{"id":23891,"date":"2013-01-21T17:34:49","date_gmt":"2013-01-21T16:34:49","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=23891"},"modified":"2013-01-21T17:39:20","modified_gmt":"2013-01-21T16:39:20","slug":"candace-imison-will-2013-be-the-year-of-meaningful-public-engagement-with-service-change","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2013\/01\/21\/candace-imison-will-2013-be-the-year-of-meaningful-public-engagement-with-service-change\/","title":{"rendered":"Candace Imison: Will 2013 be the year of meaningful public engagement with service change?"},"content":{"rendered":"

\"candace_imison\"<\/a>The Royal College of Surgeons (RCS)<\/a> is the latest to join the growing chorus of medical colleges calling for change in hospital services with RCS President Professor Williams\u2019s statement<\/a> launching their new report: “2013 needs to be the year patients, politicians, clinicians, and managers come together to support historic change in the NHS and create a lasting legacy for all of our population.”<\/p>\n

This follows statements from the Royal College of Physicians<\/a>\u2014”we must radically review the organisation of hospital care”\u2014and the Academy of Medical Royal Colleges<\/a>, which, in their call for a shift to seven day consultant care, also argued that services will need to be reconfigured onto fewer sites. All the colleges cite the need to adapt services to reflect advances in medicine and technology and the changing needs of patients, and therefore to drive up quality\u2014arguments that have been made for decades.<\/p>\n

So what is different about the RCS report? While arguing the clinical case for change, it also argues for meaningful engagement with the public on service change. Distinctively, the foreword to the report is written, not by the president of the college, but by the lay chair, Susan Woodward, who sets out the case for meaningful public and patient engagement. The tone of the RCS paper is a world away from the seminal paper Organisation of acute general hospital services<\/em> produced by the Joint Consultants Committee (JCC) in 1999. In this the JCC pronounce “It is important for the public to recognise that it is not possible for each locality to have its own small hospital to provide anything other than a restricted service.”<\/p>\n

What flows from the RCS\u2019s greater focus on the needs of patients seems to be an openness to try to find “win-win” solutions or, at the very least, a means of mitigating the potential downsides for patients that may come from service change. For example, they propose the development of surgical clinical networks, supported by telemedicine and other technological support, with surgeons working across multiple sites. They also propose strengthened ambulance services with additional training for paramedics, allowing a model of care in rural areas in which patients would be triaged so that only those needing specialist care would have to travel long distances. The RCS also addresses some of patients\u2019 key concerns by arguing that transport issues need to be central to any planning process; that consultation should be genuine and not tick box; and that any service change should be monitored and evaluated.<\/p>\n

This should be music to the ears of the Independent Reconfiguration Panel (IPR), who are charged with reviewing contested proposals for NHS service change, as this closely aligns to their “critical list” of key lessons learnt<\/a>. This includes:<\/p>\n