Saturday, 24 January 2009

The NHS Duty to Involve (Section 242 of the Health and Social Care Act)

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.”
Section 242 of the consolidated NHS Act 2006 places a duty on NHS trusts, primary care trusts and strategic health authorities to make arrangements to involve patients and the public in service planning and operation, and in the development of proposals for changes.

This duty is supported by the guidance;

Real involvement: working with people to improve healthcare

(1) This section applies to—
(a) Strategic Health Authorities,
(b) Primary Care Trusts,
(c) NHS trusts, and
(d) NHS foundation trusts.

(2) Each body to which this section applies must make arrangements with a view to securing, as respects health services for which it is responsible, that persons to whom those services are being or may be provided are, directly or through representatives, involved in and consulted on—
(a) the planning of the provision of those services,
(b) the development and consideration of proposals for changes in the way those services are provided, and
(c) decisions to be made by that body affecting the operation of those services.
(3) For the purposes of this section a body is responsible for health services—
(a) if the body provides or will provide those services to individuals, or
(b) if another person provides, or will provide, those services to individuals

(i) at that body’s direction,
(ii) on its behalf, or
(iii) in accordance with an agreement or arrangements made by that body with that other person,
and references in this section to the provision of services include references to the provision of services jointly with another person.
(4) Subsection (5) applies to health services for which a Strategic Health Authority is not responsible by virtue of subsection (3), but which are or will be provided to individuals in the area of the Strategic Health Authority, and for which—
(a) a Primary Care Trust any part of whose area falls within the Strategic Health Authority’s area, or
(b) an NHS trust which provides services at or from a hospital or other establishment or facility which falls within the Strategic Health Authority’s area,
is responsible by virtue of subsection (3).
(5) A Strategic Health Authority may give directions to Primary Care Trusts falling within paragraph (a) of subsection (4), and NHS trusts falling within paragraph (b) of that subsection, as to the arrangements which they are to make under subsection (2) in relation to health services to which this subsection applies.

Patients to get more say in NHS services
Thursday 30 October 2008 16:33 Department of Health (National)

The Department of Health today urged Primary Care Trusts (PCTs) to engage better with patients and the public in developing plans and making decisions about local health services.
New guidance, published today, will help the public have more say in decisions made by their PCT, enabling them to shape local health services.
The strengthened 'Duty to Involve' guidance will also make feedback on public consultations more transparent and accessible.
This follows on from Lord Darzi's review of the NHS earlier this year in which he recommended that any changes to NHS services should be transparent, locally-led and for the benefit of patients.
Today's guidance 'Real Involvement' is being issued to help PCTs and other NHS organisations understand changes to the Duty, and also to offer practical advice on how to put local people at the heart of service changes.
Increased patient involvement will enable local NHS organisations to put patients' wishes first and give staff the freedom to respond and deliver safer, more personalised care. Developing NHS services in partnership with the public and staff plays an important role in creating a modern NHS which meets the changing needs of the population both nationally and locally.

Health Minister Ann Keen said,

"Feedback from patients is one of the most powerful tools available to the NHS to help improve services which is why the Duty to Involve has been strengthened. The NHS is a public service so it is only right that the public should have their say on how the service is shaped.
"Helping local NHS organisations to understand and act upon the Duty is essential to making the most of this feedback which is why we have produced this guidance to help them involve patients effectively."

The new Duty to Involve is also expected to be included in the NHS Constitution due to come into force next year. The Duty will take effect next month but will be included as one of the existing rights set out in the Constitution - to make it easy for patients to find all their rights in one place. The Duty is one of several ways the public can have their say on NHS services including Local Involvement Networks, the Patient Liaison Service and complaints channels and feedback is always encouraged to make sure services are meeting patients' needs.
The guidance will be published on the Department of Health website and letters will be sent to chief executives across the NHS to raise awareness of the changes to the Duty. Materials such as leaflets and presentations will also be provided to help spread the guidance through local NHS organisations and regional briefings will be provided to help with understanding and implementing the guidance.
Notes to editors: 1. For further information please contact the Department of Health press office on 020 7210 5221 2. The Duty to involve was first introduced in 2003 in response to members of the public who were interested in having more say over their local NHS. 3. 'Real Involvement' can be downloaded from : 4. The strengthened Duty to Involve came from the Local Government and Public Involvement in Health Act 2007 5. Case studies of best practice in the Duty to Involve are available on request

Misconceptions about ‘involvement’

- 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 a 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

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.

Specific commissioning situations

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.

makes it clear to patients that they have a legal right to be involved in planning and developing services provided by the NHS.

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