Corporate report

IRP annual business review 2020 to 2021

Published 10 June 2021

Applies to England

1. Chair’s foreword

2020 to 2021 has, of course, been dominated by Covid-19. The virus has impacted globally and, at the time of writing, continues to maintain a strong grip in many parts of the world. In this country, there are early signs that we are turning the corner and I pay tribute both to the NHS staff who have worked tirelessly throughout the last year and to those who have developed the vaccines that will provide the solution.

The pandemic has had a substantial impact on the Panel’s workload in the last year. As the number of Covid-19 patients grew rapidly, much planned work was necessarily placed on hold as NHS organisations were required to respond at speed to adapt facilities and practices. The 2013 regulations permit changes to be made to services without consultation where there is a risk to safety or welfare. While such changes are generally considered to be temporary, the Panel is aware that some have provided evidence of successful change that could be implemented permanently. As we gradually return to a more normal way of life, further local engagement and consultation will be required in these cases.

The reporting year ended with publication of the Government White Paper, Integration and innovation: working together to improve health and social care for all. The White Paper announced the intention to remove the local authority power to report (refer) contested proposals for reconfiguration to the Secretary of State. It follows that any future role for an expert panel advising on NHS service change will likely differ from the Panel’s current terms of reference. The White Paper has yet to be worked up into a draft bill and we do not know the timetable for the bill’s passage through parliament. We will watch progress with interest. In the meantime, we stand ready to offer advice on any referrals submitted to the Secretary of State while the current legislation remains in place.

The Panel can be proud of its record having, since its establishment in 2003, successfully offered advice on more than 80 referrals to Secretaries of State of various political persuasions, along with informal advice to organisations and interested parties the length and breadth of England. I have no doubt that the Panel has been a force for good and am pleased to see that the lessons learned from the Panel’s work will be used to inform the next stages in developing NHS service change policy and implementation. Learning from our work has been encapsulated in a separate report on insight from the work of the IRP.

Professor Sir Norman Williams
IRP Chair

2. Introduction

The Independent Reconfiguration Panel (IRP) is the independent expert on NHS service change. The Panel advises ministers on proposals for NHS service change in England that have been contested locally and referred to the Secretary of State. It also offers support and generic advice to the NHS, local authorities and other interested bodies involved in NHS service reconfiguration.

Established in 2003, the IRP is an advisory non-departmental public body. It comprises a chairman and membership of experienced clinicians, managers and lay representatives who have wide-ranging expertise in clinical healthcare, NHS management, involving the public and patients, and handling and delivering successful changes to the NHS. The Panel membership and our general terms of reference are published on our website.

3. The Panel’s formal role in advising ministers

The current regulations governing local authority health scrutiny and the power to refer proposals for substantial developments or variations to health services came into force on 1 April 2013.

The Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013 require NHS organisations to consult local authorities on any proposals under consideration for substantial changes to local health services. If the authority is not satisfied that:

• consultation has been adequate in relation to content or time allowed
• the reasons given for not carrying out consultation are adequate
• the proposal would be in the interests of the health service in its area

it may report the matter to the Secretary of State for Health. The Secretary of State may then ask the IRP for advice.

The 2013 Regulations supersede the Local Authority (Overview and Scrutiny Committee Health Scrutiny Regulations Functions) Regulations 2002.

Since July 2010, NHS organisations involved in service change have also been required to assess proposals against four tests intended to demonstrate:

• strong public and patient engagement
• consistency with current and prospective need for patient choice
• a clear clinical evidence base
• support for proposals from clinical commissioners

In offering advice to the Secretary of State, the Panel is also mindful of the additional test introduced by NHS England from 1 April 2017 that requires local NHS organisations to show that significant hospital bed closures subject to the current formal public consultation tests can meet one of three new conditions before NHS England will approve them to go ahead:

• demonstrate that sufficient alternative provision, such as increased GP or community services, is being put in place alongside or ahead of bed closures, and that the new workforce will be there to deliver it and/or
• show that specific new treatments or therapies, such as new anti-coagulation drugs used to treat strokes, will reduce specific categories of admissions or
• where a hospital has been using beds less efficiently than the national average, that it has a credible plan to improve performance without affecting patient care (for example in line with the Getting it Right First Time programme)

The IRP’s general terms of reference reflect these tests. All advice offered on referrals by the Panel is provided, on a case by case basis, in accordance with our terms of reference.

4. Commissioned advice on contested proposals submitted and published during 2020 to 2021

Advice was submitted and published on one contested proposal:

• Improving Healthcare Together 2020 – 2030, Epsom and St Helier

On 27 July 2020, Merton Council Healthier Communities and Older People Panel, referred to the Secretary of State the decision of a joint committee of clinical commissioning groups (CCGs) covering the London borough of Sutton, parts of Merton and Surrey Downs to locate a new specialist emergency care hospital in Sutton (Belmont) to be complemented by district hospital services at Epsom and St Helier together with the development of out of hospital services.

Referral was made on the grounds of inadequate consultation and that the decision was not in the interests of the health service in the local area. The IRP was asked by the Secretary of State to provide advice using documentation received from the scrutiny committee and the local NHS.

The Panel submitted its advice on 28 October 2020. It considered that the current pattern of services provided by Epsom and St Helier NHS Trust was neither sustainable nor desirable. Change is essential and requires significant new capital investment to provide appropriate buildings. The Panel found no reason to contradict the choice of Sutton (Belmont) as the location for the specialist emergency care hospital with complementary district hospital services at Epsom and St Helier along with the development of out of hospital services. The normal approvals process for major capital schemes should provide further scrutiny and assurance moving forward.

The Secretary of State for Health and Social Care accepted the IRP’s recommendations in full on 30 October 2020. The Panel’s advice to the Secretary of State on Epsom and St Helier University Hospitals NHS Trust is published on our website.

5. The Panel’s informal role in offering advice and support

The IRP was established to offer expert independent advice on proposals that have been contested and referred to the Secretary of State for a final decision. However, clearly it is in everyone’s interests that options for NHS change are developed with the help and support of local people and that, wherever possible, disagreements are resolved locally without recourse to ministers.

With this in mind, the Panel also provides ongoing support and generic advice to the NHS, local authorities and other interested bodies in the consideration of issues around reconfiguration.

5.1 Advice and support offered

During 2020 to 2021, various NHS bodies, local authorities and scrutiny committees, and other interested organisations approached the Panel for impartial advice on NHS reconfiguration and effective engagement and consultation with patients, local people and staff, including:

• NHS representative, health services in south west London
• local campaigner, health services in Dorset
• NHS representatives, health services in Devon
• local authority representatives, health services in Devon
• local campaigners, health services in Devon
• community representative, health services in community hospitals
• local campaigner, health services in Hertfordshire
• local campaigner, health services in Kent and Medway

Throughout these dialogues, the Panel has been mindful of the potential conflict of interest should a proposal for reconfiguration later be formally referred to the IRP. The advice offered is therefore always generic, rather than specific, in nature.

Feedback continues to be positive with those involved in reconfiguring NHS services welcoming the opportunity to talk through issues and to hear about good practice from other parts of the country. We are keen to see more NHS decision makers and those scrutinising those decisions draw on our advice and expertise.

6. Other work undertaken

In addition to its formal and informal advisory roles, the Panel has undertaken various other activities as outlined below.

6.1 Input to policy

The IRP has had a number of meetings and conversations with NHS England and NHS Improvement and Department of Health and Social Care officials to discuss:

• facilitating effective service change
• disseminating learning and good practice on service change
• revisions to guidance on the assurance process for service change

6.2 Links with other interested bodies and input into other organisations’ work

Throughout the year, the Panel has sought to develop relationships with a variety of organisations and bodies interested in the provision of NHS services, including the Centre for Public Scrutiny, the Nuffield Trust, the National Meeting of Chairs of Clinical Senates in England and NHS England and Improvement, including the co-production group for developing system-wide guidance on working in partnership with people and communities.

6.3 Continuous professional education

During the year, members were updated on issues affecting the Panel’s work including understanding approaches to reconfiguration, judicial review and, most notably, the impact of Covid-19 on service reconfiguration – both currently and looking ahead. Outgoing IRP members reflected on their experience in offering effective advice.

6.4 Disseminating our learning

The IRP continues to assist in disseminating good practice and helping localities to achieve successful service change.

IRP representatives have attended reconfiguration events to provide presentations on the IRP’s work, disseminate good practice and discuss service change issues. This included contributing to an expert panel on local authority health scrutiny subsequently published as an online learning resource on health scrutiny.

Slides used at an NHS England seminar have been published on the IRP website as part of the Panel’s Learning from Reviews series of publications. The presentation provides the latest distillation of the Panel’s learning and demonstrate that, while the context and circumstances of the NHS change over time, familiar themes persist. The slides have been reproduced as a report on insight from the work of the IRP.

6.5 Communications

The IRP website transferred to the Government Digital Service GOV.UK platform in autumn 2014. The website provides useful background information on the role of the IRP, its members and ways of working as well as links to the Panel’s formal advice.

Media support to the Panel is provided by Grayling International which offers media monitoring and advice on a time and materials basis. Following an invitation to tender for interested parties to submit applications for a new contract to take effect from 19 July 2018, Grayling was awarded a new contract that can be extended to a maximum of 19 July 2021. The contract has undergone assurance against, and is compliant with, the requirements of the General Data Protection Regulations. Options for providing a similar service beyond July 2021 will be considered with appropriate procurement advice taken.

6.6 IRP office accommodation and media support

The IRP has, for a number of years, shared office accommodation with, and as a sub-tenant of, the Professional Standards Authority (PSA). The two bodies occupy space on the sixth floor of 157 – 197 Buckingham Palace Road, London. The arrangement offers appropriate accommodation and value for money.

A new memorandum of terms of occupation (MOTO) between PSA and IRP was signed extending the MOTO to 31 October 2022.

7. IRP terms of reference and code of practice

The IRP terms of reference are reviewed annually and agreed by the Secretary of State.

Under the terms of their appointment, members agree to adhere to a code of practice and the Cabinet Office Code of Conduct of Board Members of Public Bodies. Members have also agreed a further policy on the use of social media in relation to IRP work. The IRP is an open and responsive body and all Panel advice and minutes of meetings are published on the website. However, the Panel also has to take account of the sensitivity of issues under consideration and requests for confidentiality. Members agree at all times to be mindful not to disclose official information without authority and to refrain from discussing the detail of IRP work via social media (or through any other activity).

8. Panel meetings and membership

The Panel convened five times in 2020 to 2021 – on 8 July, 9 September, 11 November 2020, 13 January and 10 March 2021. Approved minutes from the IRP are published and available on the IRP’s website.

The IRP recognises the government’s desire to refresh membership of its public bodies and to “test the market” periodically. Equally, there is a need for such bodies to maintain their organisational memory and not lose valuable learning from past work.

Panel recruitment exercises are undertaken by the Department of Health and Social Care and conducted in line with the Commissioner of Public Appointments code of practice and Cabinet Office guidelines. During the year, Shera Chok, Stephen D’Souza, Helen Thomson and John Wilderspin completed their terms of office and the Panel thanks them for their valuable contributions to its work. Irfan Chaudry (clinical), Tansi Harper (lay), Graham Jagger (lay), Nick Relph (managerial) and Michael Scott (managerial) were appointed to the Panel in autumn 2020. A recruitment exercise to fill current vacancies is underway.

9. Review of activity with departmental sponsors

9.1 Introduction

The Panel was established in 2003 to offer advice to ministers on contested proposals for NHS reconfiguration and service change. It has since expanded its role to offer advice and ongoing support to the NHS, local authorities and other interested parties on reconfiguration issues. In 2020/21, the following meetings took place between the IRP and DHSC.

Meeting with Minister of State for Health, 20 July, 15 September 2020:

Independent Reconfiguration Panel

• Professor Sir Norman Williams, Chair
• Richard Jeavons, Chief Executive

Department of Health and Social Care

• Edward Argar, Minister of State for Health

Video meetings with DHSC Acute Care and Quality and NHS Legislation Team officials, 2 November 2020, 29 January 2021 and 10 March 2021:

Independent Reconfiguration Panel

• Professor Sir Norman Williams, Chair
• Richard Jeavons, Chief Executive

Department of Health and Social Care

• William Vineall, Director Acute Care and Quality
• Helen Beazer, Branch Head, Acute Care and Provider Policy
• Jason Yiannikkou, Head of NHS Legislation Team

In year stocktakes with sponsor branch:

Independent Reconfiguration Panel

• Richard Jeavons, Chief Executive
• Martin Houghton, Secretary to the IRP

Department of Health and Social Care

• Amit Bose, Helen Beazer, Ceeleena Gordon, Paul Griffiths, Christine McGuire, DHSC Acute Care and Provider Policy

9.2 Relationship with the Department of Health and Social Care

The Independent Reconfiguration Panel is an independent body offering impartial expert advice. The 2015 triennial review confirmed that it should remain so. Its relationship with the Department reflects appropriately the principles set out in the Cabinet Office publication ‘Partnerships between departments and arm’s-length bodies: Code of Good Practice’ (February 2017).

Whilst maintaining its independence, advice offered by the IRP should continue to take account of developments in government policy for the NHS.

9.3 Advice provided on contested proposals

During the year, commissioned advice was submitted and published on one referral:

• Epsom and St Helier, southwest London and Surrey

All advice was delivered on time. The Secretary of State accepted the IRP’s advice in full on the Epsom and St Helier commission.

The Secretary of State had been grateful for the Panel’s advice

9.4 Informal advice

The Panel’s informal advisory role had been particularly busy with requests for assistance received from throughout the country. Feedback continues to confirm that the service is valued by those accessing it.

9.5 Other work undertaken

The IRP has assisted the Department and NHS England and NHS Improvement in furthering initiatives to enhance the reconfiguration process.

Following an open recruitment exercise, Irfan Chaudry, Tansi Harper, Graham Jagger, Nick Relph and Michael Scott were appointed to the Panel.

The media contract with Grayling International runs to July 2021. Discussions are taking place regarding an extension. The contract has undergone assurance against, and is compliant with, the requirements of the General Data Protection Regulations.

10. The Panel’s future workload

The Panel continues to enjoy good working relationships with its sponsor branch.

Action agreed: to maintain appropriate channels of communication to ensure (i) the ongoing review of the Panel’s workload whilst respecting its independence (ii) that the Panel is kept fully informed of developments in government policy

Feedback from areas where the IRP has provided formal advice continues to suggest that the Panel’s advice has been helpful in enabling service change to move forward for the benefit of patients and residents.

Action agreed: the Panel stands ready to offer advice on any referrals to the Secretary of State.

The pattern of IRP formal advice has changed to reflect the nature of referrals. While advice is more often now completed using documentary evidence, the Panel retains the option to undertake site visits and seek targeted oral evidence in providing its final advice to Secretary of State.

Action agreed: stakeholder response to be kept under review to ensure that Panel documentation and working methods remain fit for purpose

NHS bodies, local authorities and patient groups continue to seek the Panel’s informal advice.

Action agreed: to continue

The Panel’s Learning from Reviews publications continue to provide helpful advice to NHS bodies and local authorities which will help to shape the next stages of NHS service change policy development

Action agreed: IRP learning will continue to be disseminated through appropriate channels

The need to refresh Panel membership whilst retaining corporate memory is acknowledged. A recruitment exercise to fill current vacancies is underway. New member induction, continuous professional education and appraisal are important facets of maintaining membership capability.

Action agreed: appointments to be made in 2021 and the programme of continuous professional development to be maintained

The IRP website provides useful background information on the role of the IRP, its members and ways of working as well as links to the Panel’s formal advice.

Action agreed: function and content of the website to be kept under review

The IRP’s terms of reference and code of practice are subject to ongoing review to ensure fitness for purpose.

Action agreed: the IRP’s general and specific terms of reference and its code of practice to be kept under review. IRP documentation to be reviewed