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NHS England must get smarter about how it engages the public

Chris Wajzer looks at how the NHS should be engaging citizens to tackle this spending challenge

NHS providers will record a deficit of £2.45 billion for 2015/16. And last week it was revealed that more hospitals may close as part of NHS England’s Sustainability and Transformation Plans (STPs). Chris Wajzer looks at how the NHS should be engaging citizens to tackle this spending challenge.

For ordinary citizens, last week’s media coverage was likely the first they heard about the NHS Sustainability and Transformation Plans (STPs). According to the Guardian, the plans have been ‘shrouded in secrecy’ with the public largely unaware of how significant the changes are going to be. The STPs — of which there will be 44, one for each of NHS England’s ‘designated footprints’ — are five-year plans for radically transforming the way care is organised and provided. They are a crucial part of addressing the unprecedented financial challenges currently facing the NHS. NHS England will eventually consult the public — as it is required to do — but it appears that this will take place once the plans have more or less been formulated. Such an approach risks being perceived as a ‘decide and defend’ strategy and goes against the grain of best practice when it comes to genuinely engaging citizens in decision making processes. The public cares deeply about their healthcare system and want to have a voice on the choices it faces. While some elements of the STPs may be welcomed, others, such as hospital closures, will undoubtedly result in controversy and backlash. As we’ve previously seen, failing to engage is more likely to result in protests, judicial reviews and decisions being overturned. In our work on Smarter Engagement, we looked at case studies of citizen engagement where governments had moved beyond typical consultation approaches to involving citizens in tough decisions. The lesson for NHS England is that while there may be reasons for not engaging citizens earlier — such as time constraints or fear of negative headlines — any gains from not bringing the people into the decision making process is likely to be a false economy. Quality and resilience of government decision making is significantly strengthened when citizens are involved in the process and given opportunities to help shape solutions. In fact, people were willing to think differently about some of the issues they are most passionate about, and get involved in finding solutions to the challenges of spending cuts, service reconfigurations and infrastructure development when given the opportunity to engage more deeply. For example, in 2008, Redbridge Council sought to engage the public in the trade-offs that it faced in its difficult budget deliberations. To do this, they developed the 'YouChoose' platform which allowed participants to propose their own adjustments to the council budget. The savings programme that was implemented largely reflected the decisions made by citizens, who opted to make larger cuts to environmental and housing spend while making smaller cuts to education and community safety. Similarly, Thurrock Council involved the public in its decision to close the council’s large, costly multi-purpose day centres. To overcome opposition and ensure the process of reform resulted in a better service, the reconfiguration was run as a co-design process that engaged the public and users from the start. In both these examples, citizens worked with decision makers to understand trade-offs, agree less contentious solutions and even generated opportunities for service reform that could not have been anticipated without their input. NHS England is now on the back foot, with the press framing this as largely about cuts, rather than a more balanced discussion about reconfiguring health and care services to match people’s changing care needs. The NHS funding crisis is not going to go away — and citizens need to be involved in agreeing solutions. But the mind set of decision makers on the value of engagement needs to change. Consultation after plans have been made will not be enough to convince an already sceptical public to back the hard decisions required to ensure the future sustainability of the NHS.
May government
Institute for Government

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