Engagement in 2012: a balancing act amidst the sound and fury

Here at MAC we always like to say that the best time to engage with people is when they can see the point of engaging, when there is something to fight for or against.   Number One in the Reasons to Engage Top Ten is “Taking It Away”.   We see this in the NHS – the mere mention that something is to close is enough to get the placard wavers out in the streets (not to mention the odd local politician).  No matter that the thing which is being taken away is not needed, overpriced, under-performing or the source of numerous complaints.  No matter if it is going to be replaced with something better.   As all public servants know, you “Take Away” at your peril.  But I have recently been getting a new insight into user engagement which may be pushing “Taking It Away” out of the Number One Slot –  and replacing it with  ”Giving Something New”.

The Shock of The New

Crucially, whilst it can be very hard to get people to engage early on with the theoretical idea of Something New, the actuality of the New Thing, once it appears, can trigger wild enthusiasm to engage.  It is usually relatively easy to identify what people dislike about the Existing Thing but harder to put your finger on exactly what they like about it.  And it is very hard indeed to discover what they might want in the New Thing if it does not yet exist.   So the appearance of something new provides the perfect trigger for engagement and dialogue.  Complaint and concerns become the engagement entry point but as we all know (don’t we) a complainant properly handled can be converted to a fan: complaints as opportunity, not threat.

I have been involved as the chair of my local park user group in a major project funded by the Council and the Heritage Lottery Fund to restore the park and the almost derelict 18th century house within it.  £9m and two years since the contractors arrived on site, the house and the cafe within it opened at the beginning of this month.  Inevitably the new cafe was inundated with people from the minute it opened (5000 customers in the first six days) and, just as inevitably, the cafe, the Council and the User Group have been inundated with complaints and comments.

It being 2012 these take a multitude of forms and are directed at anyone who cares to listen: lengthy emails to Council officers and the user group; witty, sensible and balanced blogs full of good ideas followed by bitter and angry riposts from both named and anonymous  commentators; tweeters tweeting and retweeting into infinity and the familiar range of constructive and snide comments on the pages of Facebook.  Amidst all the noise there has in fact been a lot of positive feedback too but somehow that’s not what you notice or what sticks in your mind when you down that second glass of wine after reading Bile Man’s tenth post of the day.

High volume feedback

It feels like there is a heck of a lot of noise going on, though if you read carefully and once your ear is attuned you start to realise that in many cases it is the same people having the same conversation in a multitude of different forums (and I suspect under a number of different “identities” aka silly names).    I am glad I have had twenty years in this game, otherwise I think I might have been a bit overwhelmed by the wave of anger and vitriol that has been washing over my computer screen in the last few days.

If I were doing this as a job, rather than as a volunteer and interested amateur, I’d find it hard to know where to begin in terms of being responsive. I might well wish for the good old days of having to respond only if a complaint was submitted in writing to the right department and followed the Complaints Policy to the letter, complete with a turn-around time of twenty working days.  As yet no-one from the Council seems to have joined any of these public debates (although I feel sure they are watching).  I can see why, but they do need to be tapping into this wealth of user feedback in some way and letting people know they are listening – not just by making changes but telling people that they are making these changes in response to their comments.  The good old Feedback Loop.

Bad old days but simple complaints

In the old days people complained that they could not get into the cafe because there was no step free access, the coffee was horrible, the food was unpleasant and unhealthy, the service poor, you had to queue for up to half an hour to get served when it was busy and you had to go outside to use the dirty smelly toilet block and there was nowhere to change a nappy.

So what has the Council done?  It has put in a lift so buggies and wheelchairs can have access to the whole house, it has brought in an experienced cafe provider which sells good coffee and healthy and attractive food, it has knocked down the disgusting toilet block and put the toilets in the house with fancy hand-dryers and a separate baby-changing room and it has introduced table service so people don’t have to queue whilst trying to control their children, leaving their friends to hang on to a table while they waited.

Are the good people  of the Stoke Newington twittersphere falling over themselves to demonstrate their appreciation of the Council’s responsiveness and their gratitude to the Heritage Lottery Fund?  Of course not. They have long since forgotten what was wrong with the old cafe that closed two years ago.  What matters is what’s wrong with what they see now.

Panning for gold

Maybe it is not the “Taking Away” or the “Giving Something New” that is the problem.  Maybe it is simply a matter of change.    It is a fact of life for anyone involved in delivering change in the public realm that some people won’t like it.  And it is another fact of life that you won’t get everything right first time: them damn punters just won’t use the building the way they are supposed to.  But our new cafe is not finished, the building has opened but what happens inside it is a work in progress and here we have a great opportunity to get a dialogue going with users.  We have existed for twenty year struggling to get more than twenty people into the room for our bi-monthly meetings to talk about all the boring stuff.  Suddenly everyone, everywhere seems to want to be heard and there is gold in them there users (once you can filter it out).   How we handle this is the next challenge facing User Group and the Council.

I can understand why the people who are working flat out to deliver new and better things to an apparently ungrateful public might be tempted to start seeing these people as a tiresome minority who will never be satisfied and metaphorically dump them in the files marked variously moaner, whinger, nutter, axe-grinder, single-issue-obsessive. And from personal experience this week I can assure you that it can be very difficult to respond positively in the face of the unfounded, misinformed personal attacks that often accompany the nastier blogs and tweets.  I get this stuff at some of our meetings too so it is nothing new.  Some are insulting – some plain baffling. (The man who turned down my offer to meet him in person to talk about his concerns suggested “knitted yogurt” may “float my boat”. Huh?)

Listening is a two way street

It is hard to stay in listening mode with people who seem determined to think the worst of everyone who is engaged in trying to make things better whether they be public servants, politicians or local volunteers and who insist on attributing the worst possible motives to your involvement: I obviously must be receiving back-handers from the Council; the cafe offering to provide free tea and coffee for the user group’s first meeting is a sign not of support for local involvement but of “ingratiation”; because I described the bread as “fresh” when the word is not actually used on the menu, I am thought to have some sort of insider knowledge which probably results from the fact that I hold shares in the cafe.  And not content with having a go at people like me who are sort of asking for it, they even have a go at other ordinary people who have the audacity to say they quite like the changes.  If this is what Big Society feels like I am not surprised it is not get many takers.

Instant gratification – instant turn-off

Every time your respond you simply breed yet more comments and sometimes you wish they would just shut up and leave you alone.   You want to turn off the computer but you know if you do they will still be at it, angrily bashing at their keyboards forming new alliances with other people with equally silly made-up names, finding new people to despise and practising their one-up-man-ship skills. Just waiting for you to come back as you surely will and must.  Worst of all are those websites where every single reply invites another reply, and that reply another reply and so on for ever and ever and suddenly you have not a single snake of comment and counter-comment but a multi-headed hydra with all the heads screaming at each other and at you.

You can’t even satisfy them by asking them to read info you have prepared earlier.  ”I’ve waited two days for a direct reply to Emma’s question….” said a post at 9.58am on Sunday haranguing me for not answering a question about the user group’s constitution posted at lunchtime on Friday even though I had immediately posted a link to the website where there is loads of detailed information about how we work.  The more you try to respond the more the process saps your time, your energy and your goodwill.  And like I say, I am just a volunteer. If I worked for the Council (WHICH I DON’T BTW) I’m not sure I’d be wanting your hard-earned Council tax to be spent paying me to do this.

We need an engagement answer that works

So what is the answer to this modern conundrum?  How do service providers and small unfunded voluntary community groups like the Clissold Park User Group engage constructively and cost-effectively with users in this new world where so many people are keen to share their view, opinion or bad experiences (plus the odd inaccurate or misleading “fact”  and a couple of unpleasant insinuations) not just with the service provider but with other users?  How can providers and user representatives  manage and make sense of a wealth of unfiltered, uncontrolled feedback?  How do you get the facts out to people amidst all the clamour?  How do you get the dialogue right when each individual can choose the time, place and medium through which they express themselves rather than following the rules of engagement set down by others.  How do we all make sense of a world where it feels as if, to quote Tim Minchin in the musical Matilda,  ”What you know matters less than the volume with which what you don’t know’s expressed”?

Is there a way to prevent people feeling that if they get a response they are just being fobbed off and and if they don’t, no-one cares or is listening? And how do we address the inherent imbalance and lack of openness in the fact that complainants can lurk behind masks of anonymity whilst make personal attacks on named individuals who are either doing their job as officers, acting as democratic representatives or volunteering their time.   In a small and demographically compact community, how do we encourage people  to show their faces and join the debate openly- should those who won’t  be given the same status in the conversation as those who do?  After all this is not a school or a GP’s practice we are talking about where there may be real issues of confidentiality or personal anxiety about power relationships: this is just a local park with a cafe in it.

Listening to the waving – and the drowning  - but not the shouting

And while we are talking about public engagement in services like health, education and social care, it’s worth thinking about how the challenges of modern public and user involvement affect these much more important and more sensitive areas. With all this racket going on, what can people in positions of responsibility and influence do to make sure they are hearing the people who are not shouting but quietly waving or maybe even drowning?

 

The Moore Adamson Craig Partnership supports user and public participation,  trains lay representatives and develops responsive  health, care and education organisations. We work with complaint handlers to achieve user satisfaction and recommendation.

Corrupting Caroline

On Friday I shelled out £50 to a local student for looking after my daughters so I could spend the day sitting in a room full of health professionals, local authority workers and people from the salaried bit of the voluntary sector who, if not all highly paid, were certainly being paid quite a bit to be there.   I was there as the unpaid vice chair of the patient group of one of the Royal Medical Colleges and almost certainly the only person out of the 70 delegates not being paid that day.   Ironically, the whole afternoon was spent discussing the challenges of engaging with patients. Mine was the last of nine groups to report back on its recommendations and the only one to suggest that one way to get more people involved would be to give something back or, at the very least not expect them to subsidise your organisation.  I am hoping they will refund my childcare costs but I am not counting on it.  There wasn’t a box for childcare on their claim form.

Must be on the make

The next morning, I went to a meeting of my local park user group which I have been chairing for the last six months.  For the avoidance of doubt, this role is unpaid.  We are just a bunch of local people with a common local interest and I am Chair because that was the outcome of an election at our AGM.   There are many changes afoot in our park because we are nearing the end of a massive £9m restoration project which has been going on for the last eighteen months.  As is usually the case at our meetings these days, amongst the many issues on the agenda there was one which had caught the attention of one particular interest group in the park.  Before the meeting began I was told by the person who is our “rep” on this topic that some of the people who would be turning up believed that I was taking back-handers or some other form of financial incentive from the Council.  Perhaps it was not really their fault that they thought this.   Some of them had had no previous contact with the user group and had been told it as a fact by others who perhaps should have known better. Some just seemed to want to believe that the proposals which we were discussing were part of a wider conspiracy by the Council to deprive them of their rights.  My apparent willingness to work with the Council to help them gauge the views of users must surely be the consequence of some sort of corruption.  There is, after all, a lot of it about these days.

Up for Corruption?

I am not in favour of corruption but would I neccesarily become corrupt if I did not always have to give up my time and expertise for nothing?  For most of the last year my involvement in the park has taken between one and two days a week at least: attending our regular user group meetings; liaising with the Council’s project team; going to meetings with other stakeholders; walking round the park with the project managers; chatting to the landscape architects when I meet them in the park; trying to keep on top of the project timetable so I can answer the endless questions other park users fire at me; revising the text on our website; keeping the Facebook page up to date; answering emails and jumping through the tortuous hoops of a byzantine bidding process with a local charity to get a tiny sum of money to pay for a room for our regular meetings and cover the costs of our website.   I have spent more hours than I care to calculate in rooms full of paid Council employees, some of whom have remained entirely silent for start to finish.  I have not received a penny but have spend many hundreds of pounds on childcare for my younger children.

On a Hiding to Nothing while Getting Nothing

I don’t mind not being paid for the things I do.  That’s my choice and I am lucky enough at the moment to be in the position where I can (sort of) afford to pay for childcare from time to time and spend part of my time working for nothing. But it’s hard when some of the very people you are trying to represent wilfully refuse to accept that you are not somehow on the make.  There is something wrong with the equation which says that either you get some money from an organisation for helping them to do their job better and thereby immediately lose your independence and credibility or you have to keep your hands clean by relying on private means (which most people do not have) or someone else to support you (in my case my hard working and long suffering husband).

I know from speaking to the other people I meet when I am wearing my various “public involvement” hats that I am not the only person who feels like this.  In fact, I have just put the phone down on a friend who is thinking of resigning from her role as Chair of a national user group. In her working life she is paid by the hour by several different employers on part-time contracts and on pretty low public sector rates.  Each time she attends a meeting she has a stark choice between using her minimal annual leave or losing pay – and this is not just about the time she is actually in the meeting but also the hour and a half each way it takes her to travel between her home and Central London.  A half day meeting is a full day of not earning.  Her employers are grumpy at her for constantly asking to swap her hours with others and she cannot afford to give up whole days of pay.   Previously she had been very actively involved in the BMA who paid her £230 for every day she contributed.  Not so with her current involvement work despite its importance and the repeated declarations about its value to the organisation.  I guess they think a free lunch should be enough to keep her going.

I am so bored of hearing professionals in the public sector complain that the only people who are actively, consistently and effectively involved in their organisations are all middle class and/or  retired.   Of course they are. They are the only people who can afford to do it.  It’s the economics stupid!

The Moore Adamson Craig Partnership supports user and public participation,  trains lay representatives and develops responsive public service organisations.  Feel free to contact us to discuss the opportunities.

 

Big Society: big break or big bore?

Few of us who work in the public engagement world could fail to have been intrigued by the new government’s apparent enthusiasm to involve The People in its decision-making.  Intrigued, and in most cases I suspect, more than a little sceptical.  Do they really know what they are letting themselves in for? And do they really mean it?  Is public consultation finally going to earn its place in the sun or is it going to be trampled underfoot in the rush for the exit?

Consultations – A Thousand and One Commitments (not quite)

So it was off to the Consultation Institute to find out more about the new government’s plans for public engagement.  It was a lively session aimed mainly at professionals in the public sector who are responsible for running consultations with a few private sector consultants thrown in for good measure.  The Institute has analysed the government’s plans and has managed to find 31 commitments to review, 11 to consider, 10 to investigate, 6 to explore, 4 to examine and a whole raft of policy areas which programme director Rhion Jones described as “consultation significant”.  Regular readers may be interested (and unsurprised) to note that top of the list are communities, environment, energy, health, schools and transport as well as government transparency and political reform.  So is it an exciting new dawn for public engagement for those of us working in the field?

Where Are the Bodies Buried?

Working on the premise that it is good to start as you mean to go on, let’s take a look at the government’s first big discussion with the public:  Spending, or rather the Ending of Spending.  Clearly there is no time to waste on this one and government has wasted none in writing a couple of weeks ago to six million public servants to thank them for all their hard work and ask them to go online and tell them where the bodies are buried – or at least grass-up their colleagues for wasting money on new coffee machines, buying overpriced staples or taking up space with their presence in a town hall backroom.  A fine example of the benefits of mass engagement through new technologies.  Maybe this should operate like the Public Disclosure Act and people should be required to tell their managers of their unvoiced concerns before rushing off to tell Messrs Cameron and Clegg, but then again, that would slow down this very speedy consultation process.  We at MAC always encourage our clients to provide attractive incentives and rewards to consultees.  A two year pay freeze and the chance of a place near the front of the dole queue (for yourself or a friend) was not exactly what we had in mind.

Semtex Shake Up

Time is understandably of the essence for the new government and evidence to date would suggest that there won’t be much pussy-footing about with 12 week consultation periods. Just remember how much consultation has taken place around the launch of Free Schools all set to kick off next term. Precisely none.  Not much respect for the old adage that consultations should probably wait til everyone gets back from their holidays either.  Most of the big decisions about spending will have been made by the end of August.  But perhaps this is no bad thing.  As Rhion Jones said, if the last fifteen years had shown that institutions had perfected the art of good consultation and engagement we might be seriously worried, but perhaps this whole consultation business needs a bit of Semtex under it.  MAC partners have often had to deal with raised eyebrows when we suggest “quick and dirty” consultations.  They  are often just what is needed and work well as long as you talk to the right people and ask them the right questions.  (Perhaps something a little more revealing than Yougov’s recent  question about getting rid of “unnecessary” bureaucracy which produced a stonking 97% approval rating).  Of course the real answer is to create an ongoing dialogue in which a consultation is just a part of the relationship not an expensive one-off event – but that more mature approach may have to wait a bit.  MORI provides some very useful practical advice on how to get the public on board in these discussion in its post budget Tough Decisions setting out its top ten tips on priority setting with the public.

Big Decisions Little People

With the public sector being cut so fast and so ruthlessly from above is anyone going to have time or the will to stop and listen to what ordinary people have to say?  And will they know what questions to ask them?  It looks pretty much like the big decisions have already been made at government level and they are being made right now in town halls and primary care trusts as I write.   Even if some “real” people do manage to make their voices heard above the storm, it will probably be the ones who shout loudest and the ones we have heard before.  The voices that will be drowned out will be those of the most vulnerable and the those most likely to be adversely affected.

A Third Want In

There may be little room for the sort of consultation we all want to see over the next few months.  I guess I am not the only one who fancies a holiday.  But we need to take some heart from the fact that the government is still making noises about wanting to move decision-making closer to the people.  Big Society may not have gone down so well with the press but there is some evidence that real people are attracted to the idea.  According to MORI, about a third of the population wants is involved or wants to get more involved with a further  third wanting to be kept properly informed.  Several delegates at the event highlighted the importance of getting councillors, health board non-execs and other key local “public” players to champion this work within their organisations.  The challenge for all of us may well be to find new and better ways of “doing” engagement and consultation and, yes, spend less time and money on it.    High value engagement is what we need – engagement that asks the right people the right questions at the right time and which leads to real change and real improvements.  So no more empty halls, stewed tea and uneaten biscuits please!

The painful truth

“Text cloud” for this post below, created by www.wordle.net

US scaremongering is a distraction

“The painful truth about the NHS” as Marjorie Ellis Thompson said in a thoughtful Guardian comment piece recently,  is that scaremongers in the US are distracting us from the real debate about British healthcare:  “What is important is that we acknowledge the need for adaptation and change without sacrificing the central principle of equal access to healthcare, an argument that apparently terrifies those who are lucky enough to be insured in the US.” Quite so, but how to do it?

This is a stiff challenge for citizens to get to grips with because it has got harder recently to have a serious discussion about the NHS without tripping over some politician or other trying to shout louder than the rest.  If it isn’t a maverick MEP hurling vitriol about the NHS being a “60 year mistake”, then it is the Health Secretary’s sanctimonious rebuttal to such talk as “unpatriotic”. Did no one forewarn Mr Burnham of Dr Johnson’s pungent observation “patriotism is the last refuge of a scoundrel”?

Caught in the crossfire

All in all, this is not a pleasant crossfire to be caught in. The big guns are out for points and the sniping isn’t likely to die down much between now and upcoming election.  Most people will keep their heads down.

Donning my tin hat and venturing above the parapet nonetheless, I too see a painful truth about the NHS -  in the form of the shackles that bind it to party politics of all persuasions.  There will be no resolution to what passes for “the debate on the NHS” as long as political parties still have breath in them.  To have a proper debate, we need to separate “health” from “health systems” which are about delivery.

Health is not delivery

“The NHS” is just a delivery system, albeit one that has assumed the position of a surrogate national religion.  It was created out of a now-vanished post-war context to address issues like communicable disease (think TB and diphtheria, not swine flu) and the debilitating effects of grinding poverty on large sections of the population.

To be fair, it has delivered quite a lot in its 60 years – far more in fact than Beveridge, Bevan and the other founding fathers could have foreseen. But continuing to tinker with its basic design has little impact on the underlying factors - economic, educational and behavioural - largely determining the health of individuals and communities.

Outcomes matter for health

What we really need to be debating is not another ratchet of system reform, but something which is more fundamental: what do we really want in terms of health outcomes? Once that is clear, and no one should pretend it is an easy question to answer, then the job is to build new systems to encourage, incentivise and deliver those goals. Politicians should be facilitating that conversation rather than indulging in quasi-patriotic sloganising – or worse “twittering” – about who is better at loving the good old NHS.

Sadly, the 1948 model however much we flash it up in contemporary livery and lavish love on it is never going to deliver enough of what is needed. Other models in other countries have feet of clay too, so this isn’t a paean of praise for any one of them.

Thinking about ends is hard work

As informed citizens we should be addressing three questions: “what is a health system for?”; “who should be its owners?”; and only when there is a consensus on the first two, “how should it be paid for?” These are mainly questions about ends not means. It is our almost universal preoccupation with “means” that keeps the real issues in the background. Until they come centre stage, expect confusion and frustration to be the main outputs from the current “debate”.   And expect the politicians to shout even louder.  Ear defenders anyyone?