Whoever wins the election there is no doubt that the health and social care system faces an incredibly tough ride over the course of the next Parliament. The former Chief Executive of the NHS, David Nicolson recently raised his “very great concern” about the financial problems facing the health service immediately after the election.
In addition, all the main parties, and NHS England itself have identified the need to, in the words of NHS England’s Five Year Forward View, “take decisive steps to break down the barriers in how care is provided between family doctors and hospitals, between physical and mental health, between health and social care.”
Westminster politicians and NHS England are talking a lot about the twin problems of the financial hole and the need to integrate health and social care alone. However, it is local authorities which are doing most of the heavy lifting that will be required to solve the challenges of the next five years.
It is also important to note that many of the reforms and changes to health and social care services that will be required are likely to be deeply unpopular, or have unforeseen consequences, often for the weakest and most marginalised in our communities. There are significant risks for councils, NHS England and other partners if the public are not actively involved in the service redesign that will be required.
The challenge will be how to engage the public effectively in what will need to be local, regional and national conversations involving multiple partner organisations.
One part of the answer might be NHS Citizen, the design of which has recently been published after eighteen months of collaborative design with patients, public, NHS staff, civil society organisations and other partners in the health and social care system.
At its heart NHS Citizen aims to answer two questions:
- How can the board of NHS England better take into account the views of patients, service users and the general public when making decisions about the NHS?
- How can the board of NHS England be held to account by the public which it serves?
Through the open design process the NHS Citizen project team has developed a model for NHS Citizen which consists of:
- Deliberative and decision-making processes and events, such as the Gather process which allows the public to raise ideas and concerns and the Assembly Meeting which creates a space for senior managers and the public to develop collaborative solutions;
- A set of values and behaviours which are intended to create a culture of participation within NHS Citizen; and
- A set of tools and approaches designed to find and connect pre-existing patient participation as well as to identify gaps and hidden voices.
In developing this model we have also considered how NHS Citizen might help direct questions and ideas to other parts of the NHS system in recognition of the fact that NHS England has a role as system leader. There may be role to do this more widely if appropriate.
The next stage of work will develop the different parts of the NHS Citizen design and test how they work together in a live environment. A key part of this will be working with partners at a local level to test how best to develop the system so that it supports collaboration with the public in some of the difficult decisions that will need to be taken over the next few years.
Simon Burall is Director of Involve and a member of the NHS Citizen Design Team.