Hands off our Ombudsman we say. The Public Administration Select Committee has taken a look at the Big Society and is not sure what it sees. The Big Society seems to have become a curiously insubstantial reincarnation of the wooly mammoth – is it real or just a ghost that haunts the cracks and corners of our public life, trumpeting faintly? Is it still out and about or are we seeing an illusion created on a film set in the Parliamentary zoo?
Risk of Infection
But the uncertainty that dogs this initiative should not be allowed to infect institutions that are functioning perfectly well doing the job they were set up to do. The fear is that the Ombudsman becomes the cheerleader and the policeman for Big Soc programmes – promoting local resolution, specifying remedial actions. This is the way to the Heffalump pit of enforcement – ie making sure that what is specified is done.
The report has a chapter on accountability, equity, representation and management (and all this is a chapter only 3 pages long). For me the interesting idea that has applications for the areas we work is that those concerned with Big Soc projects could work more flexibly and confidently if they take a ‘murky view’ of success – a view which is more nuanced and broadminded than ticking the one box called SUCCESS!.
The Moore Adamson Craig Partnership have always favoured a metric of success – otherwise how do people know what they have achieved? However in the world of volunteers – like people coming forward to be a patient representative in a GP surgery – there is always this mix of the personal and the communatarian.
Understanding the Needs
Participation can be prompted by personal need as well as community need and in health matters the personal is often the far stronger motivation. This only becomes a problem if the personal remains so dominant that it precludes that person developing the skills and the perspective that allows her or him to use the personal as a basis for the general agenda. Matthew Taylor’s blog is referenced by the committee where he writes about the irredeemable anecdotalism of the Big Society with the consequence that ministerial policy is vague and uninformed by any evidence. However in our view, the anecdote in matters of public engagement is often where an issue kicks off with the evidence becoming stronger as the anecdotes accumulate.
A Matter of Political Inconvenience
However would we be too cynical to say that anecdotes that support a ministerial point of view are embraced while the ones that do not, are ignored even when a lot of time and energy has gone into organising feedback. I remember us agonising over the format and content of our local LINks Annual Report to be submitted by all to the Secretary of State for Health. There was such potential there to pull out common threads based on the patient representative experience. What happened? Can’t remember and now it is too late with LINks becoming another of those ghosts of PPI past that haunt the NHS patient participation landscape. Any evidence that might support the continued existence of these organisations has to be ignored since it is politically inconvenient. The Big Society revolution is certainly fulfilling that hoary revolutionary maxim whereby revolutions devour their own children – in this case the institutions that might have played a considerable role in achieving the NHS version of ‘murky success’.
The Moore Adamson Craig Partnership supports user and public participation, trains lay representatives and develops responsive health, care and education organisations. We are ready to work with and support all those who want to make sense and a success of the new structures of patient and public engagement within the new arrangements for health and social care commissioning and providing. Feel free to contact us to discuss the opportunities.
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.