Understanding the benefit of patient involvement in service redesign – will the NHS ever really get it right?

The next year or so in the NHS is going to be as challenging as it ever has been. Gone are the days of year-on-year budget increases. We are in a period of reduced budgets as the NHS looks to save £20bn by 2015 and increased demand due to an aging population. At the same time the NHS is expected not only to sustain the quality of its services but improve them.

This leads to one course of action – the redesign of services to ensure they are cost effective and meet the changing demands of the people who need them.

This is understood throughout the industry. Care has been moving out of hospitals and closer to people’s homes for some time because it improves patient outcomes and is cheaper. However, the pace at which services will have to change is going to increase dramatically and this will put a greater spotlight on how service redesign is managed, more so than ever before.

Richard Vize’s recent article about Whittington Hospital, in Guardian Professional, was a timely reminder to all NHS organisations getting ready to redesign services of the importance of good communications and engagement during the process.

What is worrying about the article is the fact that this is not going to be a ‘one-off’. Similar processes are being undertaken across the NHS in England. The NHS needs to change and change quickly if it is ever going to be able to ensure patients and the wider public understand and accept the changes that are so desperately needed.

The first steps to better patient involvement in service redesign

It is no longer acceptable for people to be informed of changes after they are signed, sealed and about to be delivered. Although keeping it quiet might seem like a good idea to some at the start of the process, it invariably leads to a lot more work to bring key stakeholders around to your point of view, if you ever can. It also increases the chance of reputational damage.

There is light at the end of the service redesign tunnel and it’s not a secret. Unbelievable as it may seem, involving key stakeholders and the patients that use the service from the start improves outcomes. There are some good examples of this happening across the NHS already.

The insight of people who use the service will be the most valuable you receive when redesigning your service. But don’t just engage a select few who are willing to attend a meeting. The online world is fantastic for harnessing opinion from a wider range of people and you can target the audiences that will help you develop your plans. This is happening in many other industries and it should be no different for the NHS.

By involving the right people at the beginning you will start to build ambassadors for the change or at least help people understand the changes, even if they aren’t fully behind them. This is a much better starting point than reacting to a ‘save our hospital’ group who feel disenfranchised by the lack of consultation.

The rest is simple communications and engagement. Ensure you understand how different groups want to receive information and make sure the information is disseminated in a timely fashion. Be part of online conversations about the changes but don’t try to control them. Organic, stakeholder-led conversations will ensure people are more engaged.

Don’t get me wrong, the NHS is starting from a very difficult position. We live in an era whereby everybody has a stake in ‘their’ NHS and the majority do not like the idea of their local hospital reducing services or bed numbers it provides. However, the NHS cannot expect people to understand the need for change if they aren’t a part of the process.

The age old district general hospital model of care is no longer the best way to serve local communities and everybody in the NHS knows this. It is now the NHS’s responsibility to engage with local communities so they start to understand it too.

What are your thoughts? Have you any good examples of patients being fully involved in service redesign projects from the start?

If you want to learn more about best practice service redesign communications and engagement, please get in touch.


| Peter Davies

As an utter, committed communications professional who has worked (and still does) at senior levels, am afraid that the rhetoric you present here does not really touch the spot.

I am not attacking you, nor am I doubting your sincerity or your passion.

But your article is riddled with buzz-words and jargon which is the language of government, the NHS “movers and shakers” who all learn how to “talk the talk”.

You are not the only one, and I have been guilty myself of abasing the English language to the point of meaninglessness.

First of all, there is a seismic shift about to happen in the NHS, where commissioning groups and other consortiums are going to change services with a sleight of hand.

You fall into the same trap as the public, in trying to articulate the NHS in terms of the hospital environment. Personally I blame BBC’s Casualty! After all, could you write a compelling soap opera which can create a cliff-hanger based upon whether the agenda will be sent out in time for the non-execs on the local PCT?

If you look at the NHS budgets, actually a small proportion is spent on hospitals.

The vast majority of money is spent in the primary care setting.

Like local government, the NHS is bad at consultation, because the people introducing the consultation do not understand the process in the first place.

I have worked for public sector organisations and “stakeholders” who think that “consultation” is a democratic process. It is not. Look up the word.

Consultation is a process where those charged with making higher strategic decisions announce what they think is in the best interests for the greater good. But more importantly, they should always state that this is what they INTEND to do and not what they want to do.

So consultation should always be presented as: “This is what is going to happen, what do you think.”

Obviously, in the course of consultation, others may come up with objections or even find fatal flaws in what is being proposed.

But it is not a democratic process.

    | musicman

    Thanks for your comments, they are really welcome. The article was intended to spark debate and I’m pleased that you have got in touch.

    Your point about new NHS organisations “changing services with a sleight of hand” is the exact reason behind writing the blog post. This cannot be seen as acceptable anymore and it doesn’t get the best results in the end. The NHS needs to involve people that will be affected by change at the beginning. From my experience they nearly always come up with the best answers on how the service should be shaped.

    I have to disagree with you about NHS budgeting. 47% of primary care trust budgets in 2011/12 (the majority will soon become clinical commissioning group budgets) was spent on acute care and A&E, with 29% being spent on community care, mental health and other secondary care settings. Primary care equates to only 24% of the budget. A shift in moving services from acute care to community settings still has a long way to go. Figures are available on the Nuffield Trust website.

    You are right that the word consultation does not help the situation and people do sometimes misunderstand its meaning. I do, however, believe that the NHS shouldn’t use the “this is what is going to happen, what do you think” model. The NHS should be asking patients, carers and families that use or are affected by a service to be involved in its development and then ask the wider community what they think about it. This is the best way to get results that ensure people are happy or ok with the change, instead of totally against it.

| john culkin

I think the root of the issue is that patient involvement is often limited to when changes need to be made. If you only start involving then at the point a change becomes necessary, no wonder they are difficult to engage with.

The key to getting better patient input in to service redesign is to get better patient input in to nhs services full stop. Routine, constant real time feedback, left honestly by patients and taken seriously by clinicians and service managers. Patient involvement needs to be at the heart of everything, not just as part of a communications exercise when a service is changing.

Once this starts to happen, it will generate and lead service redesigns, rather than the other way round.

It might sound optimistic but some big strides have recently been taken in this direction and the nhs is starting, slowly, to wake up to the need to listen to patients experiences and opinions more and more, as a matter of routine. As a patient and a health professional, I hope this continues.

    | musicman

    Thanks for your comment John. I couldn’t agree more.

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