Published on April 28, 2014

NHS Citizen

NHS Citizen

By Simon Burall

Simon Burall is a Senior Associate of Involve. He has extensive experience in the fields of democratic reform, governance, public participation, stakeholder engagement, and accountability and transparency.

NHS Cit Project page pic

NHS Citizen is a work in progress, but it will eventually be a participation infrastructure for NHS England, where participants can become citizens of the NHS, not just consumers of its services. Through NHS Citizen, people  will be able to hold the Board to account, set the agenda for discussions, and find others with shared interests  – all in an open, transparent and public environment.

Involve is working in partnership with Public-iDemsoc and the Tavistock Institute, as well as the NHS England Public Voice team, to create a public conversation about improving the democratic landscape of the NHS and increasing citizen voice. This is a new approach to patient and public participation that seeks to broaden the public conversation on health and wellbeing, and put citizen voice at the heart of decision making in NHS England.

Why is NHS Citizen needed?

NHS England was established in April 2013 as part of the government’s wide ranging reforms of the health service. The main purpose of NHS England is to “improve the health outcomes for people in England” which it does through its responsibility to authorise the new clinical commissioning groups. NHS England is now a non-Departmental Public Body and is not directly accountable to Parliament.

There are many groups, structures and organisations who are already gathering and communicating ‘patient voice’, but it seems that this overall system is not working as well as it could and there is little opportunity for people to participate as citizens and co-owners of NHS England to shape strategies and priorities. Therefore NHS Citizen aims to become a system which connects conversations and voices, taking them to the heart of NHS England in a way that can not be ignored and leads to action.

Developing NHS Citizen in the open…

Since October 2013 NHS Citizen Design Workshops have taken place across the country to develop the structure, function and governance of the NHS Citizen system. You can read our reflections on workshops on the project blog. More Design Workshops and  regional events are being held throughout 2014. These events have so far  brought together people from across the health and care sectors, external experts on governance, transparency, open data and public engagement to develop ways of extending participation beyond patient and expert groups into the wider community. Events are open to all, web-streamed and all materials are shared on the NHS Citizen website. The NHS Citizen team has also been blogging about elements of design and development.

The current vision and system…

NHS Citizen will be a system that listens to citizens through both online and offline channels, curating these conversations and exploring evidence. There are four elements of NHS:

  • The Discovery space where information and opinions are gathered through social media, public comment, online and offline tools. This gives a picture of the “state of the conversation” on health, allowing issues of public concern to bubble up.
  • The Gather space which will give people opportunities to work together around particular issues, either those that NHS bodies want public opinion on, or those that arise from issues in the Discovery space. These might be issues concerning experiences of patients, users or carers, or those that highlight more general challenges (e.g. how services are commissioned). In this space, a participant “raises a flag,” seeking others who are interested in taking action on that issue.
  • The Assembly Meeting will happen twice a year to consider the most important issues in an open and deliberative format, and hold the Board to account. The Assembly Meeting will be able to commission Citizen Panels to consider particularly challenging and controversial issues as part of its way of working.
  • Relationships and culture change – this will be a conversation about how we change culture in the NHS in England.

Involve has been working on what the Assembly Meeting will look like, how it will form its membership, how agenda items will be selected and what rules and structures will govern the process. The current state of discussion on the overall system is captured in the latest version of the System Document.

Find out more and get involved:

If you want to find out more, get involved, or follow progress then there are a number of ways you can do so, by:

Image credit: matsuyuki

2 Responses to “NHS Citizen”

  1. Kevin Blanks
    April 30, 2014 at 12:58 pm

    To what extent has NHS Citizen engaged with Healthwatch England and the many individual local Healthwatches around the country that are statutory consumer champions for both health and social care services within their local areas?

    Do you consider NHS Citizen to be an organisation that will reduce the voice of citizens through local Healthwatch or strengthen it? Please explain why you hold this view and how you intend to develop your plans.

  2. Simon Burall
    May 2, 2014 at 3:51 pm


    Thanks for your comment. It’s an important question that needs to be asked of NHS Citizen and all other significant parts of the NHS System that are inviting citizens and patients to give up their time.

    NHS Citizen has held a number of workshops around the country since last July. At each of these we reach out to as many local networks and organisations as we can. In terms of Healthwatch engagement, our last in the South West had representatives from local Healthwatch, and we have had representatives from Healthwatch England at our two national workshops. We expect more local Healthwatch representation at our workshop next week in Leeds.

    We think we’ve had broad representation from other networks and organisations engaging with citizens, patients and NHS England are getting a wide range of views as a result.

    However, like everyone else in the system, we know how difficult this kind of wide outreach can be.

    NHS Citizen is still in the design stage and our aim is to create a system that works with those parts of the system that are working well, provides them with a direct channel to the Board and other parts of the NHS System. The accountability gap within all public services is large, and is no different within NHS England. We can’t start to close it by competing, but rather by understanding where our strengths and weaknesses lie and working together. Our open design process is intended to ensure we complement the work that many others are doing very well. It isn’t intended to duplicate effort, or reduce voice in other parts of the system.

    As I said at the start, it is a good question. I’d be interested to find out how you have gone about reaching out to other networks and to help their voice be heard within the system. The system is currently very disjointed and we have a lot to learn from each other.

Leave a Reply