In light of the concerns expressed during this process, the Board should also consider the following in forming its final proposal and the subsequent implementation of any proposal:

• Development of a programme to evaluate the changes that are implemented by NHS Lanarkshire to provide public assurance that they are safe, person-centred and effective. This evaluation should include patient and public representatives.
• Feedback received during the process indicates that people are sometimes accessing out-of-hours services because they find it difficult to get appointments inhours. NHS Lanarkshire should use the opportunity of engagement it will undertake through its primary care strategy to develop a greater understanding of this.

Areas of good practice we identified

• Patient and public representation on the review programme board and communications and engagement subgroup from the outset of the review.
• Work undertaken to identify and engage with those people potentially most affected by the proposal and to support their continued participation in the process e.g. carers. NHS Lanarkshire has worked in partnership with NHS Health Scotland to consider potential health inequalities.
• Pre-meetings with patient and public representatives to discuss the option appraisal process (June and October) and respond to any queries on the information provided.
• The use of social media to share information.
• Some people welcomed the opportunity at the consultation public meetings to sit round the table with an 'expert' to discuss their views and concerns before moving into a larger group.
• The short film produced that aimed to capture key messages on why people who are involved in delivering the out-of-hours service believe that change is necessary. Although some public feedback relates to the poor quality of the video, it was nevertheless a useful way to provide consistent information to participants at the public meetings enabling them to hear from people on the front line of service delivery.
• The production of an ‘easy read’ version of the summary consultation document that was shared through the Learning Disabilities service and networks.
• In addition to capturing the views of public representatives and communities, NHS Lanarkshire also undertook a survey to gauge service users’ views on the potential impact of the proposed change, with a particular focus on transport and travel.

Learning points

The learning points to emerge from this process should be taken into account by NHS Lanarkshire for future service change. These include the following:

• Consider the time required once a decision has been taken to proceed to formal consultation and prior to the formal launch to 'road test' the draft consultation information, key messages and feedback questionnaire with a wider group of public representatives.
• Within the summary consultation, it may have been helpful to capture the service models that were considered (the 10 options) and the reasons some were discounted and similarly provide more detail on how the preferred locations were identified.
• NHS Lanarkshire focused a large proportion of its consultation activity and resource in undertaking 8 public meetings. We would suggest that consideration be given to using a wider range of methods to enable greater balance between open and targeted engagement.
• Feedback from some community forums, community councils and patient groups suggested that they would have welcomed the opportunity to have been engaged earlier in the process. NHS Lanarkshire should consider how it might use this feedback to further develop wider public networks for future service change,
  particularly in preparation for health and social care integration.

NHS Lanarkshire plans to discuss its final proposal at its May 2015 Board meeting. If the proposal is supported by the Board, it will then be submitted to the Scottish Government for a final decision by the Cabinet Secretary for Health and Wellbeing.