An Innovative Public Engagement Case Study: NHS Citizen

Jacquie Dale, OneWorldInc, PatientEngagement, PublicEngagement


Little changes go a long way. An interesting example of innovation in Public Engagement is currently taking place in England as a result of changes to their National Health Services (NHS).

Response To Major Structural Changes In The Health Care System in England

In 2012, the government changed the operating structure of the NHS so that it no longer reports to the Health Ministry of the government, but instead to the NHS Commissioning Board, a group of 24 appointees who render all decisions on its behalf.

When this shift occurred, the question arose: How will the public hold this Board accountable for the decisions they make on behalf of the NHS?

The government turned to the UK not-for-profit organization Involve to develop a strategic mechanism to hold the NHS Board accountable and to implement a process to engage citizens in the broader conversation about NHS health services.

Establishing A New Process For Public Engagement: Co-Design

The Involve team designed the process from the ground up, brainstorming potential makeups such as a citizen assembly, or a citizen panel, and asking how it should be composed, and the nature of its relationship with the board. The main concern: What is the best way for the NHS Board to take into account the views of the public when it makes decisions?

Involve broke new ground in the field of Public Engagement by using a “co-design approach” in which the public is involved in the design of the actual process of public engagement. The resulting approach called NHS Citizen will be guided by a core set of co-developed principles. Some of those principles include:

    • Identify key questions, issues or evidence about the performance of NHS England in order to inform policy;
    • Operate in a fully transparent and open way at all levels;
    • Allow enough time for stakeholders and citizens to engage in discussions;
    • Ensure balance in discussions by highlighting stakeholder and citizen voices that are less well heard;
    • Monitor that discussions are informed by strong evidence including that of citizen and stakeholder voice;
    • Include resources to ensure that discussions are informed and inclusive; and
    • Respond promptly to all reports and requests for information with support from the NHS England Board.

Tapping In To The Public Wisdom: 3 “Vehicles of Participation”

NHS Citizen will gather public input by tapping in to three “vehicles of participation” (spaces where public views are expressed):

      1. Discover Space: Information and opinions are gathered through social media, public comment, and online and offline tools, creating a picture of the “state of the conversation” on health and allowing issues of public concern to bubble up.
      2. Gather Space: These are organized spaces that provide people with opportunities to “gather” around particular issues – issues about which NHS bodies request public input, or issues that arise from citizen or patient concerns.
      3. Assembly Meeting Space: The most important issues will be considered in an open format, using both regular offline Assembly Meetings and Citizen Panels, to contribute considered citizen and stakeholder voices to the heart of NHS England decision making processes.

NHS Citizen is still in early days – it had its first Assembly test in September 2014 but it is already harvesting lessons about how we can use public engagement to inform all stages of process design in an effort to build a platform that can effect change in society. And it also provides a real case study into the vehicles of participation, showing how engaged citizens, both inside and outside a structured framework, can work together on an important project.

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