White paper - service reconfiguration, public involvement and scrutiny

While acknowledging that most service reconfigurations work well, the paper highlights that complex or controversial proposals can lead to difficult, even intractable, debates and processes that stretch on for years. To address this, a speedier reconfiguration process is promised and will be set out in statutory guidance. Local authorities’ Health Overview and Scrutiny Committees (HOSCs) will no longer have the power to refer proposals to the secretary of state, and the Independent Reconfiguration Panel (IRP) that advises the secretary of state on such referrals will be ‘replaced by new arrangements’. It is assumed that local authorities’ general review and scrutiny role will continue in some form; however it may be that local authorities will exert greater influence through their role within the integrated care system (ICS) rather than scrutinising proposals from the outside.

The secretary of state will have a new power to proactively intervene at any stage of a reconfiguration process, rather than relying on a referral from HOSC. While aimed at addressing the issues described above, it adds an additional legal and political dimension to the multifaceted service reconfiguration process. If not used judiciously, interventions against locally developed proposals (based on local engagement, evidence and strategies) could risk more controversy, complexity or delay rather than less, and will be open to legal challenge. The paper offers assurance that the intervention power will not be used with great frequency; certainly it should rarely be necessary if the vision for independent, accountable ICSs working in collaboration with their local partners to improve services is realised.

Health and wellbeing boards (HWBs) will work with ICSs in place of clinical commissioning groups (CCGs) and continue to assess needs in the local area (joint strategic needs sssessments) and prepare strategies for meeting such needs (joint health and wellbeing strategies). Existing obligations to involve local people, stakeholders and Healthwatch England in this process, and to have regard to these assessments/strategies, are expected to continue. There is no mention of the existing NHS duties to involve the public in the planning of, and changes to, services. While there may be an opportunity to consolidate or align separate involvement duties within the ICS, it is assumed they will continue in substantively the same form. Indeed, effective public involvement will be essential for ICSs to properly understand their local populations and deliver the triple aim of better health and wellbeing for everyone, better quality of health services for all individuals, and sustainable use of NHS resources.