I was invited to do a 5-minute speech at Llais’ event at the Senedd yesterday. Llais is the public body for citizen voice in health and social care in Wales, and they were launching their manifesto of recommendations to all the political parties in advance of the Senedd 2026 election. The theme I was asked to speak to was “citizen voice is important”.
Listening to citizen voice (and acting on it) is essential.
Why? Because it’s better than the alternative.
By “the alternative”, I mean professionals devising solutions on their own, making decisions about services and people’s lives, doing *to* people, or doing *for* people. Of course, they’re not strictly speaking on their own – they’ll be working with colleagues, interfacing with the public, patients and service users… But professionals talking to other professionals within a given system – that’s too narrow a lens.
Let me qualify this: when we have a process that works and delivers satisfactory solutions (for example I just need the right jabs before I travel abroad), we don’t need to reinvent the wheel. By all means use the systems that work, use your professional training, deliver the expected outcomes. Some services work best when they are transactional and efficient and just do their thing well.
But with all the challenges that the sector is facing right now (in terms of population, workforce, climate change, funding, all the things we know), we are far from having perfect systems that work for everyone.
Llais have been listening to thousands of people (tens of thousands) about their experiences of health and social care – and the evidence is clear. Our services are not supporting people well, and they are not meeting people’s needs everywhere they should be.
And that’s why listening to citizen voice is essential.
If we could have solved this already we would have; but we are facing complex challenges with multiple factors interacting, and our only chance is to bring more perspectives to the question – which means more and different understandings, more ideas, and solutions developed closer to where the problems lie.
When we join forces and add citizen lived experience to professional experience, the result is bigger than the sum of its parts. Listening to citizen voice means really hearing what the problem is. It’s not always what professionals think it is; services don’t always work in practice the way they are designed on paper – and patients can tell you what the professionals don’t suspect. It also means being open to different solutions and ideas from different perspectives, that will make a direct difference to people’s lives.
And I know you’ll be thinking, how do we start a process in which we don’t know what people are going to propose, how do we manage that risk? To which I say – get comfortable with the uncertainty, and learn to trust that people have good ideas and don’t actually ask for the moon on a stick. I’ve been seeing the evidence of this for the past 15 years. Build the relationships with your patients and service users – not the “do what I tell you” transactional interactions, but the listening ones. The ones that start with “you’re doing a great job, how are you feeling today?”
It takes 5 million minutes to become a doctor. (That’s my glib approximation – it’s about 10 years.) After 10 years of training you are very knowledgeable, and very expert. But it takes 5 minutes to make your patient feel seen, understood and reassured. Don’t skip the 5 minutes.
It takes time, you say, to change these relationships, to change our ways of working, our ways of thinking. And it does for sure, but what about the time wasted failing people over and over again, how does that compare? And the cost to individuals and their families, let down by the systems and services that should be supporting them?
Where we are right now, we can’t afford to *not* listen to citizen voice.
Getting health and social care right is what can make the biggest difference in people ‘s lives (let alone the knock on effect on society, the economy, and everything else).
You might be wondering – who am I to be talking to you about this?
I’ve been working in co-production and involvement for a long time. I’ve been training and accompanying public service teams to put the voice of the people they support at the heart of their thinking and their decision making.
I do this because I believe in co-production, and involvement, and meaningful engagement, and citizen voice being at the heart of our organisations and services. I say I *believe* because it’s partly a matter of principle: because this also means kindness, and compassion, and dignity. (Dignity is a universal human right.) And also because I’ve been seeing it in action, through working with and around people doing brilliant co-production, involvement and engagement in health and in social care. Listening to citizen voice works. And it’s better, safer, more effective, with better outcomes.
We need to be doing more of this listening to citizen voice, in many ways and in many places. So I urge you to hear what Llais have got to share with you tonight, because this will make a huge difference to everyone in this room – and far beyond.
Diolch yn fawr. (Thank you very much.)
Image credit: Llais