Table 3.

Policy comparison

	ENGLAND	NORTHERN IRELAND	SCOTLAND	WALES
Who proposes major service change?	Clinical Commissioning Group	Trusts	Health Board	Local Health Board
How do national guidelines define quality engagement in change processes?	“Effective involvement means being open and transparent about proposals enabling local stakeholders to have the opportunity to influence change. Sometimes the most logical and well planned changes are not achievable due to inability to effectively involve the local population.” (NHS England, 2013, p. 14)	No guidance specific to service change but in general policy document: “PPI should be part of everyday working practice, underpinning communications and decisions regarding care or treatment. It should be an integral part of service planning, commissioning and delivery. It means discussing with those who use our services and the public: their ideas, your plans; their experiences, your experiences; why services need to change; what people want from services; how to make the best use of resources; and how to improve the quality and safety of services.” (Department of Health, Social Services and Public Safety, 2007)	“Public consultation about a service change should grow naturally out of a Board's everyday communication and dialogue with the people it serves. This guidance should support staff in their efforts to engage the public, and offer potentially affected people and communities a real opportunity to influence the Board's decision-making about the design and delivery of services through their involvement in: developing and appraising possible options to decide which should be the subject of a public consultation; and the public consultation on the preferred option(s).” (Chief Executive NHS Scotland, 2010)	“a further rebalancing between continuous engagement and formal consultation, with an even stronger emphasis on the former. The new NHS bodies and reformed Community Health Councils (CHCs) must work together to develop methods of continuous engagement which promote and deliver service transformation for their populations. It is not necessary to consult formally on every change that is required. Some changes can be taken forward as a result of effective engagement and widespread agreement.” (NHS Wales, 2011)
Who ‘assures’ quality public engagement has taken place for a specific change?	NHS England	No single body: Public Health Agency has oversight and Patient Client Council has a challenge function	Scottish Health Council (a Government agency)	Local Community Health Council
Who takes the final decision on change?	Clinical Commissioning Group	Trust	Board for most change. All major changes approved by Scottish Government	Trust (but cannot implement until CHC agrees)
Who can refer or call-in the decision for review?	Local Authority	Northern Ireland Executive	Scottish Health Council advises if a change is ‘major’: all major change is referred to Scottish Government	Community Health Council refers to Welsh Assembly Government
What are arrangements for independent scrutiny of decisions?	Independent Reconfiguration Panel: standing group with Department of Health secretariat	Equality Commission for Northern Ireland	Independent Scrutiny Panel can be convened by Scottish Government (none since 2009)	National Clinical Forum (last met in 2012)