News and Comment

The NHS needs your help. Have your say.

Thursday 21 November 2013


The NHS Call to Action published earlier this year was a call to arms from NHS England to get the public involved in the big challenges of the NHS – this means a whole range of events, conversations and debates happening in all kinds of settings including today’s NHS Futures Summit – a national event with leaders from across the health sector. A team from OPM and DbyD are there today, working with colleagues from Grayling to facilitate conversations exploring a range of visions for the future of the NHS.

But I’d like to use this space to have another conversation about how the NHS can meet the challenges of maintaining financial sustainability, improving care and engaging citizens. A few weeks ago I spent two full, exhausting, inspiring, tense, insightful, disruptive, collaborative days working with a diverse group of people to think about co-producing a Citizens Assembly for NHS England. One of the suggestions from that group was to use the Call to Action as an opportunity to invite others into a discussion about how the NHS should listen to its constituents – so here is my take on the Citizens Assembly, and an open invitation for others to give their views via the NHS Citizen website.

As a new body, NHS England, are looking to build in accountability and challenge right up to the board level on commissioning decisions, and they’ve taken the bold decision to ask stakeholders to design that mechanism with them. I dropped in to the middle of this process at a two day workshop run by Involve,Public-i and Demsoc where 60+ people tore down and built up again a model for an Assembly.

The process is being driven at board level by Tim Kelmsley as National Director for Patients and Information, who seems genuinely committed to finding a form which allows the board of NHS England to hear directly from the people affected by commissioning decisions. Hearing him speak at the event it was clear he had a picture in his head of doughty citizens telling it like it is and compelling board members to listen to them. It’s a worthy ambition, elegantly expounded and driven forward by a great team of people, including Olivia Butterworh, tireless Head of Public Voice. The two-day co-production workshop showed that while there are some big challenges to overcome to make this a reality, there is a lot of enthusiasm to do just that.

One of these challenges is the nature of commissioning itself: anyone working in the commissioning sphere will tell you that it’s never been so complicated, or so financially constrained. The health and social care integration agenda looms large in everyone’s minds, and high profile issues like children’s heart services have captured the public and media attention. What they will also tell you is that there are real opportunities in commissioning to improve services and outcomes. The challenge for the NHS England team is to figure out how to make this complex and technical system transparent and accessible to the citizens it seeks to engage.

The second major challenge emerging at the workshop is the difficulty of engaging in a space which is already saturated. Patient voice is everywhere, from 38 degrees to local patient support groups to Clinical Senates to the NHS Friends and Family Test. There are two big risks here: one is that the over-engaged healthcare service using public simply doesn’t see why they should bother with yet another mechanism; and two, that this surfeit of engagement consistently fails to meet the needs of particular groups, while giving the impression of comprehensiveness.

These are far from the only issues a group of 60-odd people came up with over two days of skilfully facilitated working, but they felt important as they came up repeatedly through the discussions. What was also clear is that there was often more enthusiasm for citizens assembling, than a citizen’s assembly. There was caution verging on cynicism that this could end up as just another organisation engaging a few people in a few decisions – much more exciting was the prospect of a radically new mechanism which embodied some key principles. I read those principles as:

–        Excluding nobody (but this is not the same as including everybody – democracy is a wonderful thing and it can take many forms, not just full representation)

–        Making the most of what’s already there instead of replicating it – recognising the finite resources of people’s attention, care and time and not wasting them

–        Enabling people to speak truth to power – by changing the culture within which decisions are made, as well as the mechanics

Lucy Farrow is a Project Manager at OPM’s sister compnay Dialogue by Design