There has been a lot of talk in the run up to the NHS’s 70th birthday this week. It remains a national treasure, second only to the Queen, sacred and woven into the fabric of our society.
The cause of much discussion and disagreement, more often than not dominating the news of the day, the biggest political football with which parties attempt to score points. The pride people have in the service is beyond acute, summed up very well in an expansive Ipsos Mori survey presented at a conference I attended earlier this year (at the end of his presentation Ben Page kindly shared the slides with the audience and invited to share so you can read the full report here – its really interesting).
I have been thinking about it a lot from an MES perspective recently as you’d maybe expect. We work with over 200 NHS organisations day to day in the field of public engagement, patient experience and governance. We provide software solutions and on-the-ground support for teams across the NHS tasked with involving the public in decision making and holding leaders to account.
This just wasn’t a thing 20 years ago let alone 70. Can you imagine doctors, health leaders and politicians having these kinds of conversations in 1948 …?
“Let’s consult with the public on these changes because they’re pretty radical guys” (yes Aneurin Bevan did speak like this but with a Welsh accent)
“Shall we have a focus group on this to see if we are on the right lines?”
“Maybe the third sector have some thoughts on these proposal so we should get them in, especially as it will impact their work significantly”
“Let’s not forget the patients and staff. Let’s see what they think to all this”
But it was like this for decades. Doctor knows best and all that.
In 2018 can you imagine something as game changing and significant being proposed WITHOUT public and stakeholder involvement at the design stage? The game has changed, following three key things that started at the beginning of this millennium –
- The age of digital; internet, social media; mobile phone proliferation; 24/7 media and news coverage – this has all totally changed our expectations and demands as a society. We demand to know, to know more, to know faster, to know stuff we think we have a right to know about, to know stuff we think we may have an opinion on, and to have our say. And having our say has of course become that much easier as a result of the technological advances we are seeing.
- Devolution of decision making away from Whitehall. The creation of Foundations Trusts, CCGs, localising health decision making (a work still in progress) has meant a need to put in place structures and mechanisms for accountability and more transparent decision-making. New pieces of legislation needed to deliver this agenda have to factor in good governance. Events such as the Mid Staffs scandal result in further drives for better accountability, and the creation of documents and initiatives such as the NHS Constitution with its 7 principles guiding the NHS to invite and promote involvement from the public. It is now expected. And this in turn has affected our expectations. Again, read the Ipsos Mori survey in full here but for a quick highlight, this slide shows a huge percentage of the public stating they should be consulted on decisions and more actively involved in decisions shaping treatment and services.
- Politicians and health sector leaders, at least the savvier ones, have started to understand that public involvement, at early stages of scoping and design, and then on an ongoing basis does actually make for better governance and better decisions with broader buy in. As a result responsibility is shared – decisions are collaborated on and on-going management held to account by a broader group of stakeholders. That’s a good thing right?
The past 15 years or so has seen unprecedented advancement in this area of work. It is not perfect by any means – there is too much ‘tick box consultation’ or ‘PDC’ (post-decision consultation) which can be incredibly damaging and off putting. People want engagement, but they want it to be genuine and to have purpose. The demands on the sector and the growing urgency to tackle our NHS funding crisis in the face of the challenges ahead with care needs, an aging population, staffing challenges and more means that proper, planned, pre-meditated public engagement ends up as a rushed botched job with damaging consequences. More haste, less speed.
But look at where we are, the digital tools at our disposal, the frameworks we have for involving people and the appetite amongst the public to contribute to our national treasure. That is a great position to be in and the NHS’s leaders of 2018 should seize the opportunity presented. We can, should (and I expect will) build on this and ensure that the next 70 years of the health service are the best yet.
Blog by Nick Goodman