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Citizen Engagement – everyones doing it – even NHS England!

As the great beast that is NHS England gets up and running it is already proving challenging to keep up toImage 1 speed as it churns out ideas, instructions, promises and commitments.

So as small local organisations like Healthwatch have their heads down establishing mechanisms for citizen engagement NHS England enters stage left with its own ideas…….

The Civil Society Assembly.

In a paper to the February 2013 NHS England Board (or NHS Commissioning Board as it was then) Tim Kelsey proposed that it establishes a “design group to explore the creation and development of a citizen and community assembly through enabling a civil society movement that brings transparent accountability and a powerful voice for patients and the public to NHS England”.

This is to:

“build citizen voice and influence throughout the NHS commissioning system, so that citizens hold the NHS to account, driving improvements in quality and outcomes.

I agree with this part of his analysis:

“People have a passive relationship with the NHS and their activation is generally low. The paternalistic medical model of health is not conducive to equitable person-centred approaches to involving people, their families and communities”

He then goes on to say:

“Co-designing and creating an independent ‘Civil Society Assembly’ could be the means through which NHS England can directly engage with citizen voice in a publicly accountable and transparent forum.”

The paper is clear that previous attempts at patient engagement have too often attracted the ‘professional patient’ and it has too often been white, middle class, aged/retired professionals.

The paper calls for NHS England to go beyond the ‘usual suspects’ or the ‘expert patient’ reps instead going into communities whose primary issues may not be ‘health’ but other social determinants that have a major impact such as housing and employment.

It also acknowledges the need to develop a complementary approach with Healthwatch England to ensure mutual benefit.

The paper sets out the following ambitions:

“It will be a catalyst for a social movement that engages and stimulates new, emerging and established groups and organisations to connect”

Its helpful because………..

We never heard of any attempt of trying to build citizen voice into the old Strategic Health Authority structures and certainly not into mechanisms established by the Department of Health.

Indeed when I once offered to organise a regional meeting to bring the Chief Executive of an SHA into dialogue with local community health champions their reply was “why would I want to do that?”

So national recognition that engaging with citizens is crucial. This will help cultural change in NHS England which might then drive local engagement and help improve service quality.

Its unhelpful because………

This issue is more important than this – the proposal lacks an analysis of context for example:

What happened to localism? If NHS England wanted to be truly radical it would thoughtfully consider whether it might be better served by strengthening its relationship with local democratic structures rather than going for a quick fix national forum. For example it could:

Actions NHSE could consider

What do you think?


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