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Ending the ‘us and them’ mentality – Mark Doughty

Patient leader Mark Doughty explains why it is important for NHS leaders to engage patients in care, drawing on experience of The King’s Fund’s collaborative pairs programme:

System leaders have talked for years about engaging patients in decisions about the future of health and care services.

I think we are now on the verge of a real breakthrough.

Earlier this year I was co-facilitating on a programme called ‘Leading collaboratively with patients and communities’. This ground-breaking programme brought together 12 ‘collaborative pairs’ of patients and health professionals to work on a range of local initiatives, supported by The King’s Fund.

A diverse group of patient leaders and health care professionals sat around a table talking about how they might resolve a particularly thorny issue in their local health care system.

What struck me was how they tackled this issue. People listened deeply with respect and a desire to understand.  The questions being asked were focused on inquiring into and clarifying each other’s – and their own – thinking, including their assumptions and beliefs and how they had made sense of the situation. As the dialogue progressed, people shifted positions as they responded to others’ reflections. A common understanding began to emerge and a number of options were co-produced that could be taken forward.

I had been privileged to witness collaborative and partnership working that had seen a group of diverse and disparate individuals come together and, through the quality of their relationship and dialogue, generate insights and breakthrough thinking and achieve an outcome that they all later acknowledged they could never have achieved on their own.

I believe that this, with its focus on inclusivity, and its empowering, ethical and value-driven approach, was an example of the new relationship with patients, citizens and communities called for in the NHS Five Year Forward View.

However, as a patient leader myself, I know that at times it can be difficult for system leaders to work together in this way. I have sat in meetings where conversations have sometimes degenerated into the type of debate where people from different professional backgrounds and interests have argued their point with other ‘experts’, with each group (including the patients) assuming that they knew the answer to the presenting issue and trying to convince others that they were right.

In this situation, success was measured by ensuring they left that room having not ‘lost’ anything. This ‘us and them’ mentality just seemed to perpetuate stuck thinking and adversarial relationships in which everyone was a loser, including and especially the patient.

Tomorrow is the NHS’s 68th birthday, which offers me time to pause and reflect. As a patient with a chronic long-term condition I have a vested interest in the vision outlined in the Forward View. I also want the principles, values and objectives enshrined in the NHS constitution to guide how we enact this vision.

I am particularly interested in: ‘The NHS aspires to put patients at the heart of everything it does’. As a patient and patient leader I have experienced both operationally and strategically the NHS getting this right; however, I have also been on the receiving end of care where this has not been the case. Then I have experienced at first hand the ‘factory’ model of care and repair and limited engagement talked about in the Forward View.

My work as a patient supporting health and social care leaders to partner and collaborate with patients and their communities has provided me with a number of insights into how we can support the delivery of the Forward View. First, it is crucial that our conversations have an emphasis on dialogue not debate; second, it is important to use the principles and practices of co-production when we work together; and third we should focus on a mindset that actively seeks out different and diverse viewpoints and experiences.

What encapsulates all of this is relational leadership.

I hope every NHS organisation can seize the moment by committing to a new partnership with patients, which puts their perspective at the heart of everything the NHS does.


Image of Mark DoughtyMark Doughty co-founded the Centre for Patient Leadership (CPL) in 2011 where he is responsible for designing their model of patient leadership.

This was shortlisted for the Guardian Healthcare Innovation Awards in 2013. He was also a finalist in 2012 for the International Ashoka Changemakers Innovation for Health Award.

Since 2012 Mark has facilitated leadership development programmes for more than 500 patient leaders. He has also coached and supported lay assessors for the CQC, the People Champions on the board of the NHS Leadership Academy as well as CCG and Healthwatch chair and board members.

He co-authored a series of articles written for the HSJ on patient leadership and his work is quoted and referenced in The King’s Fund’s report on Patient-centred leadership.

Mark has worked as a L&D manager in primary care, supporting staff to develop their leadership potential. He is also a member of faculty at the NHS Leadership Academy and he runs a business supporting people with disabilities and health conditions to become leaders in their organisations.

He has been a member of the BMJ Learning Advisory Committee and an associate with The Employers Forum on Disability and a trustee with Arthritis Care.

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