It’s been quite a week for the NHS at a national level. Hot on the heels of a Public Accounts Committee report questioning the ambition and drive behind the forthcoming 10-year plan, the House of Commons Health Committee has voiced concerns over NHS England chief executive Amanda Pritchard’s evidence.

Meanwhile, the government’s new planning guidance—Road to recovery: the government’s 2025 mandate to NHS England— reiterates that local systems must do more to “live within their means”.

In the midst of this flurry of news coverage and announcements, it’s clear that local NHS organisations face unprecedented pressure to balance their books. Health and social care secretary, Wes Streeting, has made it plain that “tough decisions” will be necessary, including the possibility of service closures. Health Service Journal this week also reported that the “culture of overspending” is over. The government intends to hold the NHS to account for exceeding budgets and, as Mr Streeting suggests, will back local leaders if they need to make unpopular choices.

While these measures may seem daunting, NHS bodies have a powerful resource at their disposal: the communities who depend on their services. In this climate of heightened financial scrutiny and political pressure, public engagement offers an additional layer of accountability.

When decisions are made transparently, and communities are brought along from the earliest stages, it’s easier to demonstrate how every pound is being spent.

This helps ensure that, even if certain services are reduced or decommissioned, there is a credible, well-evidenced narrative about why and how those conclusions were reached.

By drawing on the NHS duty to involve, following the NHS People and Communities guidance, and embracing genuine participatory methods, local systems can forge better outcomes—even in challenging financial circumstances.

Addressing public scepticism and rebuilding trust

The Public Accounts Committee’s report highlights a disconnect between grand ambitions for NHS recovery and a perceived lack of radical thinking among senior leaders. Public scepticism is also on the rise, particularly regarding whether new funding and efficiency measures will bring tangible benefits.

This is in line with last year’s report, ‘Independent Investigation of the National Health Service in England’, by Lord Darzi. In it, Darzi highlighted that “patients feel increasingly disengaged from decisions about their care” and reinforces the idea that “engaging patients and the public in service design leads to more effective and responsive healthcare solutions.”

Transparency and community involvement can help rebuild that trust. By inviting the public to understand the difficulties the NHS is facing—particularly the spiralling costs and the urgency to save money—leaders can demonstrate that decisions are made openly, for the benefit of patients and communities. The public might still not like or support those difficult decisions, but they will at least understand them.

Meeting legal and statutory duties

Under the NHS duty to involve, organisations must seek the views of service users when planning or making changes to services. The NHS People and Communities guidance tells us that healthcare leaders must work in close partnership with the public, local government, and the voluntary sector. Amid warnings that some services may close—and that “unpopular” decisions may be needed to address deficits—really living these requirements is how we make sure we don’t further erode public confidence.

Using participatory methods to shape decisions

In a week when senior officials are under scrutiny for lacking bold plans, participatory approaches such as co-production and citizens’ juries and assemblies can spark fresh thinking.

These methods invite patients, carers, and community groups to help design and refine proposals. Instead of consultation as an afterthought—where communities simply react to decisions—they can be central to the decision-making process:

• Citizens’ assemblies or juries: Small, representative groups of local residents hear evidence, deliberate, and craft recommendations.
• Co-design workshops: Frontline NHS staff, service users, and community representatives collaborate to develop new models or redesign services more efficiently.
• Focus groups and listening events: Targeted forums, often arranged in partnership with voluntary or advocacy groups, to capture diverse perspectives and champion under-represented voices.

By placing service users at the heart of discussions, NHS leaders are much likelier to pinpoint solutions that meet genuine needs. This can also cushion the impact of tough decisions and embed a sense of shared responsibility.

Blog by: Caroline Latta