Legislation and Policy

Current legislation and guidance relating to patient engagement and experience can be found below:

[nhs-accordion name =”Health and Social Care Act 2012″]

The White Paper, ‘Equity and Excellence: Liberating the NHS’, and subsequent Health and Social Care Act 2012, set out the Coalition Government’s plans for the future of the NHS. Built upon the principles of the NHS – a comprehensive service, available to all, free at the point of use, based on need, not ability to pay, the 2012 Act places a specific duty on CCGs to ensure that health services are provided in a way which promotes the NHS Constitution, and awareness of the NHS Constitution. The requirements in the 2012 Act specifically associated with engagement updated the previous Section (s) 242 of the consolidated NHS Act of 2006. Find out more about the legislation.


[nhs-accordion name=”CCGs (and NHS England) general duties under the NHS Act 2006″]

The NHS Act 2006 (including as amended by the Health and Social Care Act 2012) sets out the range of general duties on clinical commissioning groups and NHS England.

Commissioners’ general duties are largely set out at s13C to s13Q and s14P to s14Z2 of the NHS Act 2006, and also s116B of the Local Government and Public Involvement in Health Act 2007.

  • Duty to promote the NHS Constitution (13C and 14P)
  • Quality (13E and 14R)
  • Inequality (13G and 14T)
  • Promotion of patient choice (13I and 14V)
  • Promotion of integration ((13K and 14Z1)
  • Public involvement (13Q and 14Z2)
  • Innovation (13k and 14X)
  • Research (13L and 14Y)
  • Obtaining advice (13J and 14 W)
  • The duty to have regard to joint strategic needs assessments and joint health and wellbeing strategies (116B of the Local Government and Public Involvement in Health Act 2007)

Commissioners should also ensure they are familiar with s244 of the NHS Act 2006 regarding the duty to consult the relevant local authority in is health scrutiny capacity. Of particular relevance to engagement and experience is s14Z2 of the 2012 Act, which states that CCGs must involve and consult patients and the public:

  • in their planning of commissioning arrangements;
  • in the development and consideration of proposals for changes in the commissioning arrangements where the implementation of the proposals would have an impact on the manner in which services are delivered to the individuals or the range of health services available to them; and
  • in decisions affecting the operation of commissioning arrangements where the implementation of the decisions would (if made) have such an impact.

The Act also updates s244 of the consolidated NHS Act 2006, which requires NHS organisations to consult relevant Local Authority Overview and Scrutiny Committees on any proposals for a substantial development of the health service in the area of the Local Authority, or a substantial variation in the provision of services.

National Health Service Act 2006


[nhs-accordion name =”The Equality Act 2010″]

The Equality Act 2010 unifies and extends previous equality legislation. Nine ‘protected characteristics’ are described in the 2010 Act: age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion and belief, sex and sexual orientation. Section 149 of the Equality Act 2010 states that all public authorities must have due regard to the need to a) eliminate discrimination, harassment and victimisation, b) advance ‘Equality of Opportunity’, and c) foster good relations. GCCG has developed an Equality and Diversity Strategy, which details our approach locally and includes guidance regarding the undertaking of Equality Impact Analysis (EIA) to support GCCG activities including engagement and consultation.

The Equality Act 2010


[nhs-accordion name =”The NHS Constitution 2010″]

The NHS Constitution was established in law in section 1 of the Health Act in 2009 and came into force in January 2010. The NHS Constitution places statutory duties on NHS bodies and sets out a number of patient rights, which are a legal entitlement protected by law. It also sets out individual personal responsibilities. One of the rights relevant to engagement is the right to be involved directly or through representatives:

  • in the planning of healthcare services;
  • the development and consideration of proposals for changes in the way those services are provided; and
  • in the decisions to be made affecting the operation of those services.


[nhs-accordion name =”Statutory duty of candour for health and adult social care providers”]

From October 2014, subject to parliamentary approval, NHS providers will be required to comply with the duty of candour. Meaning providers must be open and transparent with service users about their care and treatment, including when it goes wrong. The duty is being introduced as part of the fundamental standard requirements for all providers. It will apply to all NHS trusts, foundation trusts and special health authorities from October and the government plans to implement the standards for all other providers by April 2015, subject to parliamentary approval. The CCG will consider processes to be put in place locally from 2015 with our providers during the annual contract discussions.

Read more about the Statutory duty of candour for health and adult social care providers.


[nhs-accordion name =”Clinical Senate Review Process”]


Single Operating Framework

Guidance Note

What does Clinical Senate Review mean?

NHS England has a role to support and assure the development of proposals for service change by commissioners via the NHS England Assurance Process. One step in this process is to review major service change proposals against the clinical evidence base for it – it is this role that NCAT delivered previously and which Senates will now take on.

There are other elements of service change which are reviewed (patient engagement, patient choice, quality benefits, fit with best practice etc.). Clinical Senates will only be involved in the review of the clinical evidence base.

What is the expected process?

  • Request for clinical review will come from either sponsoring commissioner or local area team of NHS England (with 3 months notice)
  • Terms of reference (timescale, scope et.) for review agreed and signed off by Clinical Senate Council
  • Review Team developed (minimum 8 weeks notice)
  • Commissioner provides information (options appraisal etc.)
  • Review of data, interviews and meetings led by Review Team
  • Report written to be signed off by Clinical Senate Council (determining strength of evidence base)


Useful resources

A wide range of engagement resources are available here, together with links to national, regional and local partners.

[nhs-accordion name=” Your Circle “]

Your Circle Gloucestershire is a directory to help you find your way around health and care and connect you with people, places and activities in Gloucestershire


[nhs-accordion name=”NHS England “]

Patient and Public Participation in commissioning health and care: statutory guidance for CCGs and NHS England. This guidance will help staff in clinical commissioning groups (CCGs) to involve patients and the public in their work in a meaningful way. It shows the importance of involving people in commissioning to improve health and care services, and how CCGs and NHS England can meet their legal duties to do so. It provides a range of links and information that patients carers and the public will also find of interest.

Engaging local people – a guide for local areas developing sustainability and transformation plans  for teams developing Sustainability and Transformation Plans (STPs). It is intended to clarify the expectations on stakeholder involvement, in particular patient and public participation. It also covers legal duties around engagement and consultation.

New Care Models, New Care Models: empowering patients and communities (December 2015) – sets out a directory of what support is available from the 5 Year Forward View (5YFW) partners and voluntary sector strategic partner organisations to fully engage with people and communities.

Good practice guide to major service change – This is the good practice guide for commissioners, to assist clinical commissioning groups (CCGs) should they choose to develop proposals for major service changes and reconfiguration.

Everyone Counts: Planning for Patients 2014/15-2018/19 – As part of the annual commissioning cycle, NHS Commissioners are expected to work with providers of NHS funded services to put in place mechanisms for systematically collecting and reacting to feedback from individuals’ experience of care. The explicit details of methodologies to be used by providers changes from year-to-year (e.g. real time feedback, Friends and Family Test). CQuINS, both national and locally developed, are used as the mechanism within provider contracts for defining quality requirements.


[nhs-accordion name=” National Institute of Health and Care Excellence “]

Community Engagement: improving health and wellbeing and reducing health inequalities, NICE Guidelines NG44 (March 2016)–  covers community engagement approaches to reduce health inequalities, ensure health and wellbeing initiatives are effective and help local authorities and health bodies meet their statutory obligations.

NICE Quality Standards for Patient Experience in Adult Services (2012) – The NICE Quality Standards aim to deliver the best possible experience for people who use NHS services, high quality care should be clinically effective and safe.


[nhs-accordion name=”Department of Health “]

Advice to local authorities on scrutinising health services (2014) – explains the health scrutiny regulations and provides local authorities with advice about how to implement them to ensure that existing health services are providing effectively for local communities.

Hard Truths: the journey to putting patients first (2014) – Hard Truth’s is the Government’s further response to Robert Francis QC’s report on the Mid Staffordshire NHS Foundation Trust public inquiry. ‘Hard Truths’ Volume 1 explains the changes that have been put in place since the initial response was published, and sets out how the whole health and care system will prioritise and build on this. Volume 2 outlines the responses to each of the 290 recommendations made by the public inquiry.

Patients First and Foremost (2013) – sets out an initial overarching response on behalf of the health and care system as a whole to the Mid Staffordshire NHS Public Inquiry and the ‘Francis Report’. It details key actions to ensure patients are ‘the first and foremost consideration of the system, and everyone who works in it and to return the NHS to its core humanitarian values.’ It sets out a collective commitment and plan to eradicate harm and to promote excellence. GCCG has reviewed its process for handling complaints (4Cs compliments, comments, concerns and complaints) – the revised policy is a linked document to the strategy.


[nhs-accordion name=”NHS Improvement “]

Communications and engagement toolkit: for teams in service change programmes (June 2016) –  a step-by-step guide to the different phases of a potential service change programme and the role of communications and engagement.


[nhs-accordion name=” Kings Fund”]

Reading List: Public involvement in health services August 2014


[nhs-accordion name=”Care Quality Commission (CQC)”]

The CQC’s role is to check whether hospitals, care homes, GPs, dentists and services in people’s own homes are meeting national standards. The CQC does this by inspecting services and publishing its findings, helping people to make choices about the care they receive


[nhs-accordion name=”The Francis Report”]

The final report of the Mid Staffordshire NHS Foundation Trust Public Inquiry chaired by Robert Francis QC was published on Wednesday 6 February 2013 and made 290 recommendations. This Strategy acknowledges and responds to recommendation 135 of the Francis Report on public accountability and commissioners and their responsibilities for public engagement.


[nhs-accordion name=”Local Government Association (LGA)”]

The LGA is the national voice of local government. It works with councils to support, promote and improve local government. It is a politically-led, cross-party organisation that works on behalf of councils to ensure local government has a strong, credible voice with national government. It aims to influence and set the political agenda on the issues that matter to councils so they are able to deliver local solutions to national problems.


[nhs-accordion name=” Scottish Health Council “]

The Participation Toolkit (2014) – This was compiled to support NHS staff to involve patients, carers and members of the public in their own care and in the design and delivery of local services, and is particularly useful on different involvement approaches.


[nhs-accordion name=” The Engagement Cycle “]

InHealth Associates  Engagement Cycle:

  • Serves as the foundation for an engagement culture – where working with patients, carers and the public becomes part of everyday behaviours, and effective relationships between professionals and patients is the norm
  • Provides the basis for developing sustainable systems and processes in order to turn engagement into everyday practice
  • Sets out what is required when engaging patients, carers and the public at each stage of the commissioning process
  • Supports the development of effective engagement strategies and plans that embed engagement in decision-making – ensuring that ‘nothing about us without us’ is more than rhetoric
  • Outlines, who needs to do what at each stage of the commissioning cycle, to ensure meaningful engagement for maximum impact


[nhs-accordion name=” Centre for Public Scrutiny “]

Smart Guide to Engagement: Working with Local Authority Scrutiny


[nhs-accordion name=” Participation—Spice it up! “]

Spice it up is a valuable resource for all professionals who work with children and young people—including local authority staff; teachers; play and care workers and health professionals. Many of the methods described also work well with grown-ups too!


[nhs-accordion name=”The Patients Association (PA)”]

The Patients Association’s motto is ‘Listening to Patients, Speaking up for Change’. This motto is the basis on which the PA builds its campaigns. Via its Helpline, it captures stories about Healthcare from over thousands of patients, family members and carers every year. It uses this knowledge to campaign for real improvements to health and social care services across the UK. In addition, the Helpline provides valuable signposting and information for patients and supports them as they navigate the Healthcare service.