Will the New NHS Citizen Programme involve citizens (people)?

In September 2016 the Board of NHS England approved a new way of involving people in their work (to make sure that the NHS in England provides the services people need and that these services are accessible, safe and effective.)

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Will the NHS Citizen Programme really involve the public in a way that allows them to influence the work of NHS England?

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What’s in this New NHS Citizen Programme?   

Well to be honest we’re not really sure.  The only information that is available to the public is the paper that was presented to the NHS England Board.

And as it says:  “This paper provides a summary of the changes to NHS Citizen since the November 2015 Citizens Assembly, and the proposed new approach for delivery.”

However the paper is not written in Plain English – as the title clearly shows – it is called “Improving the quality of customer insight through NHS Citizen” – so it’s basically in ‘management speak’ and will need some translating maybe!

On P3 (item no 10.) the Board paper says: nhscitizen-guide

“The new approach for NHS Citizen aims to:

i.   Strengthen public participation in NHS England in line with our new participation policy, and to meet the requirements of the duty to involve;

see P34 – Appendix 1 – of the document this link takes you to where  Section 13Q – or the ‘duty to involve’ – is explained

ii.   Support NHS England commissioners, policy and programme leads nationally and within the regions to have the tools to engage patients and the public and learn from existing insight;  

We think this seems to be about all the different parts of NHS England  knowing how to gather the views and suggestions from patients and the public and to make use of what people say in surveys and on line feedback sites.  (basically ‘insight’ = feedback from people that offer solutions to the problems)

iii.   Enable citizen input through a single, simplified approach which is easy to access, and meets the needs of different patient groups without generating significant labour intensive approaches for citizens or for teams;  

We cannot guess what is meant by this.  Involvement takes time to plan, facilitate and support if it is to be done in a way that doesn’t exclude people, is meaningful and is led by those involved – who decide the conclusions from any collective discussions for themselves.

iv.   Manage the public’s expectation around where their feedback will lead; and    

We have no idea why there is a need to ‘manage’ the public’s expectation about where their feedback will ‘lead’.  Staff supporting involvement should be honest and open in the first place about how much influence they are offering. Involvement facilitation is about clear communication and not about ‘managing situations’.

v.   Explore further an initial partnership between NHS England and Healthwatch England to provide more of a one-stop shop for the public (with the potential to increase the reach of the partnership further as the approach develops and following discussion with other ALBs). ”    

We ask – does the public want a one-stop-shop for involvement?  Are the organisations talking about working together for their own convenience or ours?  (By the way ALBs = Arms Length Bodies or organisations that are part of the NHS but not part of NHS England).

Surely this one-stop-shop has nothing to do with involving people in NHS England’s work – it’s about involving people in the work of lots of NHS organisations. Shouldn’t each be separately held to account for what they do by the people who pay them and they effectively work for?

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On Ps 3 & 4 it says:

“It is proposed that the new programme will contain:

i. NHS Citizen online: A repository (= a place to store stuff or information safely) for feedback from a variety of data and engagement, including surveys and insight from the local Healthwatch network. This will be structured around national NHS England priority areas; (Why – it should be about NHS England’s accountability to the public!)

ii. NHS Citizen outreach: Dedicated engagement and co-production (= working in an equal partnership with patients & the public) with specific communities of interest, (= people with something in common e.g. race, disability, where they live, age etc.) linking into national priority areas (Whose priority areas – ours or NHS England’s?) to ensure that we are reaching out to and hearing from all populations e.g. through the youth forum, voluntary sector strategic partners and health inequalities networks.

iii. Citizen representatives (bringing together the c800 Patient and Public Voice partners) on relevant governance groups across NHS England, building on the existing participation infrastructure of having lay representation in governance (eg on Clinical Reference Groups etc) to bring all representatives within a single repository (= safe place to keep the knowledge – or the representatives?) supported by a Customer Relationship Management (CRM) system called People Bank. (800 people representing all 55,000,000 in England?)

iv. Involvement hub: A web-based involvement hub providing on-line resources and signposting training opportunities. (Have a look and see what you think – nothing about what the 800 representatives say on our behalf or how to contact them – or what the NHS Citizen Programme is about!) This will be launched in in the autumn to support patients and the public to develop the skills and confidence to influence NHS England’s work, (What if you haven’t got access to the internet and are left out of all this?) and to support NHS England’s staff to develop the skills and confidence to work effectively with patients and the public.

v. An NHS Citizen campaign: An underpinning communications plan. This allows a means of maximising the successful brand  (Pardon – what brand? We thought this was all about the legal accountability of NHS England to the public.) to simplify the many engagement routes and approaches across the ALBs.  (ALBs = Arms Length Bodies that are part of the NHS but not part of NHS England) It is expected that this will be developed as part of the plans to support implementation of Sustainability and Transformation Plans (STPs).”  

We are aware that the STPs are local area partnerships that have each planned how services will change over the next four and a half years across their area. There are 44 STP areas in England.

Services need to change because the government is not giving the NHS – or social care – the money required to meet the increasing need for the services they provide between now and 2021.

There is an extra £22 billion needed to cover the costs of meeting this increasing need for NHS and social care in England over this time.  But with no more money, and many providers in debt already, the managers are having to make savings to cover this missing funding.

Some services will close and people will have to travel further to get treated.

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N-NHS-PV (National NHS Public Voice) think that the NHS Citizen Programme:

  • Will exclude people, especially those who don’t use the internet
  • Will not follow accepted best practice in involving the public
  • Will be NHS England managers ‘ticking boxes’ – not ‘co-production’
  • Will be ‘top down’ and controlled – not collective, together or equal
  • Will not allow the public to offer ideas and solutions to improve services
  • Will not allow the public to influence any NHS England decisions
  • Will not involve the public in decisions at all – only representatives
  • Will only ‘consult’ the public – ask what we think of decisions already made

Please let us know what you think about the NHS Citizen Programme.

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