England & Wales Health and social care

Viewpoint: A year of learning from NHS Citizen


License: CC0 Public Domain

NHS Citizen has been called the most ambitious public engagement project in Europe in the last 20 years, writes Demsoc’s Susie Latta.

It certainly seems ambitious to us at the moment, as we are in full swing with Gather – open to everyone in England – and making preparations for an Assembly meeting later in the year. Many important issues are being discussed such as health outcomes for looked after children and young people, greater transparency in CCG commissioning and how to tackle loneliness.

The Board of NHS England started NHSCitizen in 2013. They decided that they wanted to hear and include more public voices in their decision making and – 18 months of public design process later – this has become NHS Citizen.

Starting with that vision of including public voice in a different way, Demsoc are one of four partners working on NHS Citizen. We have worked through a series of public co-design workshops to develop something that, once fully developed, will listen to and join up existing conversations about the NHS across England.

Ideas, comments and suggestions are brought together in a place called ‘Gather’ where anyone can add an issue and join the conversation. Then begins the process of turning those discussions into actionable statements: what change is needed? what action needs to take place? Not all of these suggestions need to go to the board of NHS England. How do we get other decision makers for example at councils and CCGs or other NHS bodies involved?

When we have the final list of issues to go to the board there will be a public online vote and 10 will go forward to a Citizens’ Jury who will consider all aspects and choose the final five issues for the Assembly meeting with the NHS England Board.

NHS Citizen is still being designed. We tested much of this process last year and the five issues discussed were mental health, gender identity services, children’s and young people’s health, self-care and personalisation and access to services. At the Assembly Meeting we really saw progress being made and both the Board and citizens engaging in an open, frank and constructive way.

Things have changed as a result: evidence is now gathered about the experience of children and young people through the friends and family test, which is being extended to under 16s for the first time. There has been an announcement of a Mental Health Task Force and significant investment in child and adolescent mental health. There has been much greater dialogue around gender identity services between those commissioning the services and those with knowledge and personal experience of those services.

What we also took away from NHS Citizen is a lot of learning. This year’s process has been improved from last. This years’ process will be improved for next. We are waiting for the tender to be announced for the development of the final technology platform. So yes we feel ambitions and like we are making great progress on a highly ambitious project but there is a lot of learning and design still to go.

Key lessons so far include the following:

  • Having conversations like this are about building trust. We need to prove our value. Conversations are important but so is action. Results are what make people trust us and want to take part.
  • To try new things in participation we need to be brave. NHS Citizen is brave and messy but good things are coming out (and we are learning and improving.)
  • When working out what it means to collaborate and co design it is easier to join in than to start. If councillors, officers and others working in local decision making join the NHS Citizen conversation it is both less risky (for you and us) and makes the conversation better (and we all get a chance to shape it).
  • We need help to make NHS Citizen work at a local level. At the moment it is set only to report to the Board of NHS England. We are working on ‘development sites’ in North Staffordshire and Seisdon peninsula, Telford and Wrekin, Calderdale, Durham and Tees, Merseyside, Birmingham and this will give us more idea about how things can work locally.
  • At both a national and a local level, NHS Citizen needs to be a conversation of all involved in health, wellbeing and social care. People do not separate these aspects of their lives so why should we. By joining up we can have better conversations and find better ways of doing things to benefit us all.

Susie Latta is Operations Director at Demsoc.