This week NHS England has been in Birmingham picking many brains to try and understand how their #nhscitizen idea might work best at a local level.   Overnight I chewed over the things below but for context.  NHS Citizen is an attempt to encourage people to voice their experience and ideas about health care and for the NHS England board and other levels of the NHS to learn how to join, listen to and use that conversation.  It’s not a concrete thing at the moment and this video gives a sense of it…

Below are some of my slightly generic thoughts on what this might need to be like…

Is it a problem that this is about citizens talking to NHS England only, after all health and social care are experienced the same.

Err towards Solutions focus (not problems focus)

Focus not just on problems but experiments and solutions.   A process that channels problems up will not shift the way we deliver good or better health to each  other.  One that frames problems partly through things people have done to try and solve them will create:

• a tone that encourages those at  the top to use (rather than avoid) the discussion and information.
• a source of inspiration for people (citizens) and practitioners (also citizens) which includes new ways of fixing/doing things
• room for those who act very differently from prevailing structures to share why they think what they do makes things better and then go an make things change.
• a chance to celebrate people who act to make things better.

Use people’s stories to inspire fixes

When you make thing personal you want to solve it.  At the personal level solutions can be more practical than at a systemic level.

Don’t wait for change: 

Some traditional structures says tell us your problems and we’ll come back with our solution or reason why we can’t solve it.  that involves waiting for change.  If you send a problem to the top and wait for change until permission comes back it stifles innovation.  NHS Citizen should be able to track innovation, solutions and change – the board can learn faster from that and it will help shift the culture from what Steve Fairman,  Helen Bevan and other’s have described as a focus on the “disruptive troublemakers” in their paper on NHS culture change.

We are all citizens

So enjoy being one – whether the NHS pays you or not.

Don’t be an institution. 

The problem of being both a thing and not a thing.  Anthony Zacharzewski was quoted as saying “there will never be a chief executive of NHS Citizen”  and yet we still tend to think of things as things.  This is more like the internet –  few people ask who is head of the internet. yet we use it and trust it, accepting it as a platform we can shape.

To understand NHS Citizens more:

Watch the live stream of the discussions

Keep track of the development at http://www.nhscitizen.org.uk/

The four organisations managing the NHS Citizen design process: The Tavistock Institute, Involve, The Democratic Society and Public-i.

Declaration – we are currently working with NHS-Improving Quality plus a number of Clinical Comissioning Groups and a Clinical Support Unit and have/do work with Demsoc and Public-i