A Clinical Commissioning Group that covers a large county including conurbations and rural areas recently conducted an extensive consultation on the development of a rehabilitation centre. This development is part of a national rehabilitation centre programme of work.

The main impact to patients and service users is the move of rehabilitation services from the current location to a new one. It would mean the closure of the current services at a large inner city hospital to a rural location. The consultation described how this move would significantly improve the service offer to patients.

The CCG stated that no decision would be made until after the consultation has closed. It also committed to publishing the results on its website and to make it available on request.

The NHS organisations leading on the consultation said they would consider the views of the participants in the consultation, as well as any impact those views may have on the proposals under consideration. The organisations would also take into account the effect these views and their impacts may have on the decision making process.

The CCG said that they wanted to hear from everyone who has an interest in improving NHS services, and those who may have had direct or indirect experience of rehabilitation – either as patients or through family members or friends.


The consultation ran for eight weeks in the summer months.

The methods offered to patients and service users to have their say included:

  • An online survey- Users were directed to a website to view the proposal details and get information on the consultation, and to complete a survey.
  • Paper copies on request, to read the consultation and complete a questionnaire to post back. A free post envelope would be provided on request.
  • Email.
  • Request copies by phone.
  • Attend virtual events using Microsoft Teams, and signing up online through Eventbrite, where clinical leaders would describe the proposal and answer questions.
  • Further documentation and information was provided on a website.
  • Healthwatch also included the information on their website.

The CCG said that they listened to patients, carers, and staff working in the rehabilitation services. This was made up of two “periods” of patient and staff engagement in July and October. This included a series of meetings and events with patients.

They also commissioned the local Healthwatch to proactively reach out to and engage people who may face barriers to accessing services. Healthwatch put the consultation information in its website. It states, “The CCG also welcomes views from people who cannot join events and have set up an online survey which can be accessed at the following link.”

They engaged with the relevant local authority council committees about consulting the public while the country is still experiencing restrictions on contact due to Covid-19. They agreed on “virtual methods” to consult the public on the proposals.

The findings of the consultation will be considered by a Findings Consideration Panel (FCP), which will make recommendations on how best to reflect the consultation findings in the final proposals. A Decision Making Business Case (DMBC) will be developed and considered by the CCG’s Governing Body, which will make a final decision on the development of the NHS rehabilitation services at the new location.

The final decision is scheduled to be taken at the CCG’s October/November Governing Body meeting.

The problem

This consultation demonstrates some of the most common methods used by organisations of all types, public, private, charity and community-based, to hear from the people they serve and/or who are affected by service and programme changes.

In person, web-based, or paper-based methods have several limitations, including:

  • Accessing the information behind the consultation
  • Literacy levels required in order to understand and respond
  • Accessing the data collection methods- an online survey, a paper questionnaire, taking time and dealing with transport issues to attend.

This can result in getting data heavily skewed to people with ready access to the internet, and a computer or smartphone, and who feel comfortable finding and engaging with a consultation. Having located the opportunity, a person with limited literacy or English as a second language may struggle to input into the consultation.

Organisations may find that only older, educated, retired people may take the time and have the resources to participate, or a narrow age and demographic that has a particular interest and is quite eager to use online methods.

It could be that even younger, tech savvy people find these types of engagement methods clunky, time-consuming, and tedious and may not bother.

Methods that require users to share either directly or indirectly detailed demographic information can naturally exclude or put off many of the people you need to hear from the most- older people, people on low incomes or with low literacy, and often, people who simply can’t be bothered with a more time-consuming method that requires a registration or log in or app download that enables that kind of tracking. People are often wary of data and privacy issues that could be implicated.

The solution

Providing a near-universal, anonymous, free, open method can ensure that you hear from a wide range of people across the demographic spectrum.

This kind of method also helps organisations avoid funnelling commentary into narrow feedback subjects through questions that inadvertently lead commenters into topics that aren’t the most pressing or relevant. If given the opportunity to freely comment on what comes to mind, commenters may shed light on aspects of the impact of proposed changes that service providers simply hadn’t considered.

In the case of this consultation, access and transport were flagged as main issues. Average travel time to the new facilities was expected to double for most people from the current location. If the change goes ahead, a universal real-time live-time consultation method will mean that the service can see the real-life impact of patients and service users as they experience them. This invaluable data means the service can make alterations incrementally that improve patient and service user experience in a more efficient and effective way.

Textocracy is an SMS-based texting service that allows the widest range of service users to provide comments and feedback to a provider with a simple mobile phone. It provides a simple, free, barrier-free way for anyone to be able to have their comments captured and counted.

Textocracy aims to overcome the digital divide and remove the barriers those with smartphone and internet access still have to providing comments through current feedback and survey systems.

It ensures that there is a larger, more representative data set in consultation processes for better service design and delivery.

It aims to support public sector organisations in their “Public Law Duty to Consult”, and to give equal opportunity of voice to as much of the population as possible.

Textocracy gives you a rich data seam of immediately usable information. With this information, you can target issues, types of people, or age groups to get more detailed feedback. It’s all in how you communicate out to your patients or service users.


Textocracy offers an important tool in the consultation toolbox. It gives services a way to hear from their patients and users as their encounters with and experiences of services are fresh in their minds. Its no-friction, no-barriers method means that challenges to them of getting to a computer, downloading an app, getting and filling in a paper questionnaire, or turning up at a consultation event- are all removed.

The service has a live data dashboard to view as comments come in, with a tag cloud showing immediately what topics patients and service users are dealing with the most at any given time.

These comments are collected in downloadable files to show issues and trends over time that can be analysed and considered for several purposes. For instance, they can inform more targeted, resource-intensive listening efforts saving time and money.  They can highlight an immediate, straightforward service change needed that might quickly improve user experience, without the need for labour intensive and time consuming consultation. This means patients can feel the benefit right away, without having to wait for a drawn out process of consultation, analysis, results, and other processes for small change that makes a big difference.

For more information on how Textocracy can save you time and money on consultations while providing immediate, impactful, usable information, contact elizabeth[at]textocracy[dot]org.