Reassurance, respect, relationships, responsibility and reporting.

These are the five criteria for quality that 30 members of the public developed after two days sitting as a PWC citizens’ jury.

A citizens’ jury is a deliberative method of research that is used to explore issues about which the public may have little knowledge and where there may be multiple solutions with complex trade-offs that cannot be adequately explored using traditional research methods. We asked market researchers BritainThinks to convene the jury because we wanted to understand what patients and citizens wanted from the NHS. We were looking in the context of the NHS outcomes framework, which sets out the national goals for health outcomes, drives improvement, and holds commissioners to account.

The jury began by exploring what quality in the NHS meant from the perspectives of patients, citizens and for the country as a whole. Experts then briefed the jurors on how the NHS is organised and why the outcomes framework was being introduced.

The experts then worked with and supported the jurors in small groups as they explored the five domains within the framework. They liked each of the domains and felt that they clearly explained what the NHS is designed to deliver to individuals and to the nation - enabling people to live longer, healthier, more fulfilling lives with greater independence as a result of world class healthcare services delivered in a safe environment. They also explored the main areas for improvement across each domain and agreed on the three top priority measures within each.

But our jury believed other measures of importance were missing. They wanted patients to feel more knowledgeable about their own health situation and have more information about treatment choices; better mental health aftercare, especially following injury or trauma; GP involvement throughout an episode of care to ensure continuity through a single, accountable professional; proper support, attention and information throughout, and actually being able to speak to someone about their experience; and reducing the incidence of unnecessary hospital or GP visits.

The jurors clearly take real pride in “their” NHS. They want it to remain free and accessible to all, with world class treatment and care that uses resources efficiently without waste, provides value for money, and gives people a positive personal experience.

They want reassurance that wherever they access the NHS they can be confident that they will receive high quality treatment in a safe environment, and they will leave healthier than when they arrived. All patients deserve to be treated with respect and dignity no matter what their age or circumstances.

The quality of relationship between patient and professional is essential for high quality service provision. Sharing knowledge, considering options together and being supported when making choices are all part of an adult relationship that citizens want. Both patient and professional have a mutual responsibility to each other - the professional has responsibility for a programme of treatment but also to communicate effectively; the patient has the responsibility to take the best care of themselves that they can and to engage responsibly with healthcare services, not wasting precious time and resources.

Finally, what gets measured gets done and citizens want to know how their NHS is doing. The jurors identified the following eight measures from the framework and two measures of their own that they wanted to see in a short but widely publicised national “annual report”:

  • reducing deaths in babies and young children;
  • reducing time in hospital for long term conditions;
  • reducing premature mortality;
  • incidence of healthcare related infection;
  • helping older people to recover their independence after illness or injury;
  • getting people with long term conditions back into work;
  • incidence of medication errors causing serious harm;
  • improving hospitals’ responsiveness to personal needs.


  • meeting commitments on waiting times from the NHS constitution;
  • preventing and reducing the causes of ill health.

So what does this mean for the NHS? Our citizens’ jury wants policy makers, commissioners and providers to keep these 5Rs in mind when making any decisions about care. In their eyes these are the things that will improve the quality of healthcare.

Dr Tim Wilson is a partner at PWC.