From talk to action: what happens after the NHS Citizen Assembly meeting?

While voters in Scotland were deciding on their independence, the NHS Citizen team were running the first full test of a very different form of democratic participation; the NHS Citizen Assembly Meeting.

This test of the Assembly was the result of 18 months of work with citizens and partners around England to design NHS Citizen.

This is intended to be a new kind of approach to public participation for NHS England and aims to answer a very simple question: what is the best way for NHS England to take into account the views of everyone in its work and decision making?

Access Dorset has produced a fantastic short film that describes the work that has been undertaken to develop the work this far:

The Assembly Meeting was a chance for citizens – patients, carers, staff and interested members of the public – to work on various issues collaboratively together and with NHS England Board members.

The test Assembly dovetailed with NHS England’s second Annual General Meeting, which took place immediately after the NHS Citizen Assembly and was informed by what had been discussed throughout the day.

The Assembly session brought together over 250 patients, carers, activists, volunteers, voluntary sector and public services workers who worked together with the NHS England Board in an informal and deliberative setting.

The participants were self-selected and mostly had a history of active participation in the health system through employment or personal experiences as patients or carers.

Participants joined groups to discuss different issues based on their own interests, expertise and personal experience.

The issue groups were: Access to Services; Mental Health; Young People and Healthcare; Gender Identity; and Self-care and Personalisation.

These topics were identified by grouping together the most popular issues among those submitted by citizens in a separate test of NHS Citizen’s online Gather process in order to form the agenda for the day.

For each topic, participants who had flagged issues through ‘Gather’ volunteered to present the issue at the Assembly Plenary, explaining what drove them to raise it and why it is important to them.

Assembly participants spent the first part of the day building a shared understanding of the issues and identifying key questions. NHS England Board members joined the conversations after lunch as they moved towards identifying potential solutions.

All seventeen Board members joined the five discussion groups and participated actively in conversations about the issues, deepening their own understanding and starting to consider how these issues have wider resonance across health and care.

Observing the interactions between Citizens and Board members was interesting and it was often a challenge to keep the dialogue open without it becoming drawn into a question and answer session with those in positions of authority.

The conclusion of this test assembly process was the start of the formal AGM where the five lead Board members summarised what they had heard during the afternoon and reflected on what action they would consider as a result.

Four citizens from the Assembly session joined with the Board members on stage and had the opportunity to reflect back, comment on and challenge the Board members on what they had heard.

I found it very interesting to observe the shift in conversation between the Assembly session, where we worked hard to encourage a dialogue of equals, where citizens and board members had respectful conversations focussed on what might be possible, and the formal AGM where some of the audience joining for that event preferred an adversarial culture of ‘them and us’ with people who were passionate about the NHS feeling the only way their voice could be heard was to shout over others.

NHS Citizen is about hearing everyone’s voice and taking account of their views, whatever they may be. I hope that those who feel so passionately about the NHS feel they can engage in this process going forward.

At the NHS England Board meeting the following day Board members expressed their thanks and gratitude to all those who took the time to participate in the day’s events. They noted that people care hugely about the NHS, and their gratitude for the service that it provides is in no way diluted by the criticisms and suggestions for improvement that came through in all of the sessions.

They agreed the importance of ensuring quick and transparent action on the issues raised and have asked for a paper to the next public meeting on 6th November. This paper will describe what steps NHS England is already taking, and what further actions it’s considering to make progress on the issues raised.

One of our next challenges for NHS Citizen is to describe and define what the long term support functions are that we will need to ensure the model as we have developed it is able to function in a enabling and facilitative way that leads to action quickly.

Join in and contribute by signing up at NHS Citizen and follow #nhscitizen.

Olivia Butterworth

Olivia Butterworth is Head of Public Participation for NHS England and NHS Improvement.

She ensures the NHS works with citizens and communities to have a voice that influences the development, design and delivery of our health and care services.
Olivia is the national lead for the People and Communities workstream of the Primary Care Networks programme and was named in the HSJs Top 50 Innovators and the Top 50 Integrators in 2014. In 2018 she was named as one of the Top 70 NHS Stars.

She has a background in Community Development and education with a passion for empowering people to be their own change.

Olivia has worked with a wide and diverse range of voluntary sector organisations, both in paid and voluntary roles, providing support with organisational development, developing services, engagement, involvement and fundraising. Olivia is very proud to be a Trustee of Manchester based LGBT Foundation and a Non-Executive Director of Local Care Direct.

You can follow her on Twitter @LiviBF

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  1. Fiona Carey says:

    I was wondering about whether anything concrete had come out of the conversations held at NHS Citizen and during the AGM?
    I think that we, collectively, probably failed to articulate sufficiently clear objectives. If anyone asks now, I have no idea what might have changed as a result of it.
    It’ll be hard to get people to come back and join in again, if it feels as though it was just another interesting conversation.

  2. ANITA HIGHAM says:

    Question to Olivia Butterworth :
    How is the NHS Citizen Assembly relating with Healthwatch England and with Local Healthwatch organisations?
    How does HWE relate with the NHS Citizen Assembly?