Here are my reflections on the latest NHS Citizen design workshop, held in Leeds on 7th and 8th May. Being posted slightly later than some of my colleagues’, because I think and digest slowly!
1. We’re designing, breaking apart and building the NHS Citizen model in the open, with as many people as want to take part. Leeds (like Expo) was another exhilarating and emotional experience for me. Nothing, but nothing, beats people and their creativity, diversity and relationships.
2. As part of this open design we are webcasting all the NHS Citizen workshops. This works pretty well for plenary sessions, but falls over when the room breaks up into group work. This is going to be an issue at the next design workshop in Bristol in July, when we are likely to have a more diverse range of design activities going on. At Leeds, for the first time, we ran some interviews-to-camera with members of the NHS Citizen team and workshop participants, to try and fill some of the gaps for the online audience. It would be good to get people’s feedback about whether this worked for them. So, we need to think about how we can make the webcasting more flexible. And do we need someone at each workshop actively looking after the online audience – our ‘correspondent in Bristol’?
3. Sticking with the online/offline connection, the lovely folk from the East of England Citizen Senate @EoECitizens watched the Assembly Meeting role-play on day 2 of the workshop from Cambridge via the webcast. I was their ‘voice’ in the room at Leeds, bringing in some of their comments and reflections which I was picking up via Twitter and a messaging app. The Senate folks in Cambridge felt it was a worthwhile attempt, but it didn’t quite work for them. They felt like second-class citizens, where they could see us but we couldn’t see them and they couldn’t interact directly: comments had to come via me and I was making the decisions about what to bring in to the room and what not.
4. The other point to make about the Cambridge / Leeds interaction was something observed by @andrewspong. Some of our interactions were happening via messaging app. We did this because it was a quick and practical way of communicating between the two venues, but of course it was not visible to anyone else.
5. So, how can we better connect people inside and outside our design workshops? Having all the interactions and conversations openly visible (e.g. on Twitter or discussion board) is one way. Having facilitators at the workshop who will bring online comments directly into discussions in the room (as we are doing at present) is another. But what else can we do to better connect the taking-part?
6. Talking of taking part, we need to get other people more actively involved in creating NHS Citizen: all the NHS England Board members, other NHS organisations and younger people are three of the gaps.
7. We need to shift now from concept to build, and this is something that is very much on the minds of the NHS Citizen team, as we plan for the Bristol workshop and for the test of the Assembly Meeting at the NHS England AGM in September.
8. We have also been reflecting on accountability. NHS Citizen is, in part, about enabling citizens to hold the Board of NHS England to account. But the Select Committee type of model is too limiting. It encourages a defensive attitude, something that we saw in our role-play at Leeds, and even if Board members are doing their best to be open it still only facilitates the organisation’s own world view. It does not enable the deliberation, opening-up and shared problem-solving that ought to be at the heart of NHS Citizen. Action (and accountability) can still flow from a more co-creative approach, it just becomes part of the outcome of a conversation.
9. Finally, a question that has been raised persistently at the NHS Citizen workshops is: ‘aren’t we just duplicating Healthwatch?’. The same question might be asked about the many, many other routes for public engagement in the health and care system. For me, NHS Citizen is both complementary and something different. It is England-wide in scope and should (if it works) enable people and organisations to connect, share and work together to have more strategic and collective influence. This adds to, rather than detracts from, what is happening locally. NHS Citizen will also bring citizens into the heart of decision making in NHS England, something that is very definitely new.