Engaging the public in designing the future for the NHS

This content relates to the following topics:

Part of The public and the NHS

In a guest blog for our public and the NHS project, Michelle Dixon, Director of Communications, Imperial College Healthcare NHS Trust, reflects on how important public engagement will be in designing a workable future for the NHS.

BBC2’s Hospital – the 2017 documentary series that featured Imperial College Healthcare’s five hospitals – challenged my thinking about the relationship between the NHS and the public. The most significant conclusion I came to was that the public needs the opportunity to make sense of what’s going on in the NHS for themselves, so together we can develop a workable plan for the future.

That doesn’t mean NHS leaders have less of a role to play in driving and shaping change than in the past – just a different one. We have to let go and actively encourage everyone – staff, patients, families, carers – to share their experiences and views as well as the ideas these spark. The job of NHS leaders is to provide easy access to the information people want, make sure we listen and understand what they say, and use their insights to help create a shared story of changing need and care that is both constructive and credible. And we need to provide the mechanisms for making those changes in partnership with one another.

With 1 million patient contacts every 36 hours and more than 1.5 million staff, most people have regular experience of the NHS, directly or through family or friends. They see what is happening though, not generally, why or how it’s happening. And they’re interested – what they see or hear often provokes strong feelings – everything from awe to despair.  

For five weeks in autumn 2016 and again in spring 2017, seven camera crews filmed pretty much where and when they wanted at Imperial, as long as staff and patients consented. From all that footage, series producers, Label1, created ten programmes of compelling television and each episode stayed true to the complexity of the NHS and health care – no clear choices, no easy answers and no villains.

With 1 million patient contacts every 36 hours and more than 1.5 million staff, most people have regular experience of the NHS, directly or through family or friends.

Our team at Imperial had wanted viewers to be given an open and honest account of what goes on every day – the highs and the lows, on our wards and in our theatres, clinics and meeting rooms. We expected to see an increase in recruitment and in staff morale as a result of the programmes and we hoped we could help inform thinking and generate some discussion about the challenges and opportunities the NHS faces. But the scale of the response – an average of 2.5 million viewers per episode – took us by surprise.

The series generated scores of stories in the news; there were thousands of views of our blog posts offering more background on the issues explored in the programmes; and we gathered many hundreds of new social media followers with each episode generating debates that trended on Twitter. The Trust even saw a dip in formal complaints about issues like waiting times and cancelled appointments.

It was the level of public engagement in the NHS’s complexity that I found most interesting. Given the scale of the challenge we face in the NHS and the fact that we will need to make some difficult trade-offs, generating and sustaining engagement – which can build understanding and trust – seems fairly critical.

Sustained engagement – or discussion, in normal parlance – would also open up involvement in the organic change that is actually the reality of ‘transformation’ in the NHS. Change that is messy and tends to take a few wrong turns on the way to producing practical improvements in response to real challenges. The rapid, but unexamined, expansion of ambulatory emergency care is a good example of this type of change. It’s now helping thousands of people safely to avoid hospital admission but could be having an ever greater impact with patients and the public involved in its design – a more helpful name for starters.

Compare that with the ‘town hall’ public meetings, hundred-plus-page ‘case for change’ documents and detailed feedback surveys that characterise formal consultations, for example, on a service move. It’s not that changes don’t deserve detailed scrutiny, it’s more about the imbalance of resource and attention and the often simplistic, binary nature of the ‘set piece’ approach – is it a good thing or bad?

Not everyone will want to play an active part in ongoing discussions but it’s vital that everyone has the opportunity; that NHS leaders do what we can to make it attractive and easy to join in and listen and respond while also feeling able to champion and challenge.

There are many simple things we can do to improve engagement. It’s interesting how even small schools are using inexpensive digital tools to keep parents informed, to encourage and offer ways to get more involved and, in some cases, to provide a platform for discussion. From a quick scan of regular posts on the ‘Parentmail’ system of my children’s school, I know what is going on as well as something about the challenges it’s facing. I feel that I can get more involved if and when I want to. And I know there are many other parents who have taken the opportunity to become involved.

Not everyone will want to play an active part in ongoing discussions but it’s vital that everyone has the opportunity; that NHS leaders do what we can to make it attractive and easy to join in and listen and respond while also feeling able to champion and challenge.

At Imperial, we’re exploring a ‘customer relationship management’ approach to facilitating engagement – something that is common place in commercial organisations. Companies ask their customers at key points whether they would like to be kept up to date with news and promotions and they look to understand all the different ways their customers interact with them. They build and use these relationships for commercial advantage – to create ‘warm prospects’, to understand and segment their target audiences and to develop and tailor their offer. We want to build relationships in a similar way but use them to help create mutual understanding and increase involvement in all aspects of our work. I’d love to hear from NHS organisations that are already working in this way.

At Imperial, we think we can generate significant engagement if we properly co-ordinate and package our offer – sharing stories from staff and patients, research breakthroughs and new trials, advice from health experts and examples of, and opportunities for, influence and impact. Above all, we want to make it easy to access all the facts and figures as well as the everyday, life-or-death dilemmas that provide a true and rounded view of our NHS to complement an individual’s own experience.

Not a million miles away from some of the principles of foundation trust membership, perhaps, but with a slightly different set of drivers.

Staff at Imperial provide care for more than one million patients a year across five hospitals. If even a fifth of our patients signed up to a basic level of contact, that’s 200,000 potential relationships. Clearly, we need to ensure we reach far beyond a traditional BBC2 audience but the wider interest in the stories covered in Hospital indicates that’s entirely possible.

It’s important, too, to understand who patients and the public consider their relationship to be with and how we deliver on that expectation. Managing and delivering our engagement offer requires a corporate infrastructure but the key is in ensuring it acts to facilitate and enhance a relationship directly with clinicians and frontline managers. And, as the spectrum of NHS organisations and local authorities grapple with genuinely integrated care models, we also need to be thinking about what genuinely integrated communications and engagement looks like from an individual’s perspective.

Giving the public access to the service front line to help them reach their own conclusions, rather than telling them what they should think, is likely to be increasingly important across many areas of public policy. If we can develop a shared understanding of the NHS’s complex challenges and opportunities, we are more likely to be able to generate a sense of shared ownership and the impetus to create and deliver a shared vision for the future.


Mr R W Ebley

Comment date
01 February 2018

All levels of government and other public funded organisations need to demonstrate good management

Independent management accreditation is required to achieve this

Thank you

Alyson McGregor

National Director,
Altogether Better
Comment date
05 February 2018

I agree with Michelle that we do need to create every opportunity for fresh and meaningful conversations with the people who we provide services for, but it is a real relationship where people get involved and generously give their time because they share the values of the NHS and want to play their part in being well. It is not a business relationship of customer and service . In Altogether Better we create collaboration between those working in health services and people from local communities, we create a fresh new space where change can happen and lives and services can be transformed. Our model of collaborative practice invites local people to gift their time as health champions, working alongside health professionals to reshape services. This opens up a range of new possibilities and helps services offer new, innovative activities and support. By changing who’s in the service ‘family’, we change the identity and culture of the organisation, creating new extended teams and reducing pressure on staff, while also making life better for everyone.

Eddie Duller OBE

Director/Trustee Communications,
Healthwatch Oxfordshire
Comment date
05 February 2018

Talking to the public in plain English is a necessity and I have found that they are only too willing to join a discussion if they understand what people are saying. Even the piece on communication drops into NHS-speak every now and again. Doctors and nurses often get praise but the management in NHS is suspect and top heavy and most people who work in the commercial world are well aware of this. The public is also fed up with NHS staff asking for more cash rather than looking at ways of improving the service within current budgets - another reality in commercial life.

Add your comment