The NHS has a habit of consulting staff and patients after decisions are made. A shiny new digital system or pathway is unveiled, and frontline teams are asked for "feedback." By then, it's too late. The design is baked, the contracts are signed, and staff feel change has been done to them, not with them.
The result? Cynicism, resistance, and wasted investment.
It brings staff and patients into the design process from day one, ensuring changes are grounded in lived experience, not PowerPoint.
Why Consultation Fails
- Tokenistic: Feedback is sought after decisions are made.
- Abstract: Surveys and workshops rarely alter the outcome.
- Disempowering: Staff feel their expertise is ignored.
- Wasteful: Patients are asked repeatedly, without seeing results.
Tools for NHS Teams
1. Experience-Based Co-Design (EBCD)
- Capture real patient and staff experiences (stories, diaries, journey maps).
- Identify emotional "touchpoints" where the system succeeds or fails.
- Co-design solutions with mixed groups of staff and patients.
Used in cancer and maternity services, EBCD has improved both experience and outcomes.
2. SCAMPER for Service Redesign
Apply SCAMPER with staff and patients in the room:
- Substitute: Can a nurse take this task from a GP?
- Combine: Can one visit cover multiple checks?
- Adapt: How do other specialties solve this?
- Eliminate: What steps add no value?
- Reverse: If this were designed around the patient first, what would it look like?
3. Rapid Prototyping
Use mock-ups, wireframes, or sketched workflows. People respond to something tangible, not abstract strategy documents.
Evidence in Practice
EBCD in Cancer Services: Improved information at diagnosis, redesigned waiting spaces, and smoother handoffs between oncology and primary care. Reported staff engagement and patient satisfaction rose.
Digital Maternity Notes: Where midwives and women co-designed digital notes, adoption exceeded 80% within 12–18 months. In contrast, top-down EPR rollouts often see <50% engagement.
Making Co-Design Work in NHS Reality
Timelines: Co-design adds 6–12 months. Mitigate with parallelisation: co-design one pathway while implementing another.
Resources: Plan ~£500k/year at ICS level for multi-pathway co-design. Engagement is ongoing, not one-off.
Representation: Paid locum shifts, community partners, and virtual workshops enable broader reach. Target at least 20% frontline participation per discipline.
Governance: Co-design outputs feed into Pathway Steering Groups. Conflicts arbitrated transparently using safety, equity, and value criteria. Final authority rests with ICS SRO or delegated board subcommittee. Platforms like HealthFoundry/DCB CoLab translate outputs into governable artefacts.
Change Fatigue: Use an ICS-wide co-design register and rotate panels to prevent burnout.
Facilitation: Skilled facilitation is non-negotiable. Year 1: external-led with NHS shadowing. Year 2: 50/50 co-lead. Year 3: NHS-led with light-touch external support.
Success Metrics: Track not just adoption, but clinical outcomes, efficiency, experience, and equity. Example: reduced readmissions, improved patient-reported outcomes, fewer duplicate appointments.
Evidence: EBCD programmes show 9–12 month timelines, £80–120k per service line, and improved satisfaction. Digital maternity notes achieved >80% adoption after 12–18 months.
The Economics of Co-Design
Poor adoption is expensive. An unused £1m system delivers zero ROI.
Co-design adds upfront costs and time:
Top-down rollout
Co-designed rollout
At ICS scale, investing £500k/year in structured co-design can prevent multi-million-pound losses in failed adoption.
Takeaway
The NHS doesn't need more consultation exercises that tick boxes. It needs co-design that puts staff and patients at the centre of transformation — supported by structures like HealthFoundry and DCB CoLab that make it governable.
Co-design takes longer up front, but it saves money, frustration, and reputational damage in the long run.
⚡️ This final version:
- Adds conflict resolution authority (Pathway Steering Group → ICS SRO).
- Expands success metrics beyond adoption.
- Gives a 3-year facilitation skills transfer plan.
- Anchors co-design in HealthFoundry/DCB CoLab as governance engines.