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Edward Andersson reflects on a little understood opening for citizen and patient engagement in the NHS. 

The NHS is going through a dramatic time of change. The Health service is of course one of the areas of the public sector most prone to reforms and changes, often to the frustration of staff. One of the more hopeful developments at the current time is a push for more transparency and openness.

Traditionally the NHS has been accountable to Whitehall rather than the public. Doctors and other health professionals have been accountable to their professional bodies, rather than patients.

The process of ‘revalidation’ represents one of the most interesting opportunities for patient influence. It is not widely understood, but I believe it may mark the beginning for something significant.  So what is revalidation?

It is, simply put, a new process by which licensed doctors regularly need to demonstrate that they are fit to practice. The process for each individual doctor happens every five years and started in December 2012. From Involve’s perspective the most interesting part is that one of the six forms of information required as part of the revalidation process is feedback from patients. Of course many good doctors have been gathering patient feedback for many years as part of their daily work; but patient feedback is now part of a legally mandated process. We mustn’t get over excited –the GMC guidelines suggest that as little as 34 pieces of patient feedback in the form of questionnaires would be enough –not much over five years!

Still, revalidation represents an opening, even though it may seem insufficient.  Revalidation is supported by groups such as National Voices, the Patients Association and the National Association for Patient Participation, who state “The scope and frequency of patient feedback in the initial revalidation model is, in our view, too limited, but it does establish the principle of patient feedback in the process”.  

From my perspective one of the key limitations of revalidation as it stands is that it relies heavily on formal questionnaires. These aim to track how well the doctor assessed the patient’s medical condition, listened to them and involved them in any decisions about their treatment. This is all useful, but my experience tells me that questionnaires often fail to capture vital nuances. It will be all too easy for the patient feedback aspects to become another exercise of box ticking.

Involve is currently working with Shared Services part of (Health Education England) to look at more innovative ways to gather feedback as part of the revalidation process. We’re looking at applied theatre based approaches and other more creative approaches which allow patients who struggle to express themselves in writing to take part, and allow more qualitative nuances of care to be explored.

Revalidation represents a very important opening for patient voices –while on its own it’s not enough, it could provide a vital narrative for shifting both thinking and practice about patients in being there to be consulted with, to one of ongoing active engagement and involvement in holding health and related services to account. If you know of good examples of innovation around revalidation do get in touch, particularly if you know of good creative approaches.