This site is intended for health professionals only

Lack of consultation over community services shake-up is a scandal

By Ian Quinn

A study of Government websites in the UK reveals there are no less than 47 official departments or quangos with ongoing consultations at the moment

The consultations range from the ins and outs of redesigning the market stalls at Covent Garden, to the beak-trimming policy towards laying hens.

There is virtually nothing that has not, is not or will not be consulted upon, it seems - except, that is, when it comes to things that really matter, such as the fate of the NHS' community services.

The way that trusts are pushing ahead with this rushed scrapping of PCT provider arms, having been specifically told by ministers that there is no need for consultation of any kind with the public, appears nothing short of scandalous.

A document released by NHS North West last year noted there was ‘no legal requirement or mandated requirement by the Secretary of State for formal public consultation in relation to Transforming Community Services (TCS) and PCTs should note that formal public consultation should normally only be considered as an option where there is a major change in service.'

Well, what constitutes a major change, if not vast number of services being transferred to acute trusts, the private sector taking control of PCT-run walk in centres, district nurses shifting to hospital control and care for patients with long-term conditions going to mental health trusts?

Examples of all these were found in this week's Pulse investigation into the shake-up, which incidentally uncovered a terrifyingly blasé approach from trusts to the process.

When asked to provide details of its proposals, one trust, which shall remain nameless (safe to say that large chunks of its Duchy are owed by the Prince of Wales and it is a great place for surfing), replied: ‘We have put forward potential options on TCS and these have been supported by the SHA but there are no specific proposals at present.'

Pressed on the matter it admitted that all the discussions to date had taken place in secret.

So, in other words, the trust has privately decided upon the fate of community services, had a chat with the SHA which has given it the nod and then, and only then, will it come up with formal proposals, which will of course not be subject to any formal consultation and doubtless will be rubber-stamped when the time finally comes from them to be aired in public.

Well that's OK then.

In fairness, the area in question is not likely to be one of the more severe examples of the way this process is shifting responsibility for community services away from primary care.

In areas such as London, Birmingham and Manchester however, acute trust are being handed control over vast numbers of services, potentially leading to them being swallowed in the vast black hole of foundation trust budgets. All of this without a scrap of public consultation, and least of all any consultation with GPs.

Some trusts have been at pains to report they are liaising with unions, such as the BMA and UNISON, and the staff who face coming under new management. But this is all surely based around fears they may breach TUPE regulations, rather than consultation in its truest sense.

After all, if they had listened to what NHS trade unions thought, the process would never have gone ahead in the first place - as they always feared it would lead to increased use of the private sector to deliver public services and much greater power being handed to acute trusts.

Pulse news editor By Ian Quinn Pulse news editor By Ian Quinn