Squaring the circle of patient voice and swift change

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The pace of change in the NHS since March has been phenomenal. What’s been achieved is nothing short of incredible. We wrote about the shrinking window of opportunity in our last blog, highlighting the limited time available to make changes permanent. But how many Trusts have had the capacity to do this in consultation with patients, how do we now involve them?

Patient voice – are we focused on the right things?

It’s right that the changes made to adapt to the demands of the pandemic often didn’t involve the patient voice. There was tacit agreement that the situation demanded swift and decisive action; the general public were willing to accept the new, presumed temporary, way of doing things. But we cannot continue to make changes this way.  What people accepted as necessary during the peak of lockdown is now starting to be questioned – despite the fact that the risks of Covid-19 have not gone away. For example, how to deliver GP care, which has been overwhelmingly done remotely since March, was recently the topic of a discussion on BBC Radio Two. Spokespeople from the Royal College of GPs and the Patients’ Association agreed that sticking with the current majority remote delivery of GP appointments shouldn’t continue. For obvious reasons, the Patients’ Association advocated consultation with patients before any more permanent changes were made. 

Change in the NHS

Anyone who has led NHS change projects will know that we try to co-create. But often you table your proposal and then a great many people tell you why it’s wrong. People’s resistance comes around perception of loss; that loss is often about the use of buildings. It’s right that we all feel a sense of ownership over the NHS, but are we attached to the right things? How can we help people to feel ownership of the services which help them manage their wellbeing, rather than the locations and buildings the services are provided from? How can we take proper account of the patient voice without holding up the pace of change? We need a new system for ensuring appropriate consultation – including with patients – on big change within the NHS. Doing it well is time-consuming. And that can be a real barrier. But we also need to try to re-write the rules of the game.

Curing illness vs facilitating wellbeing

There’s a much bigger issue – one that’s central to the reason the NHS exists. The system is paternalistic. It was set up to take care of the nation. But that approach isn’t fit for 21st-century healthcare. Nor 21st-century healthcare budgets. Our focus should be on enabling wellbeing. It should be on facilitating patients to own their own health and wellbeing. But our healthcare professionals are schooled in creating dependency.  So we need to find a way to help patients take ownership of their healthcare. And we also need to have a conversation with the public that helps them focus on what’s going to make people’s health and wellbeing better. We know co-creating solutions overcomes barriers, so how can we make this a reality? There are no easy solutions. The patient voice needs to be heard in relation to changes that are going to stay, and those that will be made in the future. But we also need to enact a 180-degree shift in attitudes in what the NHS is for. There’s a long road ahead.   Linda Prosser is a Senior Associate at thevaluecircle and a former NHS Chief Executive Officer. She dreams about health integration at scale.


  1. Thought provoking. To think of health/wellbeing (services) beyond the bricks and mortar of the NHS – a challenge for patients, clinicians and patients alike, I imagine. It has always struck me as cruel that the patients who are least likely to be heard are the ones most likely to carry the disproportionate burden of ill health. Looking forward to your next instalment Linda Prosser. Thank you.

  2. Really thought provoking and so very much in line with where I am trying to focus service reviews. We also need to co create with a greater range of partners rather than offer crumbs from the nhs table. Would welcome further thoughts o. This as a fellow passionate believer in integrated care

  3. Great start!
    Your assertions that ‘the system is paternalistic’ or that ‘healthcare professionals are schooled in creating dependency’ may be true in some parts of the NHS. However, GP based training very much values patients’ ideas, concerns and expectations and engages people in managing their own health and disease.

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