of contested proposals for NHS service

reconfigurations and service changes and to make recommendations.

1.2 The IRP will provide expert advice to the SoS on proposed significant NHS service reconfigurations where there is significant stakeholder disquiet. The decision to refer cases to the IRP rests solely with the SoS Please note that in due course, as foundation trusts come on line, the right of referral to the IRP is expected to be extended to the Foundation Trust independent regulator.

In providing advice, the Panel will take account of published DH guidance - Keeping the NHS Local - a New Direction of Travel and Strengthening Accountability - Involving Patients and the Public. It will also develop criteria for consideration of proposals such as:

·_Patient safety, clinical and service quality

·_Accessibility, service capacity and waiting times

·_National policies such as national service frameworks

·_The impact on the wider configuration of the NHS and other services locally,

including its effect on likely future plans

·_The process of inclusion and consultation and involvement in local decision

making.

Other criteria may be added by Ministers either in relation to all configurations or for

specific cases.

1.3 The advice will normally be developed by groups of experts consisting of panel

members and others co-opted if necessary. No member of these groups will have a

personal involvement or interest in the proposed service change.

1.4 The recommendations of the IRP will be delivered within agreed timescales with a view to minimising delay and preventing disruption to services at local level.

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2.0 General principles governing the conduct of the IRP

2.1 These are:

·_Working to ensure that the general principles underpinning the NHS and the NHS

Plan are upheld

·_Ensuring transparency and openness in its work

·_Being accountable to the public

·_Working to protect the general public interest

·_Using the process of cabinet decision making.

.

3.0 Time frame

3.1 As a general guideline, the IRP will attempt to review contested proposals -

investigation and report to the SoS - within eight weeks. This timescale is, however,

dependent on all requested information being supplied in a timely manner and in an

appropriate format. The eight weeks will not be deemed to have commenced until a

contested proposal has been assessed for suitability and accepted for full Panel

consideration.

3.2 In exceptional circumstances, a shorter timeframe may be required. This would have to be agreed by the SoS's office and the Chair beforehand.

4.0 Cases for IRP consideration

4.1 Only the SoS may refer cases to the IRP and it is the Minister's decision alone whether to seek the Panel's advice or not. These cases will probably have the following characteristics:

·_Substantial / significant changes in the pattern of service delivery

·_Widespread and consistent stakeholder disquiet not resolved by any other means

·_All avenues of other mediation have been considered.

4.2 Cases that are presented to the SoS may well include one or more of the following elements:

·_Closure or relocation is proposed

·_There has been significant public concern or local public opposition, or a failure to

meet public expectations

·_The proposed changes either affect large numbers of people or pose serious

consequences for a few, and proposals to mitigate the consequences are not seen

as reasonable.

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·_The proposed changes are out of step with national service frameworks

·_The proposed changes affect future service delivery and development

·_There are financial pressures.

4.3 Examples could include:

·_Hospital closures and alterations in service

·_Changes of use of buildings

·_Closure of services on contested grounds of non-efficiency and non-productivity

·_Changes to services affecting vulnerable groups

·_Relocations

·_Professional disagreement amongst health staff resulting in service deficit to

patients

·_Manpower changes resulting in service deficit to patients

·_Capital development.

4.4 Cases involving changes in governance (that is, administrative changes such as trust mergers or the formation of PCTs) will not fall within the Panel's remit.

5.0 Referral / acceptance of cases

5.1. Potential cases for referral to the IRP will be contested proposals that have been

referred to the SoS by local authority overview and scrutiny committees (OSCs) and,

until September 2003, Community Health Councils. These are the only bodies that have the power to refer proposals to the SofS (see Appendix One).

A Patient's Forum may however refer any matter to an OSC by virtue of powers under NHS Reform and Health Care Professions Act 2002.

On notification that a proposal has been contested, the SofS may wish to seek advice from the IRP but is not bound to do so.

5.2 Where the SofS decides to seek the advice of the Panel, details of the proposal, and the grounds for contesting it, will be forwarded to the IRP. Just as the SofS is not bound to seek the advice of the IRP, the Panel itself will not be bound to provide advice on every proposal referred to it. The Panel will not wish to consider in detail any proposal in which it is clear that the grounds for referral do not justify full Panel consideration or that an avenue for local resolution has not yet been fully explored.

5.3. The proposed eight week timescale for consideration of contested proposals represents an ambitious target. If this target is be achieved, there is clearly a need for clarity and consistency in the way information is presented to the Panel. This suggests that a template for submitting information would be useful. The Appendix includes a possible template for this purpose, designed around the two baseline documents the Panel will use in considering contested proposals (see Appendix Two).

5.4 Basis for assessing contested proposals

The Panel will use, as the basis for both its acceptance and consideration of proposals referred to it, the following documents:

·_Keeping the NHS Local - a New Direction of Travel

·_Strengthening Accountability - Involving Patients and the Public (Policy and Practice Guidance. Section 11 of the Health and Social care Act 2001)

(Note: it is expected that DH Guidance for OSCs on Overview and Scrutiny of

Health will be added to this list in due course)

Other relevant policy documents may also form part of the Panel's consideration as

appropriate.

The Panel will follow, as a format for its consideration, the Route Map described in

Keeping the NHS Local, considering the development of proposals - and assessing

the extent of public and patient involvement - through each of the first five stages of that

process.

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A New Approach

1. Health systems with different starting points & drivers

3. Defining the limits of the possible

5. Best option for whole system

4. Options for change

2. Developing the whole system vision

Hospital-Community/Primary-Social

statutory consultation

7. Outline business case

Building

Maintenance

New standards

& guidelines

Workforce

Dialogue with

local people

Agreed

Formal objection

Refer to SofS

Independent

Reconfiguration

Panel

6. Strategies for individual organizations and for components of the whole project

Finance

Workforce

Change

Organisational

development

Communications

Building

changes

IT

Pathway

redesign

Workforce

IT Patient and public involvement throughout the process, including Local Strategic Partnership, Overview and Scrutiny Committee, Patients' Forum,

Patient Advice and Liaison Service, and wider community

Involvement of all staff throughout the process, including healthcare professionals and support staff and their representative groups. Liaison with

other professional bodies including Royal Colleges

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6.0 Internal operation of the IRP

6.1 Preparing a case for consideration

The Secretariat of the IRP, under the Chief Executive, is responsible for managing the resources and processes of the IRP. They will keep the Chair informed of all work that is ongoing, including an overview of current workload.

6.2. Upon receipt of a contested proposal, the IRP Secretariat will acknowledge receipt immediately and activate its internal mechanisms. The Panel Secretariat will undertake an initial assessment of the information provided. They will check that all relevant information has been provided and in an appropriate format for Panel consideration.

6.3. Gathering information and evidence

It is anticipated that the preparation of each case will involve the production and use of a standard template (as referred to in 5.4 above and shown in Appendix Two). The template should provide evidence of the case for reconfiguration and demonstrate that the benefits of the change have been fully considered.

These benefits would include:

·_Improved public/patient access to services

·_Improved clinical quality of services

·_Improved environmental quality

·_The development of existing services and/or provision of new services

·_Improved strategic fit of services at the local level

·_Ensuring that national, regional and local policy initiatives and targets are met

·_Ensuring that training, teaching, research and other staffing needs are met

·_More effective use of resources

·_Greater involvement of the public.

They should also be expected to provide detailed evidence on the process of

consultation that has been used, the rationale and history of the configuration.

6.4 This information might also include:

·_Full list of stakeholders.

Recommendations on whom the subgroup should meet and which meetings could be arranged

·_Current and proposed activity levels at all sites

·_Staffing issues

·_Access.

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6.5 The Secretariat will also confirm the grounds for objection and note any relevant points of comparison (similarity or divergence) to the two baseline documents.

6.6 The case will then be passed to the IRP to assess its suitability for full Panel

consideration. The assessment will consider whether the grounds for referral justify full Panel consideration and whether there is any avenue for local resolution that has not yet been fully explored. This assessment could be conducted either by a specific

assessment group (for example, the Chair/Chief Executive/Panel member) or by the full membership.

6.7 For those cases that are considered to be suitable for full panel consideration, the Panel Secretariat will notify the relevant parties. All parties will be expected to sign up to the process and to co-operate in the production of relevant documents and the attendance of appropriate stakeholder meetings.

6.8. The subgroup

All reviews should normally follow the same protocol. Each review will be led by a

subgroup of three members from the main panel, appointed by the Chair in consultation with the Chief Executive. Members will be expected to declare any potential conflicts of interest and, if necessary, be excused from that review. Arrangements will be in place to cover sudden absence, e.g. illness of one or more of the subgroup.

6.9 The subgroup will consider the case in detail, taking into account both written and oral evidence. The subgroup will reserve the right to request additional information during the course of a review. Additional expertise may also be engaged where the subject or service is particularly specialised.

6.10A schedule of further information to be gathered, points for clarification and expert evidence to be sought should be compiled within the first week.

6.11The subgroup will normally expect to visit the contested site/sites to meet stakeholders and take oral evidence.

6.12The review process

The process by which the information will be gathered is likely to be a combination of

individual and group meetings with stakeholders from the site and expert witnesses as well as any relevant written data.

6.13 Arrangements will be made for the evidence to be recorded and compiled to form a review for consideration by the full IRP Panel.

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7.0 Decision making

7.1 The subgroup will prepare a draft report including recommendations for submission to the Panel. The Panel is expected to meet every two months.

Alternative arrangements may need to be made if an urgent meeting is required.

7.2 The whole Panel will determine the advice to be offered to the SofS. It is important that the principles of cabinet decision-making are followed in both the sub-group and the whole IRP. Where consensus is impossible to achieve, the final decision (on the IRP's advice) will rest with the Chair. However, this will be clearly reflected in the Panel's report, which will also identify differences of opinion between Panel members etc.

8.0 Delivering the message

The Panel's report will be passed directly to the SoS. The report will be made publicly available at a given date following submission to the SoS. This date will be agreed by the SoS's office and the IRP.

Appendix 2 page 1

Appendix 2: Submissions Template for Contested

Proposals to Reconfigure NHS Services

Decision-making NHS

Body/Bodies

Contact Name

Contesting Body/Bodies

Contact Name

Part One Summary Details

1.1. Please provide a brief description of the proposal. Why is there a need for

change? Please list the specialties/services affected by the proposal.

Appendix 2 page 2

1.2. Keeping the NHS Local identifies a number of core issues influencing the need

for service change. Please indicate which are applicable to this proposal.

(please tick)

Meeting patient needs

·_Service Delivery

o Technological advance

o Accessibility / access targets

o Service redesign (to meet new needs)

·_Strategic Fit

o Whole systems / integrated care

o National policies

Safety, Quality, Practicality

·_Patient experience

o Safety

o Quality

·_Infrastructure

o Capacity

o Maintenance

o Improvement

·_Affordability

o Financial constraints

o Efficiency

Workforce issues

·_European Working Time Directive

·_Teaching and training

·_Filling posts

1.3. On what grounds has the contesting body objected?

(please tick)

a. No consultation undertaken or consultation undertaken was

inadequate

b. The merits of the proposal

Appendix 2 page 3

1.4. Please provide a brief description of why the contesting body has objected

1.5. List of stakeholders involved

1.6. Background information. Please provide a brief summary of relevant

background material (eg. population data, description of building stock,

transport links, activity levels, staffing situation, map) together with references

for where more detailed information can be found.

Appendix 2 page 4

1.7. Supporting documentation. What supporting documentation is included?

(please tick)

·_Initial appraisal

·_Development of options

·_Consultation documents (full and summary)

·_Analysis of responses

·_Minutes / notes of meetings

·_Financial appraisals

·_Any supporting consultancy work

·_Official notification from Contesting Body

·_Report / supporting documentation supplied by Contesting Body

·_Patient Forum reports to Commission for Patient and Public

Involvement in Health

·_Annual Patient Prospectus

·_Relevant NSFs/DH policy documents

·_Other (please specify)

1.8. Has the information provided with this proforma been shared with the contesting

body? Does the contesting body accept that this represents an accurate

description of the situation?

1.9. Names of key contacts

Appendix 2 page 5

Part Two Development of the Proposal

Keeping the NHS Local describes a route map for approaching configuration change.

Please explain the thinking behind and action taken within each of the first five

stages of the route map, indicating how this fits with the themes explored in the

Framework.

2.1. Stage 1. Beginning the process (Different starting points and pressures)

2.2. Stage 2. Developing a whole system vision

2.3. Stage 3. Defining the limits of the possible

2.4. Stage 4. Options for change

2.5. Stage 5. Identifying the best option

Appendix 2 page 6

Part Three Public and Patient Involvement

Strengthening Accountability - Involving Patients and the Public (Section 11)

The Panel will wish to have a clear view about the extent of public and patient

involvement in each of the first five stages of the Keeping the NHS Local route map.

Please describe how the public and patients were involved in:

3.1 Stage 1. Beginning the process (Different starting points and pressures)

3.2. Stage 2. Developing a whole system vision

3.3. Stage 3. Defining the limits of the possible

3.4. Stage 4. Options for change

3.5. Stage 5. Identifying the best option

Appendix 2 page 7

Guidance Notes for completion of Template

1. The Panel will use the following documents as its starting points for assessment of

proposals

·_Keeping the NHS Local - A New Direction of Travel

·_Strengthening Accountability - Involving Patients and the Public (Section 11)

·_Any relevant national policy advice/guidelines.

2. The template follows the pattern of the route map for considering configuration change

as described in Keeping the NHS Local. Information is sought on the thinking behind

and action taken in each of the first five stages of that process.

3. Responses to each section may either be entered in the template or, where appropriate,

by providing a precise reference within supporting documentation included with the

template.

4. The Panel will be looking for evidence that the principles outlined in Keeping the NHS

Local and the legal requirements and suggestions for good practice described in

Strengthening Accountability have been taken into account in the development of the

proposal.

5. To assist those completing the template, a series of questions relevant to each stage

has been developed. The Panel's assessment of the proposal will be informed

(though not exclusively) by the responses to these questions.

Appendix 2 page 8

Part Two - Framework

Keeping the NHS Local supports NHS and partner organisations engaged in, or considering, configuration change. It identifies a process and some principles of use in any configuration change. It sets out a route map for undertaking configuration change. The Panel requires information relating to each of the first five stages of the route map.

Beginning the process

·_Has a detailed assessment of the need for change been conducted?

·_What are the core issues influencing the case for change? Have all core issues been

identified?

·_Does the analysis of these issues support the case for change?

·_Is there agreement amongst stakeholders a) of the need for change; b) to developing a

joint vision; c) a vision of an NHS designed around the patient?

Developing a whole system vision

·_Is there a whole system vision (for example, the provision of a seamless service through

integrated care, managed clinical networks)?

·_Does this include a vision for each component of the whole system?

·_Does the vision embrace the concept of an NHS designed around the patient (for

example, through the development of patient pathways)?

·_Does the vision take account of real and potential technological advances (for example, electronic health records, telemedicine, video diagnosis and conferencing)

·_Does the vision take account of relevant DH policies (for example, on capacity and

access, workforce issues, organisational changes, primary care led commissioning,

Modernisation Agency service improvements, NSFs)

·_Is the vision jointly agreed by all stakeholders?

Defining the limits of the possible

·_How readily can the existing service change to realise the vision?

·_Have the limits been fully explored and accurately defined?

·_Has an assessment been made of what is viable in terms of a) service re-design;

b) workforce redesign; c) financial constraints.

Options for change

·_Have all options been identified?

·_Have all options been correctly assessed in terms of viability?

Identifying the best option

·_How does the preferred option fit against the core issues driving the proposal (as

identified in Part One)?

Appendix 2 page 9

Meeting patient needs

Does the proposal:

·_Improve ability to meet access targets?

·_Improve travel time by public and/or private transport?

·_Improve accessibility by public transport?

·_Create greater equality of physical access (between different care/ethnic/disability/socioeconomic

groups/catchment area)?

·_Improve the provision of services closer to home?

·_Provide for an improved patient experience?

·_Contribute towards a whole systems vision?

·_Improve the strategic needs of the locality/region?

·_Contribute towards the achievement of national priorities?

Safety, Quality, Practicality

Does the proposal:

·_Address clinical problems in the service?

·_Prevent quality of services deteriorating?

·_Provide optimum health outcomes for patients?

·_Facilitate improvements in clinical practice?

·_Contribute to clinical advances?

·_Improve productivity?

·_Improve flexibility?

·_Improve the quality of the estate?

·_Address (backlog of) maintenance requirements?

·_Improve functional suitability (for example, facilitate the implementation of technological advancements)?

·_Enable the meeting of statutory requirements (for example, fire, hygiene and health and safety regulations)?

·_Improve the use of cash, human and estate resources?

·_Deliver net revenue savings?

·_Meet service needs within available resources?

·_Provide greater opportunity for generating income?

·_Provide opportunities for transferring risk cost-effectively?

·_Contribute to reduced expenditure elsewhere?

·_Provide better overall value for money?

Workforce issues

Does the proposal:

·_Facilitate sustainable compliance with the requirements of the European Working

Times Directive?

·_Meet or protect accreditation standards?

Appendix 2 page 10

·_Facilitate staff recruitment and retention?

·_Does the preferred option meet the whole system vision signed up to by stakeholders

at the outset?

·_What are the advantages of the preferred option over the other options?

Appendix 2 page 11

Part Three - Public and Patient Involvement

Section 11 of the Health and Social Care Act 2001 places a duty on all NHS organisations - strategic health authorities, primary care trusts and NHS trusts - to make arrangements to involve and consult patients and the public in the ongoing planning and development of health services.

Strengthening Accountability - Involving Patients and the Public (Policy and Practice

Guidance: Section 11 of the Health and Social Care Act 2001), outlines what is required from NHS organisations to meet their responsibilities and offers practical help and information on ways to meet these responsibilities.

The Panel will assess the extent of public and patient involvement and consultation in any proposal against the requirements and suggestions described in this guidance. The Panel will pay particular attention to the use of the Toolkits described in Part Two of the Policy and Practice Guidance.

As before, information is requested in relation to each of the first five stages of the Keeping the NHS Local route map.

Beginning the process

·_Are arrangements for representation of public and patients in place (for example,

patients' forum, PALS service in place and operational)? ICAS

·_LEGAL requirements under Section 11 etc - OSCs access to papers etc., voluntary and community sector - local compact agreements

·_Has a baseline assessment been undertaken of current work and arrangements to involve and consult patients and the public? (Toolkit 1)

·_Has a strategy for patient and public involvement been developed? (Toolkit 2)

·_Has an annual planning process for patient and public involvement been formulated?

(Toolkit 3)

·_Has a local compact with the voluntary and community sector been established?

(Toolkit 4)

·_Was a detailed assessment of the need for change conducted?

·_How do preparatory arrangements compare against Toolkit 5?

·_Which stakeholders (NHS and non-NHS) were involved?

·_How were they involved?

·_Was there genuine understanding of the starting positions of all stakeholders?

·_Was there common agreement across all stakeholders about the assessment of the need for change?

·_Did all stakeholders support the need for change?

·_If any stakeholders disagreed with the need for change, how was this managed?

·_Were the views of local people sought at the outset?

·_Was information about current and future services made available to the public?

·_Was information about existing or potential problems and the possible need for change made available to the general public?

Appendix 2 page 12

·_Are appropriate arrangements in place for seeking the views of staff? (Toolkit 8)

·_Were these views sought?

Developing whole system vision

What methods for involving patients and the public involvement were used? (Toolkit 11)

How does the process undertaken compare against other Toolkits?

·_Which stakeholders were involved?

·_How were they involved?

·_Was an agenda for discussion agreed jointly across stakeholders?

·_Did any stakeholders disagree with the whole system vision developed?

·_If so, how was this managed?

·_Was there any wider dissemination of information?

·_Were the views of patients and the public beyond stakeholder representatives sought?

·_Were the views of staff beyond stakeholder representatives sought?

·_What efforts were made to overcome barriers to involvement? (Toolkit 7)

Defining the limits of the possible

What methods for involving patients and the public involvement were used? (Toolkit 11)

How does the process undertaken compare against other Toolkits?

·_Which stakeholders were involved?

·_How were they involved?

·_Did any stakeholders disagree with the limits defined?

·_If so, how was this managed?

·_Was there any wider dissemination of information?

·_Were the views of patients and the public beyond stakeholder representatives sought?

·_Were the views of staff beyond stakeholder representatives sought?

·_What efforts were made to overcome barriers to involvement? (Toolkit 7)

Options for change

What methods for involving patients and the public involvement were used? (Toolkit 11)

How does the process undertaken compare against other Toolkits?

·_Which stakeholders were involved?

·_How were they involved?

·_Was there any wider dissemination of information?

·_Were the views of patients and the public beyond stakeholder representatives sought?

·_Were the views of staff beyond stakeholder representatives sought?

·_What efforts were made to overcome barriers to involvement?

How does the process for statutory consultation compare with Toolkit 6?

·_Was statutory consultation undertaken?

·_If not, why not? Was this with the agreement of all stakeholders?

·_Was there common agreement between all stakeholders about which body should lead

the consultation?

·_If not, how was this resolved?

Appendix 2 page 13

·_Were the roles of other bodies agreed and understood by all?

·_Was there common agreement about the subject of the consultation?

·_Was there any conflict over what was, or was not, included within the consultation?

·_If so, how was this managed?

·_Was there common agreement about the timing of the consultation?

·_Was sufficient time allowed to notify interested parties in advance?

·_Was sufficient time allowed for the consultation to be conducted (normal expectation is three months) and receipt of responses?

·_Were consultation documents clear, informative, balanced etc?

·_Was the process for submitting comments clear?

·_Was sufficient effort made to inform and invite comments from all parties that may be affected by the proposals - including specific (eg ethnic, disbility) groups?

·_Was the process monitored and evaluated?

Identifying the best option

·_Was it agreed in advance which body/bodies would be making the decision following statutory consultation?

·_Was sufficient time allowed following the consultation for consideration/analysis of

responses?

·_Is it clear that responses to the consultation have been taken into account in reaching a decision?

·_Was the decision taken at an open meeting to which stakeholder representatives and patients and the public were invited

·_Was sufficient prior notice given to enable stakeholder representatives and patients and the public to attend?

·_Which stakeholders supported the preferred option? Why?

Conflict and handling complaints (Toolkit 12)

·_Which stakeholders opposed the preferred option? Why?

·_How was opposition expressed?

·_What alternative options did stakeholders propose?

·_What was the analysis of these proposals?

·_Was further evidence/views heard at the decision-making meeting?

·_How was the final decision reached?

·_If by vote, was it a unanimous or majority count?