During February, to celebrate 10 years since our first project, we’re looking back at some of the highlights. Today, our Treasurer Catherine Howe looks back at the glory and the pain that was NHS Citizen.

The ambition of NHS Citizen was either incredibly audacious or unbelievably naïve – how do you create a meaningful democratic connection between the board of NHS England – the governing body for England’s health service – and the system that they are responsible for? Our answer was a model which worked in three parts:

  • Discover: finding and connecting the conversations that were already happening in order to:
  • Gather: Bringing people together to listen to the system and using a citizen jury to collaboratively set an agenda for:
  • The NHS Citizen Assembly: We held 3 deliberative events that brought together senior figures from the NHS with the patients to talk about the agenda set bottom up not top down

Probably the best overview and reflection of the work we did was written up by Rikki Dean, John Boswell and Graham Smith in a paper summarized in this blog post. Even this doesn’t really reflect the complexity of the NHS system and culture which we at various times described as beautiful and terrible.

Looking back, there was so much learning in this work which still feeds and inspires the work we do today.

We took a whole system approach – designing process and approaches for the different parts of the system we were trying to influence. This is now a much more common framing and a major pillar of our emergent theory of change.

We thought deeply about power in the system and looked hard at how to make sure that this was never unchecked or without evidence. Our focus on the agenda setting process in Gather is something we still advocate and have weaved into work RBKC which we will talk about later in this series.

We worked closely with brilliant partners; Involve, Public-i and The Tavistock Institute and developed our thinking and approach to the challenge and strengths of deep multidisciplinary working. We worked with a fantastic project sponsor who created the space for us to be truly ambitious.

We spent the first year in a collaborative design process which was designed and ‘held’ by the four project partners but brought in voices and challenge from across the NHS Citizen community. The passion and wisdom of the hundreds of patients and staff we worked with was astonishing – and always reinforced our belief in the appetite and importance of creating a more collaborative and deliberative system.

We learned so much about how to make events more accessible and how to welcome a huge of variety of people into spaces in a way which meant they could fully participate – this has become another pillar of our practice.

The Assemblies were notable in that they created – for the first time – a direct connection between board members and the patients that they serve without the filter of the organisation’s strategic plan or policy research. We were all struck by the vulnerability that this created and power this opens up when a real connection is formed.

There were some amazing moments in NHS Citizen and we did support some patients groups to deliver major changes but ultimately we failed in our system change ambition. While there are still echoes of the work we did, the NHS is a large and complex institution which has deeply wired institutional power that is not ready for the messiness and creativity of more open and deliberative governance – and we were not well placed to change that. However we have no regrets about our ambition – we have to start our work aiming to change the whole system because even when we fail we lay the ground work for future change.

On the topic of changing huge systems with deeply wired institutional power, tomorrow Anthony will be talking about an experiment in multilingual deliberation that went much better than we had any right to expect.

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Published by Anthony Zacharzewski

Anthony Zacharzewski was one of the founders of Demsoc in 2006. Before starting work for Demsoc in 2010, he was a Whitehall civil servant and a local government officer.