I spent last Thursday but one with a group of senior managers at NHS England – including Sir David Nicholson – as part of the NHS Citizen programme which I have written about before. NHS Citizen has been ‘real’ for some months but this was really the organisational launch. I was there with colleagues from Demsoc, Involve and the participation team from NHS England and the workshop was led by our other project partners the Tavistock Institute.
This post is an attempt to capture my personal response to the workshop because the event evoked a number of responses from me and I imagine from the other participants as well.
First the easy stuff. The NHS Citizen proposition was well received and there was support for the animating principle of the programme which is that patient and citizen voice needs to be central to decision making for NHS England – we have to move past too little, too late consultation approaches which do not allow people to shape the agenda. This is not entirely a surprise – this first internal event attracted people who were already thinking this way – but we were pleased about how quickly the overall model was absorbed and seen to capture what was needed. In fact, a number of conversations sprang up with respect to how the approach might be used on live issues right now and we will do our best to build this into the design work.
But to leave my reflections on the event on this point would be to neglect the responsibility of the researcher to try and capture a complete picture of the experience. I also want to put these thoughts out in the world as I want to find out whether this was a unique or more universal experience.
I am always struck by the amount of love for the NHS – and that is a deliberate choice of word – that I find within the NHS from its staff. These senior managers were no different. I think this is why it was so difficult to see a number of people really struggling with the question of how the NHS will need to evolve in order to retain its hugely significant place it has culturally and socially in the future.
The restructuring of the NHS has been substantial and profound and it has yet to be fully absorbed by the people who have been most affected by it. There is no let up with respect to the clinical needs of the organisation and the system failures seen in, for example, Mid-Staffs are deeply felt. All of this is against the backdrop of the usual concerns that I come across with every senior team I work with with respect to the need to adapt to the impact of digital change and the networked society.
Part of the positive response to our workshop may have simply been a sense of relief at having being given time to think about the bigger picture.
These are huge challenges. I don’t think there are simple answers and I am pleased that the authenticity of the event we created was such that every time someone tried to come up with a ‘we need to restructure’ or a ‘lets set up a committee’ kind of response the conversation always came back to the need for systemic and culture change – complete adaption to a very different world. No-one felt there were easy answers and everyone agreed with the need to speed up the process of adaptation.
I think that participants were daunted – I know I was – but there was complete consensus around the need to do things differently. Not just in terms of structures (though this would help) but in terms of behaviours. In the workshop we had the feeling that we had instigated a conversation which is much wider than NHS Citizen but connected directly to the shared need to create a future proofed NHS that makes sense to and effectively serves 21st Century society.
There is a lot of detail from the session that will work its way into future internal and external work on NHS Citizen. The main points for this are:
- We were given an offer to take NHS Citizen to the Exec team meeting – I’d like to try and make that a regular event
- We wanted to develop ways of feeding examples of new ways of working into the performance management process. challenging but a good way to model new behaviours
- We want to support the group that attended the event to cascade the workshop out to other parts of the organisation
- We want to build some practical things that people can test
However in conclusion I want to try and focus in on the pivotal learning point – for me – from the session. In my presentation I talked about the need to find the human in the network – and I think this is where I want to leave this. I think we need to think about very human responses to these challenges. We need to figure out how to be systemically kind. I know that I am not the first person to say this but this kindness needs to be throughout the organisation and needs to spread in all directions. We can’t just talk about compassion to patients – we need compassion throughout the system. I want to figure out how to make a system which is kind to patients but is also kind to these senior managers because those are the conditions that everyone should work within.
NHS Citizen is one potential future and its one which I think represents a significant opportunity for system-wide change but at the moment it is simply an intellectual construct. The thought I will be taking through from this last workshop is how to make it human and how to make it kind.