NHS England’s broken promise & forgotten legal duty – to involve us, the public, in decisions about NHS services.

N-NHS-PV (National NHS Public Voice) has seen how NHS England has broken its promise to involve the public in all decisions about services – and is now treating their legal duty to do so as ‘optional’. We’ve also seen how we, the public, are now excluded from influencing any decisions about services and the future of OUR NHS.


In 2013 NHS England created NHS Citizen as a way of involving the public in decisions about our NHS.  BUT in 2016 they decided to redesign it.  They closed it without telling us. They didn’t share their planned new design with us.  They took it straight to the Board for approval without us knowing what was in their new design.  They are NOT involving us in decisions – not even about NHS Citizen – which is supposed to be a ‘service’ to ‘enable’ us to be involved in NHS England’s decisions about services!

NHS England was created in 2013 by the Health & Social Care Act 2012, but first called the NHS Commissioning Board, to take responsibility for the arrangements of NHS services in England.

The NHS in Scotland, Northern Ireland and Wales is run by their own ‘devolved’ parliament or assemblies.

The Act also says they must involve the public in their decisions about NHS service planning – a legal duty to involve us.  At first, NHS England (NHSE) made a number of commitments to work with patients and the public to make sure we were involved in planning NHS services.

Commitments, or promises, such as:

  1. The NHS Constitution which gave us rights and NHSE made some pledges
  2. NHSE Patient & Public Voice – legal duty to involve us in decisions about services
  3. NHSE to be held to account –  by a Patient & Public Participation Oversight Group?
  4. NHS Citizen & Assemblies – to enable us to be involved & have influence

BUT – things started changing during 2014 and changed completely in 2016

A.   NHS Citizen Workshop – didn’t work with us, to improve NHS Citizen – did it ‘for us’

B.    NHS England Board decided a ‘new approach’ for NHS Citizen – no public involved

C.   NHS Citizen Programme Board created – but the public was not involved or even told

1. NHS CONSTITUTION:   nhsconstitution

The NHS Constitution is a Department of Health pledge to the people, updated every ten years. It says “The NHS belongs to the people” and NHS England promised to abide by its principles and values.

What NHS ENGLAND promised:

  • To follow “[Principle] 7. The NHS is accountable to the public, communities and patients that it serves.” …..  “The system of responsibility and accountability for taking decisions in the NHS should be transparent and clear to the public, patients and staff.
  • to provide you with the information and support you need to influence and scrutinise the planning and delivery of NHS services (pledge);

What we got:

The ‘responsibility and accountability for taking decisions in the NHS’  is NEITHER transparent NOR clear to us:

  • We don’t know who represents us – the patients & public – in decisions
  • We don’t know what they say and do ‘on our behalf’
  • We can’t share our views with them – and they give us no feedback
  • Records of decisions they make ‘on our behalf’ are NOT in the public domain

2. NHS ENGLAND Patient & Public Voice:

What NHS ENGLAND promised:

  • To meet their legal duty to involve individuals who use services (patients), or who may use them (the public), in service decisions and NHS planning – as stated in the Health & Social Care Act 2012 Section 23. 13H & 13Q.
  • To have regular progress ‘Patient & Public Voice’ reports at all Board meetings on how these legal duties are met

What we got:

  • NHS England started to involve us via NHS Citizen ‘Gather’ (see 4. below)  – but now does NOT involve individual members of the wider public at all
  • NHS England now ‘engages’ stakeholders such as voluntary sector service providers, social enterprises (e.g. Healthwatch), patient groups (e.g.the ‘seldom heard’) but NOT with the public
  • NHS England selects and pays people (who are NOT accountable to the public) to act ‘on our behalf’ – as Non-Executive Directors or as Patient & Public Representatives
  • The ‘Patient & Public Voice’ regular progress report at each NHS England Board meeting only happened between December 2012 & May 2014 –  then it was STOPPED


What NHS ENGLAND promised:

  • To show that it DOES involve the public in decisions about planning services by a having a ‘Patient and Public Participation Oversight Group’ check that they do
  • This group includes patient & public representatives
  • It reports to the NHS England board to reassure them the public ARE involved in service planning decisions, and in the development of any proposals to change services

What we got:

NHS ENGLAND’s Patient & Public Participation Oversight Group does NOT:

  • Meet in public
  • Make their meeting agendas or minutes public (for us to see what they say)
  • Tell the public who the patient & public representatives are on this group
  • Report to NHS England’s Board Public Sessions so their findings are on public record
  • Add their ‘assurance’ on public involvement to the NHS England Annual Reports
  • EXIST – maybe not – there’s no public record of its existence, except in the Policy document ‘Statement of Arrangements and Guidance on Patient and Public Participation in Commissioning’ (on P25 Point 4.5)

(APOLOGIES – This document has been moved or deleted from NHS England’s website)


NHS CITIZEN – was created in 2013 by NHS England to involve members of the public in their work.  An NHS Citizen website was set up with some ‘Gather’ pages that allowed public conversations online about people’s NHS concerns and ideas for improvements. NHS England regularly made promises to develop NHS citizen by working with the public.

What NHS ENGLAND promised:

  • To ‘enable’ public involvement ‘without seeking to control’ (6/11/14 NHSE Board report P8,point 14)
  • To allow public influence by posting and discussing concerns/ideas on ‘Gather’
  • Issues would be voted on and a few discussed fully at an NHS Citizen Assembly of members of the public and members of NHSE Board
  • To be held to account by holding  NHS Citizen Assemblies each year for ‘citizens’ (the public) and Board members to agree actions for the Board to take
  • The Board would give feedback on the agreed actions taken
  • To evaluate the NHS Citizen programme by working with the public
  • To continue to develop public involvement online via NHS Citizen‘Gather’

What we got:

  • NHS Citizen became ‘controlled’ by staff who were NOT ‘facilitating’ or ‘enabling’
  • Few decisions were influenced and ‘Gather’ was very tightly controlled – ‘top down’
  • Public votes selected a number of issues – but the staff selected a shortlist and a citizen panel to choose the final five to go to the NHS Citizen Assembly
  • NHSE Board FAILED to report actions taken after the LAST NHS Citizen Assembly held in November 2015, despite discussing five issues in full with ‘citizens’
  • The NHS Citizen website & ‘Gather’ was CLOSED, with NO warning in May 2016
  • The Participation Team REFUSED to meet with concerned ‘Gather’ contributors
  • The NHS Citizen Learning Report was written by staff, NO public contributors to NHS Citizen were involved in either the analysis or the recommendations
  • There is now NO public forum for ‘citizens’ to discuss NHS matters together

In 2016 things changed – more control – less involvement


This was planned for September 2016, after some contributors to NHS Citizen ‘Gather’ contacted the Participation Team when the site had been closed with no warning in May 2016.  We were told the workshop would be staff working together with people involved in NHS Citizen so far, to look, together, at how to improve NHS Citizen. 

This Workshop is discussed in full in our recent post What really happened at the NHS Citizen Workshop – September 2016.  However the key points are repeated briefly below.

What NHS ENGLAND promised:

  • To concerned ‘citizens’ they’d only invite NHS Citizen contributors to the workshop
  • To plan the workshop with NHS Citizen contributors able to say how it should be run
  • To share ideas staff had already shared with NHS England and add any ‘citizen’ ideas
  • To work collaboratively with those attending to agree the future of NHS Citizen
  • To give written feedback from the workshop to people attending
  • To create a steering group with the public to plan the future of NHS Citizen
  • To give feedback from the Sep. 2016 NHS England Board on the plans for NHS Citizen

What we got:

  • They invited providers & commissioners taking up places so some public couldn’t go
  • The workshop was NOT planned jointly with NHS Citizen contributors
  • Only a BIT of the Participation Team’s NHS Citizen plan shared with the workshop
  • We ASKED for nhsc-workshop-slides-handout – got it, incomplete & very much later
  • The workshop was VERY controlled and ‘citizen’ ideas were not discussed openly
  • The workshop was NOT asked for decisions or if they agreed with what they were told
  • NO written feedback from the workshop was sent out to people who attended it
  • NO steering group was set up – or if it has been it’s a SECRET
  • NO feedback was sent out about the Plan discussed at the 29/09/16 Board meeting
  • The NHS Citizen Plan presented to the Board was NOT shared with the public  (unless you know to look on the NHS England website Board pages for the agenda item document)


A plan was presented to the NHS England Board meeting in September 2016, written by the Participation Team, and didn’t include any suggestions from people involved in NHS Citizen.  They described it as a ‘new approach’ for improving the quality of customer insight through NHS CITIZEN.

The Board Paper is discussed in more detail in our recent post The last NHS England Board agreed a new ‘NHS Citizen plan’- to involve the public – that didn’t involve us in deciding what was in it!

The content of the NHS Citizen Programme is discussed in another recent post Will the New NHS Citizen Programme involve citizens (people)?

However the key points of both are repeated briefly below.

What NHS ENGLAND promised:

  • The workshop was told a ‘skeleton idea’ was shared with the NHSE Board early in 2016
  • There was ‘NO DONE DEAL’
  • The Board Paper would be shared with ‘citizens’ at the workshop – once written
  • A steering group would be set up to help decide how NHS Citizen develops

What we got:

  • It was NOT a ‘skeleton idea’ – we were NOT told of the ‘revised model’ of NHS Citizen developed in 2015/16 – see the Board paper  P2 point 5
  • The workshop was NOT given detail of the ‘new approach’ for NHS Citizen
  • They were NOT asked to support any of it
  • There is NO written record of the workshop to prove this
  • The Board Paper WAS a ‘done deal’ – a new NHS Citizen service is imposed on ‘citizens’ who had no say in its content
  • NHSE Board members were misled – the workshop was NOT asked to support a plan
  • They were misled again – NO suggestions in the Board paper are from NHS ‘citizens’
  • And misled again – they were NOT told the learning report recommendations were NOT agreed with the public
  • This ‘new approach’ for NHS Citizen has NOT been shared with the public
  • It has still NOT been sent to the people who were at the workshop
  • The steering group (see P 5 of the Board Paper, point 18.iii) has still NOT happened
  • OR if it has – it’s a BIG SECRET


This was mentioned in the Board paper but was news to everyone who had been involved in NHS Citizen over the last three years or more.  It was not mentioned at the September workshop.

Invitations to the public to apply to be an Expert Patient Adviser Board Member were circulated to ‘citizens’ via the In Touch emailing, and advertised on the NHS England Involvement Hub.

But there was only three weeks to apply, and if you didn’t have strategic experienced you were put off applying. (see the application pack including the new Board Terms of Reference – citizen-prog-board-info-pack.)

We discussed this in a recent post New Public NHS national Board members will be accountable to an NHS England manager – and NOT to Patients or the Public and our conclusions are repeated below.


  • The existence of this Programme Board is news to us
  • It has been imposed on us and we cannot influence it in any way
  • The Expert Patient Adviser Board members are not accountable to us
  • They are ‘managed’ by the Director of Patient & Public Voice & Insight
  • We do not know who they are, or if they understand meaningful involvement
  • The meetings are not in public – we do not know when they met
  • The minutes and agendas of the meetings are not shared with us

OUR CONCERNS (from the recent post on this subject) ARE:

This is not acceptable!  It is not honest – and it is disrespectful to the public.

  • The invitation to apply  to be an Expert Patient Advisor misleads people
  • The members of the public on the Board are not accountable to the wider public.
  • They are not required to be experienced in patient and public involvement.
  • These public Board members are not able to act independently in their roles.
  • The Director of Patient & Public Voice & Insight (PPV&I) selects them and manages their performance and how they carry out their duties.
  • The Director of PPPV&I has total control over patient and public involvement.
  • There is no collective, independent, inclusive and representative NHS Public Voice.

We now have no say in the future of our Public Voice.

We now have no Voice in OUR NHS.






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