The hidden risk in NHS commissioning reforms: the loss of community memory

There is no shortage of commentary about the sweeping and chaotic changes currently reshaping NHS commissioning—arguably the most disruptive many of us have ever experienced. I’ve been reluctant to add to the noise, but as a senior engagement professional directly affected by these reforms, I feel compelled to highlight a risk that isn’t being talked about nearly enough: the loss of community memory.

Most of the current concern is focused on organisational memory. It comes up constantly—who will hold crucial knowledge after the job cuts at organisational, team and individual levels? How will we manage when so much expertise disappears overnight? Those are valid and pressing fears.

But far fewer people are asking an equally important question: who will communities know and trust when all of this is over?

For engagement professionals, especially in commissioning, this is profound. Our work hinges on relationships—on the time, consistency and trust required to build genuine connections with people who often have difficult histories with the NHS or face additional barriers to being heard, including d/Deaf communities, Black Afro-Caribbean women, and people with learning disabilities. These are not transactional encounters. They are long, careful, human processes.

It takes time to show that you are listening, that you understand what people are telling you, that you care about it, and most importantly, that you will act on it. Listening alone isn’t enough; caring isn’t enough. Communities judge us by outcomes. But you can only get anywhere near action once you’ve earned the invitation through the door—once people feel safe enough to share their stories.

We all know how demanding this is. And we all know it is absolutely worth it.

These relationships cannot be handed off. They’re not contacts on a spreadsheet. They’re built on lived experiences, emotions, and trust painstakingly cultivated over time. And even if handover were possible—who exactly would we hand them to? With teams halved and budgets slashed, who has the capacity to sustain, let alone rebuild, this work?

This creates a real risk that engagement with these communities will deteriorate. Barriers will grow. The loss of Healthwatch bodies that once acted as a conduit only deepens the challenge, increasing reliance on already stretched voluntary sector groups. And when engagement weakens, health inequalities widen. We’ve all seen the consequences—diabetes course materials designed around the wrong family member, inaccessible clinic letters, or patients left without a way to complain because their only language is BSL.

So how do we protect community memory amid such upheaval?

Good record-keeping, stronger communications, realistic expectation-setting and robust plans for ongoing engagement can help—and we at OVL can support this, so do reach out if this would be helpful. But I worry that in the rush of restructuring, we won’t fully recognise what’s being lost until far too late. At that point, the best we may be able to do is gather the pieces and plan better for next time.

What do you think? I’d genuinely love to hear your thoughts.