Hilary Thomas on reconfiguration and supercasinos

So far this year I've enjoyed a strange mixture of speaking to the public about the case for change (otherwise known as reconfiguration); getting involved in what I might loosely term 'people processes' - all of which has been a rich source of learning; and finding myself in a new-found role of professional patient.

I'm not innately a process person but being velcroed to the discipline of working through frameworks and protocols has been surprisingly effective and has taught me how much dealing with people is governed by generic principles.

Whether it relates to handling patients, working in a team, personal or professional conduct or an overt disciplinary issue, the consistent revelation is that open and transparent communication could have headed the crisis or confrontation off at the pass. An open, learning culture would have prevented much of the angst and drama of the HR processes while simultaneously dealing with the problems and finding a mutually acceptable solution.

On the reconfiguration front the same principle seems to apply. Look at the casino debacle. Manchester, the outsider, is to get the supercasino. The chair of the casino advisory panel was at pains to point out that a matrix of factors had been taken into account. Manchester's attempts to involve its citizens, through a 'very thorough consultation', seems to have clinched the bid.

Ironically, Manchester also spent more on consultants and advisers than the competition - a further lesson for the NHS, which often uses the resource in the wrong time and place. Meanwhile, Blackpool is reeling, with the council chief executive talking about the 'terminal demise' of the town. Beyond providing fodder for future Bill Brysons, it has nowhere to go. Even the illuminations look tired.

Manchester had three trump cards - the courage to undertake proper consultation, a history of successful implementation (the Commonwealth Games) and a population base.

At the risk of being glib, perhaps Blackpool is a metaphor for the district general hospital, its sixties heyday now a distant memory in the global village. If a supercasino was Blackpool's last hope, will the propping up of the various components of the DGH matrix make it sustainable? I expect not. Joe Public never ceases to amaze me with his, or her, ability to understand and be open-minded about progress and the changing face of medicine when a vision of the future is articulated.

In my recent experience, only one person failed to grasp the point of contestability in healthcare, otherwise the questions posed were constructive and demonstrated a grasp of the issues and the underlying logic faster than many of my peers.

Recent media portraits of the NHS have painted an entrenched, inward-looking, closed culture that at best looks untrustworthy and hierarchical and at worst bullying and paranoid. Of course, it is a gross oversimplification to parallel the building of a new casino complex with our attempts to reshape and change (or close) hospitals but the principles of openness and transparency still apply. As we move into a very dynamic era for the health service in which many clearly feel uncomfortable it is important to hold on to these principles when communicating the vision.It takes courage and resilience.

Congratulations, Manchester - I wish you a successful implementation. If you continue to engage the public as you go forward in the way you have to date, your consultants and advisers will have much to teach us.