National Voices’ message for NHS ConfedExpo: At a time of change, leaders need to stay close to people’s real experiences 

This year at NHS ConfedExpo 2026, members of our team at National Voices will be speaking on topics ranging from AI to vaccines, neighbourhood health to commissioning, inequalities to medical devices. 

They are very different conversations on the surface, but while preparing for them, we kept coming back to the same issue: how easily the things that matter most to people can become invisible in health and care decision-making. 

That is not because health and care leaders do not care – quite the opposite. Most leaders we work with are trying to make difficult decisions thoughtfully, in incredibly pressured circumstances. 

Health and care organisations are dealing with financial constraints, service pressures, organisational change and workforce exhaustion all at once. Leaders are being asked to improve care, manage demand, reduce inequalities, adopt new technologies and deliver savings, often simultaneously. In that context, it is understandable that attention narrows onto what is most visible and measurable. 

But people do not experience health and care through organisational charts, activity data or programme plans. They experience it in the reality of their everyday lives. 

And unless leaders stay closely connected to those experiences, there is a risk that systems optimise for what is easiest to count rather than what matters most. 

The things systems do not always see 

One of the strongest themes that emerged for us as we prepare for Expo has been the gap between organisational assumptions and people’s actual experiences. 

In discussions about shifting from analogue to digital, for example, there is often a strong focus on productivity and efficiency. These issues matter. But what happens when technology removes an interaction with a healthcare professional that helped someone understand a diagnosis? What happens when digital tools work well for confident users but create anxiety or exclusion for others?  

The same applies to service change. When services are decommissioned or centralised, systems may carefully assess organisational impact while overlooking the practical effect on patients and families. A service that looks efficient on paper may now involve two buses, time off work, parking costs or extra caring arrangements for those who use it.  

These issues are often not visible in formal decision-making processes. Or they are treated as secondary considerations rather than central ones. That is where meaningful engagement with diverse people and communities matters. 

The case for listening during periods of change

There can sometimes be a tendency to see engagement as something that slows decisions down. But in periods of significant change, it becomes more important, not less. 

Good engagement helps organisations understand consequences earlier. It helps identify who may be excluded, where trust may be fragile, and what unintended burdens are being created. It also helps leaders stay grounded. 

In large organisations, information naturally becomes filtered as it moves upwards. By the time issues reach senior decision-makers, they are often summarised, softened or translated into operational language. The human reality can get lost. 

That is why sustained relationships with people and communities matter so much. Not just formal consultations, but ongoing partnership with people who can say: this is what this decision feels like on the receiving end and this is what would make it better. 

Across health and care, we see examples where this makes a real difference. Local clinicians working with their own communities to improve vaccine uptake. Disabled people shaping national conversations about medical devices and quality of life. Charities identifying barriers to access that systems had not recognised. 

None of this removes the difficult trade-offs leaders face. But it does lead to better decisions. 

Staying connected to purpose 

At National Voices, we believe that improvement starts by listening to people’s real experiences of health and care, especially people who are least well served by the current system. That matters particularly now. 

Periods of restructuring and pressure can easily become dominated by process: budgets, governance, delivery plans and operating models. Those things are important. But they are not the purpose of health and care. The purpose is to support people to live the best quality of life that they can.  

Meaningful engagement helps leaders hold onto that. It helps make visible the experiences, trade-offs and inequalities that can otherwise disappear from view. 

And at a time when the system is being asked to change quickly and significantly, that connection to reality matters more than ever. 

If you’re attending Expo and are thinking about how you can apply that in practice, we’d love to grab a coffee and a chat. Please don’t be shy in reaching out to a member of our team through the NHS Confed Expo chat.