Health Service Focus

06.03.20

We need to create a future NHS that is driven by people

Olivia Butterworth is Head of Public Participation for NHS England and NHS Improvement. This article first featured in the Jan/Feb issue of NHE.

The NHS has long had a duty to involve ‘the public’. The discharge of this duty is often played out through set piece engagement and formal consultation processes. It’s not always clear how it influences, changes or improves things. We have defaulted to referring to ‘PPI’ or ‘PPE’ as a shorthand which also stand for entirely different things outside the NHS bubble.

To transform our NHS and care services we need to engage with people and communities in ways that really do hear their experiences and ambitions and then take action, together, that leads to real change. The involvement of people and communities is essential and needs to be at the heart of how our organisations and systems work, bringing people’s experience and ideas into the decision-making spaces in inclusive and transparent ways.

It’s often an engagement lead who is despatched ‘to do’ the engagement and then feed back, usually through written reports to those who make the decisions. We need to change this.

We will continue to miss the opportunities for real change unless those who have the power to make change happen, work with and alongside people to understand what the issues are and what some of the solutions might be.

I’ll give you a simple example – it’s based on a real story.

A GP practice notices that it has very high A&E use by people from a particular community. This same group also experience higher than average diabetes. It’s always been like that, say the partners.

A new partner steps out of the practice and in to the community, connects with people in the community and asks questions about how people are using services, why they go to A&E and what their lives are like. They build relationships with community groups and start to develop a deeper understanding of the people who live there and the lives they live.

Working in partnership with this community they understand why people go to A&E and work with the community newspaper and radio station to talk about the other services available, in ways that people understand. Working with a community café they talk about the foods people are eating and start to understand how this could be linked to their diabetes. The café changes the ways it’s cooking some foods and shares their learning with the rest of the community.

Guess what? A&E use goes down and diabetes starts to reduce.

Connecting with the people and groups in communities offers us vast insight and opportunities to work together to make change, rather than continuing to do things to people that don’t resonate with their lives. 2020 and beyond offer great opportunity to make this change – whether it’s the emergence of Primary Care Networks, CCGs transforming their commissioning practice, providers developing integrated and person-centred services, the strategic leadership of STPs and ICS’, the relationship with social care and the potential reforms on the horizon – the involvement of people and communities is critical to shifting the culture and achieving change.

Stop doing to people and start working with them.

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