Reinventing the wheel?

Guest post by Johnny Hoover

HealthWatch and NHS Citizen

Your December meeting highlighted again that NHS Citizen is an idea in the very early stages of development and you are at a point where you are still getting to grips with understanding how patients currently interact with the NHS.  Now there’s no harm in mapping all the patient’s “routes to power”, but it seems to me that this is something that NHS England should have been asking of HealthWatch.  Because in the end, if we need to re-engineer those routes through one place, then HealthWatch is the place decreed by statute.  If HealthWatch decide (with input from NHS England) that NHS Citizen is something worth having, then they will have ownership and nobody can argue NHS Citizen is just NHS England’s poodle.

The reality is that NHS England is fully committed to being open to patient, service user or carer’s input.  But, they do not need to take on the responsibility for creating that network.  NHS England is a massive organisation that commissions a myriad of projects and services, and each of these projects and services should be listening to the “patient voice”.  At the highest level NHS England should be kicking HealthWatch hard if the advice, guidance, and people they put up to support NHS England are not actually helping or truly representative of the wider patient body.  Likewise, HealthWatch should be kicking NHS England hard if they allow any commissioning and projects to steam ahead without patient input.

Whatever happens, if there is a need for a Citizens Assembly for the NHS, then it should be driven by and paid for by HealthWatch.

What’s Really Good Right Now – F+F and Care Connect

Whilst you were having your December meeting, the NHS England Board papers were released.  Tim Kelsey’s update on patient involvement was rightly upbeat about the F+F test early results.  And the Care Connect pilot certainly looks like a precursor to more great things ahead.  The data coming from those systems will quickly highlight where there’s room for improvement and make real, quick differences to patient experiences.  And, for NHS England, these are IT projects that can be delivered and can also deliver lots of transparent data.

We need to see NHS England, the HSCIC, HealthWatch, Trusts themselves, the press, and the public getting at this data and coming up with real information that can highlight good performance and whistle-blow on bad.  I’m daft enough to think that something as simple as F+F at South Staffs might have been enough for others who analyse the data to quickly pick up “something’s wrong here”.

The Man on the Clapham Omnibus

My view is that the true “patient voice” is not really about some mythical enlightened patients sitting down with NHS England to come up with a 5-year plan for the NHS.  Their collective voice (including yours and mine) speaks out each time they use the NHS.  All they have to do is tell us what was good, what was bad, and yes, if they can be bothered, how might they see it being improved.  Your average man on the Clapham Omnibus doesn’t care about the arcane workings of the NHS until he falls off that bus and gets a broken leg.

Those individuals (often with long-term conditions) that wish to take a more active role in planning, will work within their local HealthWatch, influencing local care through their CCG.  Through this route, HeathWatch nationally will have a ready breeding ground for the local specialists that will support NHS England nationally.

Use of Twitter and Forums

I think that using Twitter to engender initial interest and “chat” is an excellent idea, but it makes it difficult for those outside the room to ever make any meaningful comments.  I think Twitter should link into a proper forum during events, so that people can debate the issues outside of the rather crass 140-character limits.

The contents of these forums would be a much better place for ideas that would advance the issues, and a better resource when reviewing the discussions.  Lets say that Twitter is “discovery”, but the forum would be “discussion”.

The Future

As a patient/customer of NHS services, I want clear routes to involvement.  For quick feedback, make that F+F and Care Connect.  For complex issues, then offer me the support of my local HealthWatch, my “Citizens Advice Bureau for Health and Social Care”!  Is that not enough?

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One reply on “Reinventing the wheel?”

  1. Thanks for your comment.

    This is an issue that came up at the workshop as well – do we really need another thing when there are already so many different bodies looking out for patient voice?

    It may be that in the end we decide that NHS Citizen adds nothing – that possibility is open – but my current view is that creating routes for *citizen* voice is important, too.

    Taking your Healthwatch point specifically. They have a critical role in holding NHS England, at different levels, to account. However, creating a route for citizen voice on wider priorities is not part of their mandate. One test for whether NHS Citizen is a necessary part of the infrastructure will be whether it can support Healthwatch by bringing new information and insight which will help it to play its accountability role more effectively.

    All patients are citizens, if not in the legal nationality sense at least in the sense of having a stake in the care that they are being provided with and having the right to comment on it. However, not all citizens are (yet) patients. To take the patient experience of the NHS as the only area where public engagement is needed would be to reduce the debate to an important, but not the only important, perspective.

    In fact, the NHS spends billions of pounds of public money every year, often on services and treatments that make a significant difference to a whole community, not just the users of a particular service.

    My vision (personally speaking) for NHS Citizen is something that gives people a chance to be involved as citizens rather than as patients or as bits of data on a spreadsheet – to discuss and shape the way in which services are decided upon, as citizens in a democratic discussion, rather than service users or consumers.

    I also want to create something that is a support and a connection for existing patient voices – and creates a wider and more joined-up conversation about the health service, that the NHS Board and managers lower down will not be able to ignore.

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