briefing October 2013

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1 briefing Octber 2013 Recnfiguring services: when must NHS bdies cnsult the public? Hw d they g abut ding it? And hw can they prtect themselves frm legal challenge? As the squeeze n public funding cntinues, cmmissiners have difficult decisins t make abut services - which t cntinue, which t cmmissin, and which t stp. Service users and prviders are mre inclined than ever befre t take a case t curt t try t stp r reverse decisins t change r decmmissin services. Prviders attempting t recnfigure services face the same challenges. Intrductin...2 The legal duty t cnsult...3 Guidance...3 What happens if yu fail t cnsult?...5 Are there sme types f decisins where we d nt have t cnsult?...5 The timing f a cnsultatin...6 Recrd keeping...6 What des a cnsultatin actually invlve?...7 Lcal authrity scrutiny...7 Public sectr equality duty (PSED)...7 Lessns learned frm recent cases...8 Ten rules fr an effective, lawful cnsultatin prcess...9 Get in tuch...10 Useful links...10 Resurces...10 Legislatin...10

2 Intrductin The law requires cmmissiners (and prviders) t invlve the public when making changes t the prvisin f NHS healthcare. NHS bdies discharge this duty by carrying ut cnsultatins. This is an area fraught with difficulty and the ptential fr legal challenge. There have been numerus reprted cases in the last three years, where cmmissiners and ther public bdies have faced a judicial review brught by individuals r grups angered by service changes. Nt all f these have been NHS related sme, fr example, relate t cuts in library services. Readers in the NHS may particularly recall the fllwing cases already in 2013: R (n the applicatin f Save ur Surgery Ltd) v Jint Cmmittee f Primary Care Trusts relating t specialist centres fr paediatric cardiac surgery R (n the applicatin f Cpsn) v Drset Healthcare University NHS Fundatin Trust relating t Mental Health Urgent Care Services recnfiguratin R (n the applicatin f Lewisham LBC and Save Lewisham Hspital Campaign Limited) v Secretary f State fr Health (and thers) relating t the Trust Special Administratr appinted t Suth Lndn Hspital Each case ver the past few years has helped t prvide guidance n what invlving the public really means. The brader tpic is gaining prminence as the gvernment is cncerned abut the numbers f judicial reviews generally (nt just relating t health). A Ministry f Justice cnsultatin has just been launched by Chris Grayling. Grayling said: We want t make sure judicial review cntinues its crucial rle in hlding authrities and thers t accunt, but als that it is used fr the right reasns and is nt abused by peple t cause vexatius delays r t generate publicity fr themselves at the expense f rdinary taxpayers. The cnsultatin prpses changing the rules arund wh has t pay the legal bills fr cases s all parties have an equal interest in cutting csts. This culd include making applicants wh bring unsuccessful cases pay sme f the defendant s bill. Legal aid funding will be targeted at cases with merit, althugh there is little detail in hw these cases wuld be selected. The appeals prcess culd als be changed s it is pssible fr them t be cnsidered by the Supreme Curt withut first ging t the Curt f Appeal. Briefing This briefing is nt an academic review f the case law. That wuld nt assist hard pressed cmmissiners trying t ensure that a cntrversial service redesign is prperly administered. This dcument draws ut the central principles frm the case law and frm published guidance, setting ut the grund rules fr a lawful cnsultatin and pinting ut the elephant traps t avid. Service changes are always likely t be cntrversial and even the best run cnsultatin will nt prevent that. Scial media can quickly whip up a strm and lcal pliticians ften find there are vtes in prclaiming their utrage abut prpsed changes. Hwever, a well run cnsultatin will d fur things: It will ensure that yur decisins are as well infrmed as pssible. The whle pint f cnsulting the public (ie, thse wh will use the services yu cmmissin) is t ensure that yu make better cmmissining decisins. It will reduce the prspect f a legal challenge (which, even if yu fight it ff, will be cstly in time, mney and reputatin). cnsultatins briefing ctber

3 It will reduce the pr publicity that can ften accmpany decisins t reduce r even just t alter a particular service. It will give yu the best chance f winning if yur decisin is challenged in the curts. Belw, we aim t help yu achieve each f these bjectives. The legal duty t cnsult The law requires NHS bdies t engage with members f the public befre making decisins n changes t health services. Currently, separate sectins f the NHS Act apply t CCGs and t ther rganisatins. CCGs are gverned by sectin 14Z2 f the NHS Act 2006, which states: (1) This sectin applies in relatin t any health services which are, r are t be, prvided pursuant t arrangements made by a clinical cmmissining grup in the exercise f its functins ( cmmissining arrangements ). (2) The clinical cmmissining grup must make arrangements t secure that individuals t whm the services are being r may be prvided are invlved (whether by being cnsulted r prvided with infrmatin r in ther ways): (a) in the planning f the cmmissining arrangements by the grup, (b) in the develpment and cnsideratin f prpsals by the grup fr changes in the cmmissining arrangements where the implementatin f the prpsals wuld have an impact n the manner in which the services are delivered t the individuals r the range f health services available t them, and (c) in decisins f the grup affecting the peratin f the cmmissining arrangements where the implementatin f the decisins wuld (if made) have such an impact. There are tw ther relevant aspects t sectin 14Z2. Subsectin 3 requires all CCGs t include in their cnstitutin a descriptin f their public engagement arrangements and a statement f the principles that they will fllw in when implementing them. Subsectin 4 empwers NHS England t publish guidance n cmpliance with this sectin, which CCGs must have regard t. This was published in September 2013 see belw fr mre details. Sectin 13Q f the Act applies t NHS England and cntains effectively identical prvisins t sectin 14Z2. Sectin 242 f the Act cntains the same bligatins fr NHS Trusts and Fundatin Trusts. Any NHS bdy cnsidering changing the services it cmmissins r prvides must be aware f the bligatins discussed in this nte. In summary, any significant cmmissining decisin r recnfiguratin will be caught by these statutry requirements. Yu will nte that the statute des nt insist n cnsultatin, but seeks t make sure that service users are invlved. In practice, fr any significant prpsed change t services, sme frm f cnsultatin exercise will be required t cmply with this duty. Guidance The mst recent guidance n cnsultatins fr the NHS was published in September 2013 by NHS England, and is called Transfrming Participatin in Health and Care. Transfrming Participatin des nt expressly replace the 2008 Department f Health dcument, Real invlvement: wrking with peple t imprve services, but clearly cmmissiners shuld fcus n it as the mst recent guidance and the dcument that they have a statutry respnsibility t take int accunt. The Natinal Directr f Patients and Infrmatin at NHS England cmments in the guidance that We must put every citizen and patient vice abslutely at the heart f every decisin we take in purchasing, cmmissining and prviding services. There is a clear fcus n maximizing the participatin f patients and the public. cnsultatins briefing ctber

4 The sectin mst relevant t yur cnsultatin bligatins - public participatin - begins at page 29, and the Hw? t effect public participatin can be fund at pages This guidance includes a number f specific tls designed t aid cmmissiners in their cnsultatin, including the Ladder f Engagement and Participatin. This sets ut different levels f participatin which may be apprpriate when invlving the public in decisins abut healthcare. There is als a Engagement Cycle, setting ut key pints in the cmmissining cycle fr public participatin. The guidance then sets ut a number f suggested features f public participatin. The infrmatin prvided shuld be f gd quality, and in a number f different frmats t ensure that it reaches the intended target. There shuld be a range f pprtunities fr participatin, which culd include nline surveys and dedicated lcal events, as well as wrk thrugh vluntary and cmmunity sectr rganisatins. Patients and the public shuld be invlved frm the initial planning stages f service redesign, and special effrts shuld be made t reach ut t diverse cmmunities. The guidance ges n t suggest an eight pint actin plan fr cmmissiners, setting ut the steps which ideally shuld be taken in rder t invlve patients and the public. These include identifying expertise in participatin within yur wn rganisatin and making best use f it, wrking with health and wellbeing bards n shared appraches with cmmunities, as well as develping a jint apprach with lcal authrities, lcal Healthwatch, vluntary grups and ther rganisatins with existing relatinships with the lcal cmmunity. It als suggests that cmmissiners seek feedback thrugh the CCG assurance prcess as t the efficacy f wrk t ensure public participatin. This actin plan can be fund at page 35. While we wuld advise all NHS staff invlved in service redesign t be familiar with the actin plan, we wuld strngly advise yu t take int accunt ur ten rules at the end f this dcument. These are mre f a practical hw t guide than the higher level plicy guidance prvided by the actin plan. The guidance als cmmits NHS England t prvide practical supprt t cmmissiners, and this is detailed n pages Such supprt includes, but is nt limited t, nline resurces, natinal excellence award schemes, a digital participatin space allwing anyne t start r jin in a cnversatin abut health and care as well as a learning netwrk. The 2008 guidance is nw clearly quite dated and superseded by the NHS England guidance. Hwever, it is still recmmended that staff invlved in service redesign are familiar with it, as it des cntain sme useful principles. We wuld particularly draw yur attentin t the fllwing sectins f the Real invlvement dcument: What invlvement really means pages Wh shuld be invlved pages 21, & What is invlvement pages 21 & When shuld users be invlved pages As well as the 2008 and 2013 guidance, NHS bdies shuld be aware f the Cabinet Office Cnsultatin Principles, published n 17 July This is aimed at Gvernment departments and ther public bdies it is mre a set f general principles than detailed guidance. It replaced the 2008 Cabinet Office Guidance. It states that the gverning principle is prprtinality f the type and scale f cnsultatin t the ptential impacts f the prpsal r decisin being taken. NHS rganisatins shuld als ensure that they d nt frget Andrew Lansley s fur tests. A lt f water has flwed under the bridge since they were first set ut in May Their cntinued relevance and significance was highlighted in the recent judicial review cncerning prpsed service reductins at Lewisham Hspital. T recap, prpsed recnfiguratins must meet the fllwing requirements: 1. Supprt frm GP Cmmissiners. 2. Strengthened public and patient engagement (including with lcal authrities). cnsultatins briefing ctber

5 3. Clarity n the clinical evidence base underpinning prpsals. 4. Cnsistency with current and prspective patient chice. Where the prpsed recnfiguratin is being led by a CCG, the first test shuld be easily met, althugh interesting issues may arise where member practices (r individual GPs) bject t a prpsal made by the gverning bdy. The imprtance f engagement with lcal authrities is dealt with belw, and is nly underlined by the secnd f the fur tests. As set ut abve, peple affected by changes t services are increasingly willing t challenge the decisins f NHS bdies. Becming familiar with the relevant guidance and putting it int practice will maximise yur chances f aviding such challenges. What happens if yu fail t cnsult? The cnsequences f failing t cmply with the requirement t invlve the public can be severe. NHS rganisatins can face legal challenges frm several different directins. Individual service users, grups f service users and current prviders wh risk lsing ut when a service is changed, can all bring a judicial review. It is n defence t pint ut t a judge that the decisin yu tk was plainly the best ne. A judicial review is cncerned with the prcess by which a decisin was reached. If a public bdy des nt cmply with its legal bligatins when planning and implementing service changes, the curt is likely t strike its decisins dwn, whatever the merits f thse decisins might have been. Injunctins can be sught as part f the curt prcess t stp the public bdy frm implementing its intended changes befre the curt case is decided. At the end f the curt prcess, when making its final ruling, a curt cannt usually substitute its wn decisin fr that f the public bdy, but it can refer the decisin back t be recnsidered. All f this takes time ften many mnths and will hld up plans yu may have wished t implement. Defending a judicial review is a cstly prcess. Judicial reviews have several stages. They invlve a great deal f paperwrk and ften several separate curt hearings. The internal csts in time and distractin and the external csts in legal fees are significant. The publicity is ften damaging. If a judicial review is lst, the NHS bdy is likely t have t pay sme r all f the claimant s csts as well as its wn. If the NHS bdy wins, it is unlikely t recver much f its wn legal csts frm a claimant wh may well be in receipt f public funding frm the Legal Aid Agency. Are there sme types f decisins where we d nt have t cnsult? Yu shuld apply a sense f prprtin (remembering the 2012 Cabinet Office guidance). A public cnsultatin is nt needed fr every minr r temprary change in the way a hspital functins r cmmunity health services are prvided. Hwever, any prpsal that will lead t a significant change in the way that lcal health services will be prvided shuld be cnsulted n. The law is clear that this applies even t changes that are temprary r are driven by clinical cncerns. Nt every change requires a full 12-week cnsultatin. If yu expect t be challenged, hwever, yu shuld cnsider btaining legal advice befre deciding t adpt a mre truncated prcess. Care shuld be taken ver fixed term cntracts. Simply because a cntract has a fixed end-date and makes n prvisin fr extending r renewing the agreement, it des nt fllw that an NHS bdy can simply let the cntract expire and allw the particular service t stp. If ding this wuld affect the way in which services are delivered, r the range f services that are available, the duty t cnsult will apply. What abut changes that implement gvernment plicy? Public invlvement, ie, sme frm f cnsultatin, is still required. The curts have ruled that even where a cmmissiner was simply implementing Department f Health plicy, the prvisin f services was still the cmmissiner s respnsibility and therefre it had an bligatin t cnsult. cnsultatins briefing ctber

6 The rule is this: if a cmmissiner r prvider will be making significant changes t hw services are prvided, even if it is ding s because it is bliged t d s by external pressures, it is the cmmissiners bligatin t carry ut a cnsultatin. The timing f a cnsultatin Cnsultatins shuld begin when prpsals are still at a frmative stage. Remember, the NHS Act requires yu t invlve the public in the develpment and cnsideratin f prpsals. What des that actually mean? If a CCG is cnsidering whether t cntinue cmmissining a particular service, d they have t invlve the public frm the very first meeting when this issue is discussed? In shrt, n. Yu d nt have t begin yur cnsultatins at such an early stage. Once yu have cnsidered what ptins are pen t yu and yu are ging t start lking at thse ptins in mre detail, that is the time t start cnsulting. By ding s at an early stage, yu are cnsulting n the develpment and cnsideratin f the prpsals yu are lking at. Real invlvement is helpful n this issue. It states, page 22: Users must be invlved nt nly in the cnsideratin f prpsals t change services, but als in the develpment f any prpsal that will change the manner in which a health service is prvided r the range f services ffered. Fr example, users must be invlved in the develpment f a range f ptins fr the way cmmunity services culd be prvided within a PCT [r nw a CCG] area, nt just asked fr their pinin n a mdel that has been develped behind clsed drs by health prfessinals and managers. Imprtantly, the curts are clear that public bdies are entitled t have identified their preferred ptin befre cnsulting. S lng as the cnsultatin is carried ut with a genuinely pen mind and the cmmissiner takes everything it learns frm that exercise int accunt befre making its final decisin, having an initial preferred ptin is nt a prblem. Recrd keeping This is a gd pint at which t emphasise the imprtance f thrugh recrd keeping and the need t be careful abut the language yu use in yur recrds. This applies nt just in the realms f cnsultatin f curse! Remember that if a cmmissining decisin is challenged in the curts, the curt will lk at hw the decisin was taken, nt at the merit f the decisin. Yur paperwrk is likely t be disclsable, if nt under the Freedm f Infrmatin Act, then as part f the curt disclsure prcess. Staff shuld wrk n the basis that there is n such thing as an internal, private . A thrwaway remark that suggests a decisin t clse a service has already been taken but that a cnsultatin has t be dne s the legalities are cmplied with culd undermine the whle prcess and result in a curt rder t red the whle exercise and take a fresh decisin. The cnsultatin paperwrk itself and all minutes f meetings shuld be reviewed with particular care befre they are finalised. It is very easy fr the language t imply that the final decisin has already been taken and that the cnsultatin is mere windw-dressing. Fr example: Dn t say: We have put in place arrangements with anther prvider which will mitigate the impact n service users f the clsure f the service X. D say: We have discussed with anther prvider what services they culd ffer service users in the event f a decisin t clse service X. They have cnfirmed that they wuld be able t prvide supprt that wuld mitigate the impact f such a clsure. This is nt Mills & Reeve being unnecessarily cautius. Our experience is that if cmmissiners are subject t legal challenge, every line f every dcument will be gne thrugh with care by lawyers acting fr the Applicant. Any lse language risks be used as the basis f an argument that the cnsultatin was a sham. Even if a judge rejects such an argument at curt, ne lse remark may be the reasn that a case gets all the way t a final curt hearing. cnsultatins briefing ctber

7 What des a cnsultatin actually invlve? Real invlvement and the curts are clear that there is n set frm fr a cnsultatin. It is fr the NHS bdy undertaking the cnsultatin t decide which frm it will adpt. What matters is that clear infrmatin is given t the public; that they are able t respnd; and that their respnses are taken int accunt when making the final decisin. Typical methds f cnsultatin wuld include: Public meetings Writing t all affected service users and their families/carers Pster campaigns in NHS buildings Infrmatin in the lcal media In shrt, the greater the impact f prpsed changes and the mre peple they are likely t affect, the mre detailed and cmprehensive the public invlvement will have t be. Lcal authrity scrutiny New regulatins gverning lcal authrity scrutiny f health services are nw in frce, namely the Lcal Authrity (Public Health, Health and Wellbeing Bards and Health Scrutiny) Regulatins Lcal authrities are n lnger required t have a Health Overview and Scrutiny Cmmittee as the means by which they discharge their scrutiny functin, althugh in practice mst have retained them. The key pints t nte are these: Under Regulatin 23, NHS England, CCGs, public and independent sectr prviders f NHS services must cnsult with the lcal authrity abut any prpsals fr a substantial develpment r variatin f the health service in the authrity s area. Substantial is nt defined. We wuld advise cmmissiners t be cautius abut nt mentining a prpsed change t a lcal authrity n the basis that it is nt substantial. If yu are prpsing t cnsult, yu shuld tell the authrity. If the lcal authrity ultimately disagrees with the decisin f the NHS bdy, it is entitled t refer the matter up t the Secretary f State fr a final decisin. Cmmissiners shuld ensure that they have gd channels f cmmunicatin with their lcal authrity, and that its members are kept infrmed f prpsed changes. Public sectr equality duty (PSED) This duty applies when the NHS is exercising any f its functins. It particularly applies where an NHS bdy is prpsing plicy changes that will have an effect n a large number f patients wh are in grups which have a prtected characteristic. NHS bdies must have due regard t the need t: Remve r minimise the disadvantage suffered by persns wh share relevant prtected characteristics (such as race, age, disability, r sexual rientatin) Take steps t meet the needs f thse wh share such characteristics Encurage participatin f thse wh share such characteristics This duty t have regard t these needs must be met befre r at the time any plicy is being cnsidered. Curts talk f it being an essential preliminary and nt a rearguard actin. Imprtantly, the public bdy des nt have t achieve these needs. This might be impssible given cmpeting pressures (such as the need t reduce services t break even). The weight t be given t cuntervailing factrs is a matter fr a public bdy and nt a curt unless the assessment is unreasnable r irratinal. cnsultatins briefing ctber

8 What matters is that the public bdy can demnstrate that it paid due regard t these needs. The due regard has t be with rigur and an pen mind but if that is dne then the PSED is nt a back dr by which challenges t the merits f decisins may be made. What this means in practice is that NHS cmmissiners need t fully understand the likely impact f any prpsed changes t lcal NHS services n disabled peple, the elderly, racial minrities r any ther grup that has a prtected characteristic under the Equality Act. Althugh nt a requirement under the Act it will be helpful t undertake a prper Equality Impact Assessment (EIA) prir t any cnsultatin n whether t alter r stp a particular service. The curts have recently restated that there is n requirement t undertake an EIA, but that it is a useful tl t demnstrate that an NHS bdy has had due regard t the relevant needs. Decisin makers need t put themselves in a prper psitin t cnsider the questin in the first place by gathering sufficient relevant evidence. This duty des nt mean that the NHS cannt take changes that adversely affect, fr example, the access that disabled peple have t lcal services. It des mean that thse wh take the decisin need t have a prper understanding f hw their decisins will impact n disabled peple and take thse factrs int accunt when taking the final decisin. Fr mre detail n the public sectr equality duty, please fllw the link t ur briefing n that subject. Lessns learned frm recent cases An academic review f recent case law is f little help t hard-pressed cmmissiners and prviders faced with challenging budgets and a need t redesign services. What matters are the practical lessns yu can learn frm thse cases. >> We set ut belw a print ut and keep guide t ur ten rules fr an effective, lawful cnsultatin. There is sme cmfrt t be fund in the case law! The curts have repeatedly acknwledged that, if a cnsultatin exercise is challenged in curt, it will be struck dwn nly if it can be shwn that smething went seriusly and radically wrng. The cases accept that, with hindsight, it will always be pssible t suggest a way in which a cnsultatin exercise culd have been imprved n. That is nt the test. If the basics f the cnsultatin exercise are prperly cnsulted, the bjectrs shuld nt succeed in their challenge. Remember, thugh, that even the csts f successfully fighting a judicial review are high. Carrying ut a cnsultatin as well as pssible will reduce the chances f having t d s. If an NHS bdy knws that a particular service change will be cntrversial, it shuld cnsider seeking legal advice t health check its prpsed cnsultatin prcess and dcuments. Finally, if service users threaten a judicial review by way f a Pre-Actin Prtcl Letter then legal advice shuld always be sught as a matter f urgency. Often there are 14 days r less t respnd. The curts pay careful attentin t a public bdy s first respnse t the threat f legal actin even befre prceedings are issued. cnsultatins briefing ctber

9 Ten rules fr an effective, lawful cnsultatin prcess 1. Cnsult when yur prpsals are at a frmative stage Making a decisin n a change t services, and then cnsulting n that decisin, is unlawful. If yu are strngly f the view that nly ne f a number f alternatives is realistic, then yu shuld say s and explain why, but yu must give peple the pprtunity t disagree. 2. Mind yur language! Decisins by public bdies have been struck dwn by the curts simply fr the use f language that gives an appearance t the public that a decisin had already been taken and the cnsultatin was a sham. 3. Set ut what yu are prpsing; what the ptins are; and why these changes are needed The public bdy must give ut infrmatin that cntains sufficient reasns fr particular prpsals, t allw thse cnsulted t give thse reasns intelligent cnsideratin and an intelligent respnse. If the public d nt knw what they are being cnsulted abut r why a change needs t be made, they cannt prperly take part in the cnsultatin prcess. 4. Be up frnt abut the reasns fr a prpsed change In the current climate, the driver fr change will ften be largely financial. If that is the case, say s. Set ut the financial psitin that yu are faced with and if this is the reasn fr the prpsed changes. Hiding behind ther, mre palatable, reasns t change a service risks yur cnsultatin being struck dwn as unlawful. 5. Think abut hw lng the cnsultatin will last The public must have adequate time t respnd. The Cabinet Office Principles state timeframes shuld be prprtinate and realistic t allw stakehlders sufficient time t prvide a cnsidered respnse and might typically vary between tw and 12 weeks. 6. Take the respnses int accunt befre making a final decisin NHS bdies are nt bund by the views f the public. Cnsultatin is nt a vte. It is, hwever, essential that yu put the public's views in frnt f the decisin makers and that they take thse views int accunt when reaching their decisin. Yu must ensure that yu have a paper-trail demnstrating that this was dne. If a public bdy takes a decisin that ges against the general views f the public, it needs t have gd reasns fr it and t make sure thse reasns are recrded. 7. There is n set frm fr a cnsultatin Hw t cnduct ne is a decisin fr the public bdy. The curts have apprved cnsultatins that invlve respnses n paper r electrnically, public meetings and even citizens juries. What matters is whether the cnsultatin is fairly cnducted. 8. Yu can cnsult n a single ptin If a public bdy identifies nly ne serius ptin t put t the public, it is entirely lawful t cnsult n implementing that single ptin. Hwever, yu may need t justify why nly ne ptin was realistic. Als, yu must allw members f the public t suggest alternative ptins and, if they d s, yu must give thse ptins genuine cnsideratin. 9. Yu can reach a final decisin that was nt ne f the ptins put frward fr cnsultatin But remember tw pints. First, there must be gd reasn fr such a change f apprach usually it will be based n infrmatin discvered as part f the cnsultatin. Secndly, if the final decisin departs very substantially frm the initial ptins, it may be necessary t undertake a secnd cnsultatin. Yu d nt have t give cnsultees the pprtunity t see and t cmment n the respnses f ther cnsultees. Hwever, if a respnse has pened up a new issue that yu are taking int accunt, yu shuld cnsider giving ther cnsultees the pprtunity t cmment n that issue. 10. Be careful f making prmises! If clear, unequivcal prmises have been made t individual service users r grups as part f the cnsultatin prcess, the public bdy will have created a legitimate expectatin that thse prmises will be kept. If yu want t g back n them, yu will need t red the cnsultatin exercise. Failure t d this risks the whle prcess being struck dwn by the curts. It is far safer never t make a prmise r, if yu d s, t qualify the circumstances in which yu will be bund by it. cnsultatins briefing ctber

10 Get in tuch Duncan Astill Partner T +44(0) Jill Masn Partner T +44(0) Philip Grey Assciate (Barrister) T +44(0) Katrina McCrry Assciate T +44(0) Jane Williams Senir Slicitr T +44(0) Useful links Resurces Transfrming participatin in health and care Real invlvement: wrking with peple t imprve health services (NHS) Cabinet Office Cnsultatin Principles Department f Health smart guides t engagement Where d public authrities stand in relatin t the Public Sectr Equality Duty? Health Cmmissining Prtal Sir David Nichlsn s letter t NHS Chief Executives - 20 May 2010 NHS Cnfederatin: Tugh times, tugh chices Legislatin NHS Act 2006 Lcal Authrity (Public Health, Health and Wellbeing Bards and Health Scrutiny) Regulatins 2013 Equality Act 2010 cnsultatins briefing ctber

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