Audit & Review
Audit & Review is a short form engagement assessing risks associated with the service change proposals in light of the revised Secretary of State powers
On the 31 January 2024, new guidance from the Department for Health and Social Care set out the new process for ministerial intervention in reconfiguration of NHS services.
‘a new call-in power allows the Secretary of State to intervene in NHS service reconfigurations at any stage where a proposal exists and take or re-take any decision that previously could have been taken by the NHS commissioning body
call-in requests can be submitted to the Secretary of State - the Department of Health and Social Care (DHSC) expects these only to be used in exceptional situations where local resolution has not been reached
NHS Commissioners have a duty to notify the Secretary of State of notifiable reconfigurations - this duty does not apply to reconfiguration proposals where before 31 January 2024 a consultation has commenced with the local authority in accordance with regulation 23(1)(a) of the 2013 regulations
local authorities are no longer the only body able to make new referrals (in most cases) to the Secretary of State under the 2013 regulations’
Department for Health and Social Care - Revised Intervention Powers
The new ‘call-in’ powers have made changes
Who ?
Previously | Only the local Health Overview and Scrutiny Committee (Tier 1 Authorities), had the power to refer a substantial change to the Secretary of State
Revised | The new ‘call-in’ request to the Secretary of State is open to all individual(s) or organisation(s)
(page 20 - Revised Intervention Powers / DHSC)
How
Previously | NHS Commissioner determined whether a service change was ‘substantial’. This was typically undertaken in consultation with the local Health Overview and Scrutiny Committee
Revised | The previous process continues, however the Secretary of State can also determine whether a service change is ‘substantial’
(page 17 - Revised Intervention Powers / DHSC)
What
Previously | ‘Substantial’ change was broadly defined as range of services available and/or the geographical location from which services are delivered
Revised | A clearer definition (but not definite) of what is meant by ‘substantial change’:
the manner in which a service is delivered to individuals (at the point when the service is received by users)
the range of health services available to individuals
(page 8 - Revised Intervention Powers / DHSC)
When ?
Previously | Referral to the Secretary of State would only be accepted once an NHS Commissioner had made a decision, and once a judicial review has been completed (if applicable)
Revised | The revised power power to allow the Secretary of State to intervene in NHS service reconfigurations at any stage
(page 18 - Revised Intervention Powers / DHSC)
What is Audit & Review?
is a diagnostic tool led by AYLI which considers both soft inputs (relationship / public engagement) and hard inputs (key documentation such as travel analysis) from the perspective of challenge (Call-In Powers / Judicial Review)
is designed to be used throughout the development process (from initial scoping / project setup through to decision-making) and can flex accordingly
provides two key outputs a) readiness assessment and b) action plan, which is co-designed with the leadership team
can be used in conjunction with any scale of proposal which might face a challenge, not just those which have been agreed to be a substantive change
can be used in conjunction with proposed changes by Commissioners and Providers
What would Audit & Review Support?
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Audit & Review would provide a clearer understanding of the environment in which the proposals are to be developed within, the likely level of challenge and mitigations that would reduce the risk
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Where reconfiguration proposals are already in development, this provides the Commissioner within a check point against which the current wider position can be understood and help inform the option development process, the draftin of the Pre-Consultation Business Case and stakeholder engagement
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This allows the Commissioner to understand the context in which they will be making decisions, and allow further work either to inform the Decision-Making Business Case or engagement with stakeholders, which cannot be further developed once a decision has been taken
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The revised intervention powers provide the Secretary of State with the ability to determine that a change (manner or range*) is a reconfiguration, regardless of the position of Commissioners. As a result, Commissioners might wish to utilise a Check & Challenge review to support their decision-making
