Putting patients at the heart of all we do

As NHS England publishes refreshed statutory guidance on the importance of involving patients and the public in commissioning, NHS England’s National Director: Operations and Information, reflects on how successful implementation of this guidance can support the NHS and Care services to meet the objectives of the Five Year Forward View:

Our job as commissioners is challenging – we have many factors to consider before we make decisions.

With increasing demand and ever tighter budgets, we are under pressure to improve health outcomes, deliver quality services and make good use of resources. But how can we be sure that the services we commission best meet the needs – and preferences – of the populations we serve?

Patient and public participation is key to understanding what matters to people, and how we can respond most effectively to that.

The refreshed statutory guidance on patient and public participation in commissioning, for CCGs and our own staff at NHS England, will support us to embed participation in our work. This will be particularly important in the context of our new commissioning approaches, through sustainability and transformation plans, co-commissioning and the development of accountable care systems.

What I like most about the guidance is that it supports us as commissioners to involve patients and the public in our work in a timely and meaningful way. There is no ‘one size fits all’; good participation requires a ‘pick and mix’ approach, where we choose the most appropriate methods to fit the circumstances. The guidance sets out principles of effective participation that can be embedded throughout the commissioning cycle.

It’s impressive to see good practice examples from across the NHS showing how participation has improved services in the eyes of those who use them.

Involving people isn’t always straightforward, it can be uncomfortable and even challenging, and we will never please all of the people all of the time. It takes time to engage people properly and to feed back to them on the impact of their participation. But what’s clear to me is the value of doing it well and that there are some fantastic examples of where the NHS is getting it right.

The guidance also demonstrates the value of working in partnership with others in local government and the voluntary sector to reach communities and understand their needs, whether that be with charities, local Healthwatch, faith groups or patient and carer groups. The guidance highlights the importance of engaging people who may be harder for us to reach, but who experience worse health outcomes and who could, arguably, be more disadvantaged by changes to health and care services.

Not only is involving patients, carers and the public the right thing to do, it’s also a legal duty and as commissioners we need to be able to assure ourselves, and others, that we have engaged people in a fair and proportionate way. The guidance gives clear advice and practical tools to commissioners to meet their legal duties.

As with any guidance, its true value will be demonstrated by how we use it in practice and make participation part of ‘business as usual’.

The Five Year Forward View sets out clear ambitions to improve engagement with people and communities, and make the most of what they can contribute to better health, care and wellbeing for all. This guidance supports us to make the ambitions a reality, enabling us to make the most of people’s experience, knowledge and passion for the NHS to transform our services and make them fit for the future.

Matthew Swindells

Matthew Swindells is NHS England’s National Director: Operations and Information.

He joined NHS England in May 2016 from the Cerner Group and his role as Senior Vice President for Population Health and Global Strategy.

Matthew is responsible for national performance of the NHS against the NHS Constitution Standards, assurance of Clinical Commissioning Groups, achieving a paperless NHS, information and technology programmes and investment in data.

He has over 25 years’ experience in health care services and has worked in the Department of Health as a Chief Information Officer and as a Senior Policy Advisor to the Secretary of State for Health. Prior to this he served as a Principal Adviser in the Prime Minister’s Office of Public Service Reform.

Matthew began his career at Guys and St Thomas’ Hospital in the early 1990s, and went on to become Director of Clinical Services of Heatherwood and Wexham Park Hospital and later Chief Executive of the Royal Surrey County Hospital, in the early 2000s.

He is visiting professor and chair of the advisory committee in the School of Health Management at the University of Surrey and Member of the Editorial Board for the Journal of Population Health Management.


  1. Derek W says:

    Sadly I have endured the most dishonest medical treatment of any of the many countries I have visited, in my view coordinated by my local Clinical Commissioning Group.

    After over eight years of dishonesty it is likely that I will not recover and so will have gone from a World-level veterans’ athlete to my present state – unsure of my future and in considerable pain.

    The NHS should “clean up its’ act” and avoid more unnecessary deaths

  2. John King says:

    We are using simulation to engage patient, carer and citizen groups. A risk free environment is provided where teams can explore, evaluate and communicate the benefits of alternative care models. Buy in and engagement is the key.

  3. Anonymous says:

    Unfortunately hospitals do what they like. I was in the middle of rheumatology treatment then they told my GP to send me somewhere else for no reason. I didn’t find this out until after 3 months of chasing & being ignored. Now I’m suffering an AI condition without treatment after 2yrs. The hospital will not tell me the reason for the decision which according to GMC is incorrect. This is Western Sussex Hospital Trust. If they don’t follow the GMC & treat people like this, what hope is there!!

  4. Fred Bloggs says:

    NHSE et al has a duty of care to provide a safe and stress free environment for all those it works with.
    It is legally bound to do this for its paid employees, but no proper policy exists for unpaid community advisers e.g. Patient Leaders – why?
    In some parts of NHSE there appears an increasingly “yawning gap” between the theory of these documents and their practice – why?
    What is worse dissenters – a vital part of any consultation are, being ,purposely, ignored and/or attacked by NHSE and those who it chooses to work with – leading to disengagement by those that NHSE MUST consult. Why does NHSE allow this to happen?
    NHSE has a desire for transparency, however it appears quite the opposite is happening – why?

    It is unfair and dangerous for NHSE to continue to endorse such practices as bad policies and practices always harm communities NHSE is supposedly meant to serve.

  5. Lynne Craven says:

    I like the guidance… I really do! The title of this blog however! ‘Putting’ patients at the heart… why do we need to be put? We will get there under our own steam… why not consider.. or working with patients in everything we do!

    Please stop putting us anywhere.. it speaks of paternalism rather than autonomy!

    Lynne ‘part-time patient full time patient’