1. Working with people to improve health services
Real involvement
Working with people to improve health services

2. About these slides This pack includes slides on :
These slides have been produced to support local discussion and awareness raising about Real Involvement, the statutory guidance for section 242(1B) of the NHS Act 2006, the duty to involve. They are not intended to be used as a standard presentation: pick and mix the slides according to your audience, aims and objectives
This pack includes slides on :
the main messages relating to section 242
information on statutory guidance
the background to the section 242 legislation
the legislation
an explanation of what involvement is
how to plan involvement activity
user involvement in commissioning
techniques
information on the new duty to report on consultation

3. The main messages
The law has been strengthened so that the NHS is clearer about when it must involve people in planning, developing and delivering health services.
SHAs and PCTs have a new duty to report on consultations they have undertaken that relate to any commissioning decisions.
The NHS Constitution will make it clear to patients that they have a right to be involved.

4. What is statutory guidance?
Real Involvement, is statutory guidance for section 242(1B) of the NHS Act It was published by the Department of Health in October 2008.
NHS organisations must have regard to statutory guidance.
‘Have regard to’ does not mean that you are bound to follow the guidance in every case, but
if you are not following the guidance you must have good reasons for departing from it.

5. The background – the context for the legislation
The operating framework for the NHS in 2008/09
“Commissioners have a responsibility to ensure that their local communities have the opportunity to be fully engaged in the decisions they take……”
World class commissioning – to become world class, PCTs are increasingly required to:
“proactively seek and build continuous and meaningful engagement with the public and patients, to shape services and improve health.”

6. Messages to patients and the public
Our NHS, our future Leading local change, one of Lord Darzi’s reports tells people:
“You will be involved. The local NHS will involve patients, their carers, the public and other key partners. Those affected by proposed changes will have a chance to have their say and offer their contribution.”
The NHS Constitution (to be published in 2009) will make it clear to patients that they have a right to be involved in planning and developing services provided by the NHS.

7. The legislation – section 242(1B) of the NHS Act 2006
Section 242(1B) came into force on 3 November 2008.
Applies to SHAs, PCTs, NHS trusts (which are not relevant Welsh bodies) and NHS foundation trusts.
The duty - NHS organisations must make arrangements to involve users, whether directly or through representatives (whether by being consulted or provided with information, or in other ways) in:
planning the provision of services;
the development and consideration of proposals for changes in the way services are provided, and
decisions to be made affecting the operation of services.

8. When does the duty apply?
The a) b) and c) on this slide refer to the duty – see the previous slide.
Under a), users must always be involved when the provision of health services is being planned.
Under b) and c), users must only be involved if the implementation of the proposal or the decision, if made, would have an impact on –
a) the manner in which the services are delivered, or
b) the range of services available to users.

9. Understanding involvement
• What does ‘involvement’ mean?
• Unravelling some misconceptions.
• Principles.

10. What does ‘involvement’ mean?
Section 242 makes it clear that users may be involved by being consulted, or by being given information or in other ways.
Engagement, consultation and participation are all words that can be used to describe different types of involvement activity.
Involvement should be undertaken to:
Discuss with users, their ideas, your plans, their experiences, why services need to change, what they want from services, and how to make the best use of resources.
Make sure services meet the needs and preferences of users.

11. Misconceptions about ‘involvement’
Pre-consultation - sometimes used to describe involvement activity that happens early.
It suggests that another form of involvement activity precedes a consultation and that these activities do not have the same importance as a consultation.
This is misconception that causes confusion as to the level of consultation required – section 242(1B) requires NHS organisations to make arrangements to involve users, whether by being consulted, provided with information or in other ways.
The duty covers a range of activities from providing information to large public consultations

12. Misconceptions about ‘involvement’
Formal consultation – a term sometimes used to describe the statutory requirement imposed on NHS organisations by the Local Authority Regulations 2002 that require NHS organisations to consult with overview and scrutiny committees (OSCs) when considering a proposal that constitutes a substantial variation or development in the provision of a service.
The duty to involve users is also ‘formal’ as it is a legal requirement, NHS organisation must involve users where section 242(1B) requires them to do so, irrespective of whether the OSC is consulted or not.

13. The principles of local accountability and effective involvement
NHS involvement practices should be:
Clear, accessible and transparent
Open
Inclusive
Responsive
Sustainable
Proactive, and
Focused on improvement

14. How to • Plan involvement activity. • Find the right people.
• Find people who are ‘easy to overlook’.
• Make better decisions.

15. How to plan involvement activity
Think about:
The givens and what people can influence.
What you need to find out from users, why you want the information and what you will do with it.
Who should be involved.
What you should tell them.
What methods it would be best to use.
Whether you need to do a health needs assessment.
Taking a social marketing approach.
How you will provide feedback.
How the feedback will be used to inform the decisions you will take.

16. How to find the right people to involve
It is important to find the right people to involve – you do not need to involve everyone each time you undertake an involvement activity.
Who do you need to involve?
Members of the public – most have a view on what they think they will need if they are injured or ill.
Patients – have experience of using a service and are in a good position to give views on how a service could be improved.
Carers – often have a wide experience of health care – their own views may not be the same as those of the people they care for

17. How to find the right people to involve
Members of self-help and support groups – should have collective knowledge and experience of a range of services – may be in a good position to represent the views held by patients
User groups – may focus on a hospital, service or condition, e.g. a patient participation group attached to a GP surgery – could be active in developing local services and policies
Representatives – are people who are in a position to speak on behalf of other service users, the views they share are the views of the people they are representing, which may not be the same as their own.

18. How to involve people who are ‘easy to overlook’
Hard to reach, seldom heard, vulnerable groups – phrases used to describe people who are ‘easy to overlook’
The reality is:
These people do not live in groups or communities
Some people are harder to reach and may require more time, money and effort
Councils and public health departments seem to have different ways of categorising the people they provide services for

19. How to make better decisions
Whatever the scale of the change have clear processes for taking decisions at the start of the involvement activity
Decision-making processes should aim to be open and transparent
Users should be told how decisions will be reached and how their views and opinions will be used

20. Techniques The involvement continuum Use a range of techniques
• Choosing techniques

21. The involvement continuum

22. Use a range of techniques
Be clear what level of involvement is required. Carefully think through what you need to do. Do you need to:
Give information?
Get information?
Hold forums for debate or participation?
Do not be tempted to always use the same technique, e.g. a focus group, and remember to be clear who you need to involve – it is not necessary to consult everyone each time you undertake an involvement activity

23. Choosing techniques

24. Working with
People who work in the NHS
LINks
Partners

25. Working with people who work in the NHS
Good practice to involve staff and others working in the NHS
Only obligation under s242 is to involve users directly or through representatives
Many people will be key partners, e.g. GPs, hospital consultants, nursing staff
You need to have clinical support and leadership for all major changes
Important for staff to understand the different ways in which they might be involved. e.g. in their professional capacity, as a user or a representative of users

26. Working with LINks
Local Involvement Networks (LINks) bring together local people, organisations and groups that want to improve health and social care services in their area.
Are an important source of information that is valuable to organisations in helping them commission and provide services.
Commissioners are expected to create a range of opportunities to involve users throughout the commissioning cycle.
Working with the LINk is one way of obtaining users’ views but should not be seen as the only way.

27. Working with partners
Users are not usually aware of the boundaries and distinctions between different providers.
May help to achieve better outcomes from involvement activity.
Local authorities have a complementary best value duty of involvement
Not a requirement under s242
NHS organisations and local authorities should share information about the needs and preferences of their local population

28. Commissioning • Involving users in commissioning.
• Involving users in specific commissioning situations.
• User involvement in practice-based commissioning.

29. Involving users in commissioning and contracting
Assess need – fact finding
Reviewing current service
Decide priorities
Get information – from local communities, users and local interest groups, health professionals, vol. orgs and LINks.
Give information – on what you have been told to deliver and why
Get information and hold forums for debate – to get feedback and gather experiences.
Hold forums for debate – to develop criteria and agree local priorities
Participation – consider setting up a service reference group to scrutinise the process.

30. Involving users in commissioning and contracting
Re/design service
Shape of structure of supply
Give information – keep people involved along the way.
Hold forums for debate – find out people’s priorities and preferences
Participation – hold co-design events and involve specialist teams.
Participation – consider using a service reference group to involve users in the development of service specifications.

31. Involving users in commissioning and contracting
Manage demand – ongoing monitoring
Managing performance
Get information on patients’ experiences, including those who are ‘easy to overlook’.
Participation – involve users in setting local standards
Get information – use feedback from PALS, complaints, LINks.

32. Specific commissioning situations when 242(1B) applies
S242 applies to PCTs for which the 10 specialised commissioning groups (SCGs) act as formal joint committees in commissioning specialised services across the area of the PCT.
Each PCT that is a member of an SCG retains responsibility for its statutory functions - which include the duty to involve.
S242 applies to any SHA that commissions services – currently London SHA is responsible for all nationally commissioned services.

33. User involvement in practice-based commissioning
Section 242(1B) does not place an obligation to involve on practice-based commissioners (PbCs)
The obligation remains with the PCT
PbCs should be encouraged to actively involve their practice populations when they are making plans to change the way services are delivered
Patient participation groups are one way for PbCs to involve local people
PCTs can make arrangements for PbCs to undertake involvement activity – but must be satisfied the arrangements meet their legal obligation

34. The new duty to report on consultation
Sections 17A and 24A of the NHS Act 2006 introduce a new duty for SHAs and PCTs
SHAs and PCTs have an obligation to prepare reports on consultations they have carried out that relate to any commissioning decisions
Content of reports set out in directions
First reports will cover period from 1 April 2009 to
31 March 2010 and then annually

35. Thank you
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