This is a quick post with my reflections about NHS Citizen, a project I’m working on at the moment you can find out more about here.
1. NHS Citizen, as well as the NHS, can be better at accessibility: We talked in the assembly session about making information accessible – and it’s occurred to me that we really need to ‘start at home’ with this idea. I took away from that assembly session a feeling that transparency (something we talk a lot about) is only as good as its visibility accessiblity and consumability. In other words, making what we do more transparent doesn’t mean it’s easier for people to understand or take part in. This is a big challenge – and one that’s about the language we use, how we communicate, how we tell the story of NHS Citizen and where we tell it.
2. People need to see change to believe in it: I got to speak to a lot of people at Expo, almost all of whom were enormously positive about NHS Citizen’s aim to make the voice of the citizen find its way to power in the NHS. But I also heard a lot of scepticism about whether this could succeed. While no one could take issue with our intentions it felt like there was a view that the NHS won’t respond to change. Whether or not that’s the case it reinforces in my mind the value of the organisational development work that the Tavistock Institute is doing as part of NHS Citizen. In particular, it felt to me that it will be very, very hard to convince people that #nhscitizen can work without this work and its successes becoming visible.
3. People also need to be part of change: If you go online and sample some of the Twitter conversation about NHS Citizen it isn’t just people slapping us on the back. There are dissenting voices. I heard that people didn’t feel like this was reflective of them, that it was just a sham and a waste of money. It would be easy to shy away from these voices – but so far I think we’re trying really hard not to do that. Importantly, the more that we speak to people – and accept that this isn’t a perfect system or that we’ve got everything right – the better. People will feel better about this if they feel we’re listening and that they can take part.
4. The project team needs to grow: I think part of this is about understanding that more people have to have ownership for NHS Citizen – and I’m not necessarily saying that this is about project team members. Obviously the more voices singing from the hymn sheet the louder the message (if this isn’t just a terribly mangled metaphor, which it almost certainly is). Having looked a lot online over the weekend, we’re doing a pretty good job of talking about NHS Citizen and to a group of people who we can expect to be interested in it – the next challenge is getting them to talk about it and to others well beyond this group. For this to happen they will need a sense of ownership over the process, to feel as if they’re part of the team.
5. ‘NHS Citizen isn’t a thing’: For some of the time at Expo I was network mapping, as part of our ‘Discover’ strand. This involved asking people what organisations they’re connected to. It was fascinating finding out how people are often at the heart of large, unique networks that link quite disparate organisations. It became clear that some may even be the only connections these organisations have. It showed me that institutions are nothing without individuals. Indeed, I felt some of the criticism NHS Citizen confronted at Expo was from those who were assuming it was an institution, because its name included the abbreviation, NHS. In fact, very much the opposite is true. Anthony Zacharzewski described, during the ‘Here comes everybody’ seminar we ran on Tuesday, NHS Citizen as a ‘disorganisation’ – and Olivia talked about it ‘not being a thing’ in the launch session. While we can’t shirk our responsibility for action, we can indicate to everyone that NHS Citizen requires and permits action from everyone who wishes to be involved – and that this action won’t be stopped or permitted by an organisation. That is the challenge evoked by Lord Adebowale when he said: “This isn’t a board, this isn’t a chair, it’s you” (or words very much to that effect).
6. But some people will never get this: I know I’ve said that everyone has the chance to take part, but I am still pretty sure that a lot of people will remain sceptical about this project irrespective of what we do. That isn’t meant to be a criticism of what we’re trying to achieve or of those people. In reality, there is just a lot of difficulty and discomfort created by what can be seen as a non-institutional approach to a problem that people tend to see in institutional terms. The argument that the NHS is an institution so it needs an institutional solution to accountability won’t be easy to refute.
7. Things don’t have to go well for the right changes to happen. NHS Citizen was really hard work – and we had some serious trouble webcasting for a variety of reasons. That was very hard for me because I wanted to make what we were doing available to the widest possible audience and it’s hugely frustrating when that doesn’t happen. But my troubles were a sideshow. The NHS Citizen team took a wide group of people on a journey – from establishing the ideas they thought were important to the NHS to actually talking to board members directly about how one issue could be dealt with. The final assembly prototype session was jaw-dropping to watch, in that we actually had a conversation (rather than a confrontation) that felt as if it could lead to genuine action. Part of the (and forgive the feintly ‘Californian’ language I’m using) personal journey for me has been in realising that things going wrong can in some ways are either not important or can even become part of that process. We adapted to what happened, we concentrated on what we could do, and it went well.
8. We may have to think differently about events in future: Events – and meetings, and other opportunities to talk to people – won’t stop being important but NHS Citizen may become a bit too big (if it is to be successful) to rely on these kinds of engagements. We will have to think really hard about how people can become part of an ongoing conversation about this that’s on and offline. At events, we’ll need to be better, too, at addressing people’s questions so that the quality of the conversations can get better and more useful to the process. This may be adopting more flexibility – but also new ways to engage that aren’t just about Twitter, for example.
9. The NHS is bloody amazing: It’s the first time I’ve gone to Expo and it was quite an amazing thing. Someone I spoke to said that Expo was much better because they’d paid to get patient leaders and other people in who would not normally go – so perhaps that went some way to explain why it felt such an interesting and engergising mix of people. No matter why, though, I thought that it was an amazing bunch of people to be in the company and I feel quite lucky to have had the chance to go.
10. There really isn’t a final, 10th, point. Rather a sense that what I need to do now is work out better how I can be an NHS Citizen. Not so much a project-team person or someone ‘working’ on this, but a part of a bigger whole. Hopefully I’ll have the chance to tell you how that goes.