The Lancashire & South Cumbria New Hospitals Programme (NHP) is a once-in-a-generation opportunity to transform the region’s hospitals and health system. Whilst there has been engagement with regional stakeholders, there is a gap in the engagement of those who are routinely underrepresented, and a paucity of knowledge about how best to address that. Using participatory design methods leading to inclusive engagement with underrepresented groups, the project will provide evidence to inform engagement approaches for future transformation projects.