Involving People in Major Service Change
Involving people in Major Service Change
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People should remain at the heart of all service change decisions, including any major change
Major service changes can have a significant impact on patients, carers, communities and staff. NHS Boards and Integration Joint Boards (IJBs) have a duty to involve people meaningfully in planning and decision-making, in line with Planning with People guidance - Health and social care - Planning with People: community engagement and participation guidance - updated 2024 - gov.scot
What is major service change?
A service change may be considered ‘major’ when it has a significant impact on how services are delivered or accessed. Factors that help determine whether a change is major include:
- Impact on patients, carers and communities
- Changes to accessibility of services
- Impact on emergency and unscheduled care
- Significant public or political concern
- Alignment with national policy or professional standards
- Changes in the method of service delivery
- Financial implications and consequences for other services
The more of these factors that apply, the more likely a proposal is to be considered a major service change. Healthcare Improvement Scotland (HIS) have developed flowcharts providing and overview of the quality assurance process for major and non-major service change - hisengage.scot/service-change/resources/overview-of-engagement-process-for-service-change/
Five things every team should know:
Before or as soon as possible after identifying a change:
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Engage early
Early involvement helps identify concerns, opportunities and potential impacts before decisions are made.
Before proposals are finalised:
- Involve patients, carers and communities
- Work with stakeholders throughout planning
- Use engagement findings to shape options
- Follow the Planning with People principles
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Agree whether the change is major
Early discussion helps ensure the correct level of involvement and consultation is undertaken.
- Contact the Public Involvement Team and Healthcare Improvement Scotland (HIS) at the earliest opportunity
- Discuss the proposal and evidence
- Refer to the service change flowchart
- Seek a shared understanding on the appropriate process
- Where there is disagreement, the Scottish Government will make the final determination
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Consult formally
If a proposal is identified as major:
- A minimum three-month consultation is required
- Consultation should encourage discussion and debate
- Information should be accessible and inclusive
- People should have meaningful opportunities to provide feedback
Formal consultation should not begin until HIS confirms engagement to date has followed Planning with People guidance.
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Use feedback to inform decisions
Following the consultation period:
- Consultation responses are reviewed
- HIS quality assures the consultation process
- Boards consider all available evidence
- Feedback from communities informs decision-making
- Boards should demonstrate how views have been considered
People’s views should be considered alongside clinical, workforce and financial information.
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Follow the approval process
For NHS Boards, the following process should be followed:
- NHS Board considers proposals at a public meeting
- Major services change proposals are submitted to Scottish Ministers
- Ministers may approve, reject or request further engagement
- Parliament is notified of the final decision
No major service change can proceed without completing the required response.
Changes affecting more than one area
Where a change affects populations across NHS Boards or IJB boundaries:
- The organisation leading the proposal leads engagement
- Affected communities across all areas should have opportunities to participate
- Boards should work together to maximise involvement
Nationally determined service changes
When service changes are decided nationally:
- Scottish Government provides information on the decision
- NHS Boards discuss local engagement requirements with HIS
- Local people should be kept informed and have opportunities to ask questions
- Feedback should be shared with Scottish Government
The level of engagement will depend on whether there is scope to influence how changes are implemented locally.
What does good involvement looks like?
- Early conversations
- Open and honest communication
- Accessible information
- Listening to patients, carers and communities
- Understanding impacts
- Listening to diverse voices
- Acting on feedback
- Explaining how decisions have been reached and showing how people's views influenced decisions
- Ongoing communication throughout the process
- Learning and improving
The NHS Grampian Public Involvement Team
The NHS Grampian Public Involvement Team have a range of resources available on their website to help do great engagement, including, Service Change Conversations, VOiCE Engagement Planning Tool, The Grampian Digital Engagement Toolkit, Foundations of Community Engagement Training and Engagement 101 Training, now available to book on Turas here
We also provide some of the key documents you will need to get started. To access all of this and much more, you can visit our website here
Key message
Major service change requires early engagement, meaningful involvement and formal public consultation.
People’s views, experiences and feedback should help shape decisions about services that affect them, ensuring changes are informed, transparent and focused on improving outcomes for the communities we serve.
NHS Grampian Engagement Team – here to support Services to involve people in decisions that will impact them.
Please contact gram.involve@nhs.scot for advice as early as you realise change is needed.
Published: 14/09/2026 14:09