How can the NHS build trust with communities?
There are few bigger challenges facing the NHS than regaining the trust of our communities. It became clear during the pandemic that trust in the NHS – and public services and information in general – had fallen off a cliff. This was deeply evident in the wide disparities in initial take-up of Covid vaccinations, with some of our most excluded and disadvantaged communities among the most hesitant. It is also reflected in how we live: areas of higher deprivation tend to have a lower life expectancy and are often the most resistant to healthcare messaging.
A ‘tick box’ approach to these challenges – with ‘engagement’ seen as either a necessary evil or an easier option than public consultation on service change – would repeat past errors and further erode public trust. What will be critical for the NHS – in particular ICBs, where the primary responsibility for engaging communities will sit – is to build on emerging best practice in this field rather than reverting to failed models.
The model ICB blueprint sets out a clear and welcome ask for strategic commissioners.
Each ICB should have a systematic approach to co-production … This goes beyond formal consultation and means working with people as partners. ICBs will need to ensure that focused effort and resources are deployed to reach seldom heard and underserved people and communities, working with trusted community partners to achieve this.
A number of systems, including ours in north west London, have already begun to develop an approach along these lines in recent years. We have put in place a dedicated Co-Design Advisory Body, which brings together people from seldom heard communities and those representing them in the spirit of better understanding their lives and experience of health services. We have an in-reach programme targeted at communities that have been poorly reached in the past or where we know there are specific health challenges. And we have a Citizens’ Panel that broadly reflects our local communities and can be used to test and explore public views of challenges we are seeking to address.
Key to the success of all of this in future though will be the extent to which talking to local communities truly affects commissioning decisions. We can point to specific examples on our patch where this happened. Our recent consultation on palliative care saw significant changes to proposals, including the addition of 46 enhanced end of life care beds, following resident input. And the whole way in which we work and communicate with people with learning disabilities, travelling communities and people with physical disabilities was transformed by input from these communities and people working with them.
If I were to devise a blueprint for how the NHS works with communities in future, it would have five key elements.
Go to where people are. Most communities, with the best will in the world, will not turn up to NHS meetings. You have to put time and effort into meeting people in their own spaces. It’s likely this will involve partnership working with grassroots VCSE bodies and local authorities.
Focus on seldom heard groups. Every organisation has an admirable group of diehards who will turn up for every meeting and have views on every proposal. While it’s important to work with the most engaged residents, it’s not a substitute for reaching those you never hear from – your approach should have a strong focus on gathering insights from communities that are often marginalised or poorly reached.
Don’t restrict the conversation. If we are to build trusted relationships, trying to restrict every discussion to what we want to talk about is a recipe for failure. Give communities space to raise their own concerns and co-design meeting agendas.
Report what you hear. We got into the habit of publishing what people told us in regular insight reports. That means actively listening to people and publishing what you’ve heard, even if it’s not what you’d like to hear. Too often, people feel their input is never visible.
Act on what you hear. Talking to residents is not ‘job done’.There are lots of things communities told us that we were able to address immediately – for example, feedback on how we communicate with people with learning disabilities or why cancer screening programmes turn off some communities. On bigger questions, all they ask is that their views are seriously taken into account rather than the NHS just ploughing on regardless. It’s fine to disagree with feedback, but you should always consider and fully address it.
*A version of this article was first published in the Health Service Journal in October 2025.
