The public engagement community is getting very excited about fracking and its impact on the world of consultation. The Consultation Institute is hoping to be very busy since consultations on this fraught issue has to be in its words ‘well-organised, inclusive and preferably underwritten by an independent body’. The integrity of the planning process is at stake especially when cash incentives are being dangled before the noses of local government – starved of carrots in austere times.
It is a great advantage if consultation is part of an established public process like planning. People may fret about delay and inaction – look at the article on the BBC News site ‘Why Does Bristol Never Build Anything?’. (The answer appears to be a very efficient and mobilised middle class which do not like/want things like football stadia particularly those with a supermarket funding the building. Contrast that with more dynamic Cardiff with the Millennium Stadium the best known of many other completed projects.) In the NHS too, issues based around buildings – eg hospital closures – attract a disproportionate amount of attention with public opinion inflamed by the whisper of closure and another ‘Save Our…’ campaign launched.
Two recent guest editorials on the nhs managers site by Brian Fisher PPI lead for the NHS Alliance and Roger Steer of Healthcare Audit Consultants look forward to NHS patient engagement in 2014. Will anything change? What needs to happen to make that change? Both authors focus on aspects of democracy – creating accountability and reframing issues in narratives that do not reflect the preoccupations and enthusiasms of those in power to the detriment of the less powerful. Fisher calls for ‘participatory accountability’ which embodies a more oblique approach adopted that looks for public concerns around what do not appear at first glance to be health issues – such as anti-social behaviour or housing. Within these issues there are always health issues to be addressed and by doing so, you attract and create participation and engagement. Patient engagement then is not about the system or organisation called the NHS.
Steer looks at one particular technique – citizen juries – and makes the point that the current case made for patient engagement is based on a fallacy:
The truth is that the NHS is not a bottom-up organisation exploring how best to meet complex objectives but is a top-down, managerially-led organisation trained to mimic the undemocratic ways of the private sector corporation and staffed by and governed by people trained to believe in expertise and technology, and prone to similar value judgements. So even if the NHS were to use juries it would not be because its leaders thought it would generate better solutions but because they believed that juries would better deliver the solutions required by the NHS leaders.
Decisions, he goes on to say, are usually scarcely concealed expressions of real vested interests with some sort of grip on the levers of power. His solution? More honesty and competence in the presentation of cases and creation of narratives.
That would be nice.
However just at the moment, it is difficult to see how that honesty and competency will emerge. If these virtues are to come from well-trained and established managers and processes – including patient engagement with identified leaders and committed activists – then we may have to wait a while longer.
My take on this is that the NHS is going through a period of profound introversion – still pre-occupied by the efforts of digestion, taking the anti-acid pills and hoping for the best. The public narrative lurches from the scary tales of mistreatment and patient abuse to fears of collapse and unsafe practice due in part to low morale. The Health and Wellbeing Boards and the local Healthwatches are silent – it is not just that no one is listening, they have not said anything yet that has shaped the national debate.
Oh dear, this is dreary and far from the upbeat message for the New Year. It is like knowing that Auld Lang Syne has lots of verses and a completely different and much better tune but still hammering out the only verse we know to the old tune. We all know better but are stuck in the old ways. In the meantime I must direct you to the Linn recordings of all the songs of Robert Burns produced by Dr Fred Freeman. You can reach him on firstname.lastname@example.org or go direct to Linn – a snip @£65 for the lot.
So with Burns night coming up here is my favourite verse to help us all through 2014
And there’s a hand, my trusty fiere!
And gie’s a hand o’ thine!
And we’ll tak a right guid willy waught,
For auld lang syne.
A ‘guid willy waught’ being a ‘good will draught’ of ale or anything else you can lay your hands on.