Mathew Lowry

This week NHSCitizen – one of the case studies I brought to my EuroPCom 2015 workshop on online communities – holds its first NHSCitizen Assembly, where the NHS Board meets citizens to ActionPlan the participants’ top 5 priorities. Time to summarise the Hangout-On-Air I had on NHSCitizen with the Democratic Society‘s Anthony Zacharzewski.

NHSCitizen is a participation project for the National Health Service, the largest single healthcare provider in the world, and is probably the most ambitious and interesting participation project I’ve ever heard of. But don’t take my word for it.

“NHS Citizen is the most exciting participation project in the last 20 years”
Oliver Escobar, Lecturer in Public Policy, University of Edinburgh

Although participation projects are not the same as communities of practice nor “normal” public comms, my gut feeling was that NHSCitizen has a lot to teach in those fields anyway, which is why I invited Anthony’s client to EuroPCom. After all, as I’ve pointed out before:

  • it’s hard to imagine a participation project without some form of online community;
  • participation is brilliant for building an online community;
  • both need good comms to work, and bring good comms opportunities to the host organisation as a bonus.

This Wednesday (Nov 25) represents a key moment: the first NHS Citizen Assembly, where the NHS England Board work together with 200 citizens to workshop Action Plans on five issues identified via the NHSCitizen process of live events, citizen juries and online processes.

“The Board and 200 citizens will workshop Action Plans for each issue during the Assembly”

The entire thing will be streamed and covered live on social media.

So it’s a textbook – if highly sophisticated and experimental – case of combining online spaces and physical events to convene a community and involve citizens (not just Usual Suspect stakeholders) in policymaking.

Something which a lot of people talk about, but rarely actually achieve.

Key takeways

It would take several posts and more time than I have to transform everything we discussed into ‘proper’ blog posts, so please make do with the notes and quotes below the video. You’ll still miss out on a lot if you don’t actually give it a listen:

Designing in Public

The Board started out with a very traditional view of what civic participation might look like – a bunch of stakeholders sitting in a room with the Board ruminating on how difficult it all is.

Instead NHSCitizen ran an 18-month “Design in Public” process, with regular public workshops to show everyone where they were heading and what they were thinking. The design phase ended last March.

Agile = essential (but leave your MVP at home)

While it may be cool and hip to follow LinkedIn founder’s adage that “if you aren’t embarrassed by version 1 you launched too late”, leave your hipster jeans in your warehouse flat:

“where a government’s involved there’s a lot more riding on it .. there’s been a disconnect for some people because our site says ‘NHS’, which is a huge funded thing, but looks like a very early alpha test version, because it is”

That’s partly because they’re trying to build the technology around the social model, so you need the social model worked out … but for that you need the technology.

So while agile iteration is unavoidable, be prepared for the downside:

“we’ve inadvertently frustrated people by making a big democracy promise, but not delivering the level of tech they’d anticipate from a government”

On the other hand, designing in public means that when you are actually ready to truly open your community to everyone, you already have a core group of community members, thus neatly avoiding the chicken & egg problem you would normally face.

But it really helps if you have something to start with – a mailing list, an existing network, an ally with a social media presence. In most cases, of course, you will. So consider using the concentric ring audience model, and aligning each ring with a major site development step.

Key Issues for establishing a community

Make the purpose clear

“the communications has got to be either about the issues that people are raising, or about the process, so people can understand it better. It’s not a general conversation about the NHS – there are plenty of places to have those, so signpost them so people have the right conversations with you”

… and make the purpose shared:

“In the early days you can pick up a culture from the early arrivals, but you need to create a culture focused on the task”

A solution-oriented approach based on citizenship: They started from the idea of citizenship, and of starting the conversation with:

“what can we do to make it better … it’s about us being citizens as much as it is about wagging the finger at government… The offer is not an epetitioning system – they exist already. This is about starting with an issue and trying to work on a solution and taking that to the right bit of NHS England. There’s no wrong door”

Connecting existing structures: there is more value in creating connecting tissue’ between the existing structures than there is in creating another one:

“One of our team spent the summer going from event to event getting people’s ideas … the aim is to build a network of communities and forums not specifically badged NHSCitizen, but which know that it’s somewhere they can take issues. We hardly ever organise an event ourselves”

While there are enough local structures already, however, they are not connected nationwide. The connecting tissue model therefore does not just take issues from the grassroots up into NHS England – it also helps bring people together with a similar problem, and hopefully into contact with those who have already found solutions – a classic Community of Practice goal.

“Don’t have your conversation here”

But that does not necessarily require building your own community. In fact, although project issues (a “tight turnaround time” was mentioned) meant they started by building a community platform (my emphases):

“We never intended to start by building an online community. We intended building a democracy process online – the community element was meant to be brought in from conversations elsewhere…

if we’re having a conversation about diabetes, we want to get to a point where we can say: “Don’t have your conversation here – have them on diabetes forums, and bring the conclusions back to us”.

So we become a signpost for discussions, and a route for those discussions to go somewhere… we want to create a networked conversation, rather than a linear one on one website

[at this point – about 27 minutes in – I remarked that an image to illustrate what that networked conversation could look like would be pretty useful, so. if anyone has one, drop me a line]

For policy traction, don’t forget cultural change

Obviously, NHSCitizen can’t deliver unless the ideas that emerge from it get traction within the NHS. But is the NHS ready?

“NHS Citizen is not just a website or a process, it’s a cultural change exercise going on invisibly inside the NHS. One of our partners is helping management understand how to respond and do more participative design around these issues.

Because we’ve got to work out how our ideas on citizenship are seen by the system as not just Special Interest complaining, but groups of people coming together to say “this is how we want to make it better”. It has to be seen as collaborative, not confrontational”


Further Reading

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