Reflections on the path to excellence

The Executive Director of Operations at South Tyneside CCG reflects on his experiences of a major NHS service reconfiguration that successfully navigated both a Judicial Review and a referral to the Secretary of State:

On contemplating the progress we have made in South Tyneside and Sunderland, here are seven lessons I’d like to share with other areas undergoing major service hospital reconfigurations.

A relentless focus on why things needed to change

In considering our approach to conversations with the public, we spent a great deal of time learning from other systems. The most important point of learning for me was listening to our colleagues from North Cumbria describe their reconfiguration and how they maintained a focus on the “why”. They were absolutely right. I was struck by the amount of time we spent describing the need for change both strategically and practically.

A shared view on the need for change across commissioners and providers

It’s not always the case that commissioners and provider share the same view of the world. Sometimes organisational interests get in the way. I don’t think I can overstate the importance of genuine, shared intentions across commissioners and providers, particularly when this is tested under pressure. Because of substantial issues with workforce, sustainability, quality and safety, it was clear to all of us that change was needed. As our engagement work began, the options for addressing these issues crystallised and we were clear on a shared goal for our patients.

Clear, clinical evidence base

Our changes were genuinely driven by our desire to improve quality, safety and sustainability of care for our patients. The evidence base we have from external clinical stakeholders was substantial and we listened to it. Our proposals were developed on the back of iterative thinking between local clinical perspectives and independent experts.

The evidence that most resonated with the public was when we presented the stroke audit data from the Sentinel Stroke National Audit Programme (SSNAP). Those datasets were visual, intuitive and powerful with many members of the public visibly taken aback by our level of performance against these quality standards.

Genuine attempts to be open to external input, views and assurance

We listened.  We sought out external input, views, opinions and assurances and genuinely heard, reflected and acted on them. We considered evidence from a wide range of stakeholders including the Clinical Senate, Clinical Networks, national clinical experts as well as, independent impact assessments across travel and transport, equality, health and health inequalities.

We were open-minded BUT we were guided by a clear clinical evidence base. This is noted in the judicial review judgement which reiterates the point that it would have been misleading to the public to consult on options that were clearly clinically unrealistic or unviable, such as retaining services as they were.

We set out a range of different mechanisms to gain public views, input and feedback. We undertook surveys and consultation meetings, including specifically tailored events on hot topics such as travel and transport. We also facilitated focus groups with vulnerable cohorts and sought lived experiences from those who had reasonably used our services.

Strong programme approach from the outset

We established a fantastic group of people with different skills across programme management, clinical leadership, service reconfiguration (including the statutory and NHSE processes), corporate governance (from both an FT and CCG perspective) and communications, engagement and consultation (from both an external and internal FT perspective). We recognised the importance of creating an environment that allowed different perspectives to be valued.

Often communication and engagement experts are excluded from these processes until it is too late – we were keen to avoid that mistake, so every document, decision and discussion had strategic congruence with the process that we followed. Having an expert in the content, process, assurance and statutory guidance around service reconfiguration was critical to the success of our programme – all of us understood the expectations placed on us by the NHS and the law from the outset. Above all, we were fortunate to have a brilliantly talented, dedicated, programme team with every member worth their weight in gold.  All supported by an exceptional legal team.

Exhaustive efforts on transparency

We always felt it was likely that our changes could end up with a Judicial Review and/or referral to the Secretary of State, so we worked backwards from that perspective. Early engagement allowed us to strategically plan all consultation, engagement, stakeholder management and every document that we produced.

This was recognised by the judicial review judgement which stated “…I can see no case whatsoever of a lack of involvement of the public at a formative stage or indeed any insufficiency of information provided to the public.”

We set out to be transparent, with every document publicly available. Where feasible, we produced two versions of documents; one packed with detail, the other a more digestible summary.

Again, this was recognised by the judge that the consultation “…was both transparent and carried out with integrity”

Recognising that there are no shortcuts

Commissioners and providers must work together, really understand and appreciate the issues we face and want the same outcome.  Relationships and shared goals are tested under pressure, so you have to mean it. We must want to, seek, listen and act on external views and inputs – not just from the public and our patients, but also from clinical experts, impact assessments and other stakeholders.

And my final point of reflection, this is not easy, but it is absolutely doable with the right mindset.

Matt Brown is passionate about working to improve services and outcomes for patients, having spent 15 years working in the NHS around the country, particularly in Cumbria and the North East.

During that time, Matt has worked for a number of commissioner and provider organisations, across a range of strategic and operational roles, latterly as Head of Primary Care and Head of Strategic Planning for NHS England.

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