Managed Care Swiss Style – will voters buy it?

The World Health Organisation Annual Assembly was in Geneva last week. I am sure great issues were discussed – Le Temps asked if the planned reorganisation had any traction. Accusations were made that the organisation had been captured by private interests, lost its independance and that the whole effort should be stopped for a big rethink. (Bill and Melinda Gates gave $220m to the 2010-11 budget.) Against that, Le Temps suggests,  Margaret Chan elected by 98% of the votes to head up the WHO for her second and last term, may chose to pick the pace of the reforms to see what she can do before leaving in 2017. Let us know, someone.

Common concerns in the world of health

It would be sad if the main pre-occupation of the WHO over the next few years was its management systems and it became as inward-facing as most national healthcare systems. The NHS is so resolutely inward facing contemplating its own chronic intestinal complaints that it is a surprise to be reminded that there a lot of people trying to pick up stuff from other healthcare systems and trying to solve or at least manage the problems common to them all – the rise in both demand and expense. How to square that circle?

Feeling the pinch, even in Switzerland

Even the Swiss with their comprehensive healthcare system are facing up to the fact that insurance premiums cannot keep increasing every year. And what is the latest phrase on the lips of insurers and clinicians here in Switzerland? Managed Care. The Swiss especially those in the French-speaking bit are used to finding and choosing their own doctors. The insurers want to keep the lid on premiums and are now trying to persuade their customers that there is another way that offers good quality care at a lower cost. The deal on the table is that if Swiss citizens give up free choice of doctors and take the one on offer from their insurers, they will get a cut in insurance premiums.

Probably NO – but good to vote?

There is a vote about it on June 17th with the current odds in favour of the proposition being rejected. The initiative will join the seven previous attempts to reform healthcare – in the bin. The issue has united the left and the far right with both committed to rejection and guess what – the doctors cannot make up their minds. No threats to withdraw their labour as yet.

Selling change to healthcare users seems to be a political no-no wherever or whoever is trying to do it. It would appear that insurance companies are little better than doctors in selling change. Is the root cause an unfamiliarity amongst all parties described by the Kings Fund in a recent report on why patient preferences matter? The KF points out the consequences of what the report calls a lack of skills in understanding what patients want, labelling the outcome as a  “silent misdiagnosis” of patients’ preferences. Will the Swiss getting a vote on this sort of issue make for clearer preferences and better outcomes? Or will the insurers keep trying in the hope that people will ‘see sense’ the ninth time around?

 

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.

Parental Fingers on the Inspection Trigger

On April Fools’ Day we reported that the schools’ inspector Ofsted was considering giving parents the right to tell them directly what they thought of their children’s schools.  The teaching unions seemed to think it was a joke in bad taste but Ofsted, true to its word, has now launched Parent View on its attractively redesigned website.  Well worth a visit.

“By sharing your views, you’ll be helping your child’s school to improve. You will also be able to see what other parents have said about your child’s school. Or, if you want to, view the results for any school in England”.

A dozen simple questions

You simply log in and give the name of your child’s school, confirm that your child attends that school and then answer 11 graded questions (strongly agree, agree, disagree, strongly disagree and don’t know).  The questions cover the same territory as the paper questionnaires that are distributed to parents in the week of an inspection asking for parents’ perceptions in a range of areas: how happy and safe your child seems and how well they are looked after; their progress; the amount of homework they are given; how bullying is handled by the school; how children in the school behave; how good the teaching is; how the school is managed and how well parental concerns are handled.  The twelfth and final question (and one we at MAC  always like to see in surveys) is whether or not you would recommend the school to other parents.  Just a simple yes or no on that one which is a pity since there are degress of readiness to recommend – it is not a black and white choice.

It would be interesting to have heard that debates which led to a special definition of “bullying” being added to the site when there is no definition of some of the other equally vague and subjective terms such “this school is well-led and managed” or “my child receives appropriate homework for their age”.  But there is  nothing wrong with a subjective responses on these sorts of questions as long as the feedback is used intelligently.

Dare to be free?

I did find myself wanting to tell them more and qualify some of my answers and it is slightly frustrating to have only the blunt instrument of the graded marking to respond to the questions.  How do I tell them that I think the teaching in History is exemplary whilst I know the teaching of French is most definitely not?  And how do I tell them that although they have responded to most of my concerns quickly and efficiently I am still feeling disgruntled by the fact that after years of complaints from many parents French is still being taught in exactly the same way?  A bit of free text somewhere on the form would not go amiss – but I suspect this may be where Ofsted conceded to the unions’ anxieties about those mad, bad parents saying nasty, dangerous things.  Remember Chris “Cassandra” Keates of the NASUWT?  She’s the one who said that a survey like this would be

“Open to abuse and manipulation and would therefore be an inappropriate and unreliable mechanism for triggering something as serious as inspection.”

Feedback, insight, foresight – keeping the Inspectors from the door

Well, you can be sure that if a  school is in the doldrums or heading that way, parents will soon pick it up and be only too keen to use the Ofsted website to have their voices heard. And bearing in mind that it was almost impossible to do this in the past unless you happened to live next door to the Secretary of State for Schools, this mechanism is surely to be welcomed.  If giving parents a voice means triggering questions and even an inspection, then so be it.  Isn’t that the point of the whole thing? Any sensible school will be encouraging parents to fill it in and update their views regularly and will be incorporating this feedback from parents into its normal feedback and insight processes long before the sort of problems arise that would trigger a call from the Inspectors.

The pros and cons of anonymity

The site makes it clear that all feedback is anonymous so there is no way for schools to know who it is that is commenting.   Overall I can see the benefits of this from the point of view of a parent but past experience makes me worry that schools may use this as a way of dismissing views they do not like: the “Yeah, well, we know who THAT is”  or “Oh it’s just an organised campaign” responses that we all too often hear  (subtext: Dismiss, as you were).   But as a governor I can see that there might be times when it would be useful to be able to analyse the data in some ways: do the parents of children in reception have a stronger sense that their child is being looked after than those with children in Year 6?  Still, there is plenty of time and room for developing this sort of sophistication.

So congratulations to Ofsted for what we will assume to be phase one of their new website.  And an extra bonus mark for sticking to its guns on its plan to use information from parents to trigger inspections despite the knee-jerk resistance of the unions.  Let’s watch this space to find out how appropriate and reliable this mechanism proves to be.

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.

 

 

 

 

 

 

 

 

 

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!

Parent power – just another piece of populist spin?

A few weeks ago Gordon Brown declared that he wanted to make schools more accountable to parents. The National Union of Teachers spat back that this was just a bit of “populist spin”.  After all, they argued in their press release, “Schools already work with parents and governors to ensure that information is fully available to the local community”.  As my kids would say, “Yeh, sure.”

Some sorts of information, it would appear, are rather more available to parents than others however.  My daughters’ school is currently being run by one of the government’s newest beasts, the Interim Executive Board, an unelected and apparently entirely unaccountable group of “experienced educationalists” which replaced the governing body when the school went into Special Measures a year ago.  It took the Parent Forum seven months to get our lovely shiny IEB to agree to “publish” its minutes. Publish in this context means sticking them on a notice board inside the school where parents seldom tread and refusing to put them on the school website.  And funnily enough, despite massive changes taking place in the school every week, the minutes say little more than the date of the meeting and who was there and are posted approximately six weeks after the event.

Now they are setting up a “shadow governing body” for an unlimited timespan.  At last, we thought, a chance for parents to stand to be elected as governors and have some say in what it going on.  We had been promised elections a few months ago, but now we are told that the new governing body will be made up of the same old “experienced educationalists” plus three hand-picked new members: a parent, a member of staff and someone from the local community.  No elected trouble-makers here please.

But this worrying lack of stakeholder accountability extends well beyond Schools Causing Concern, such as ours where some might argue you need emergency measures to deal with emergency situations.  In her column last week in the Education Guardian, Fiona Millar describes how, despite massive protests from parents and other local people in the London Borough of Camden, the local authority has decided to go ahead with an Academy run by a “preferred sponsor” (preferred by the local authority that is).  What worries her is that the legislation around Academies means that their governing bodies can be entirely dominated by the sponsor, whether it be a creationist accountancy firm or a used car salesman with a side interest in selling cigarettes to young women in developing countries.

She writes: “Meanwhile, the academies experiment is still being rolled out with a vengeance, and is making a nonsense of local community empowerment. The wholly controlled governing bodies put in place by the sponsors are often fronts for more shadowy charitable trusts that make the real decisions – such as appointment of the head – from headquarters that are often hundreds of miles from the schools they control.”

The Conservatives have been a bit vague so far about what sort of schools they want to have in the future but they seem to be quite taken with the idea of parents running schools themselves following what is described attractively as a Swedish model.  A recent MORI poll however suggests that this is not really what most parents want.  Only 11% of parents thought parents themselves were the best people to run schools preferring local authorities (39%) or teachers (32%).  7% said they would definitely get involved in setting up a school if they could.  Another 36% said they might help.  A reality check based on our own experience and other research reminds us that the good intentions expressed in a questionnaire are not a reliable guide to who will actually turn up on the night.  But if they did build the school and the people came, how accountable would this small band be to everyone else in the local community?

Whose schools are they anyway?

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

Whose service?

There has been a whole lot of very interesting debate over the last few years about who the health service belongs to but what I’d really like to know is, who does the education service belongs to?  I recently contributed to a government review of governance in schools (supposed to be published in October 2008 but still eagerly awaited).  I was there to put forward the case for parental involvement but met with a depressingly familiar reaction from the teaching professionals:  just who do these parents think they are ?

Who’s baking, who’s being heard?

Most schools will tell you they work hard to involve parents.  But scratch below the surface and you will find that many are adhering to a conveniently self-serving model of parental involvement where in fact parents do most of the work.  An “involved” parent is one who gets their child to school on time, helps with homework, encourages respect for teachers, bakes cakes for Parent Teacher Association events and turns up to parent evenings i.e a parent who is seen but not heard.  Have a look at the average home school agreement and you will get the message “parents and their children must….(do what the school says)” , “the school will…(do what it likes)”.

But the government is now seeking to give parents much greater influence in what happens in schools.  Since May 2007 all schools have had a duty to take account of the views of parents and are encouraged to set up Parent Councils to help them to do so.   They even produced a useful, if poorly publicised, toolkit to help them to do it. But as yet, there has been no research into how many schools have set up Parent Councils or similar parent-led bodies or what, if anything, their impact has been.  Are schools really beginning to take account of parental views or is it still the case that teacher (or the local authority) knows best?

Whose Views?

Some people argue that having parents on governing bodies ticks the box as far as parental involvement in decision-making is concerned.  This might work if anyone was at all clear about the role of parent governors. They are elected, but what is their role: to represent the forty or so parents who voted for them, to represent all parents, or simply to be themselves?  Do they really know what other parents think and if so, how?  Does the presence of parent governors mean that schools are absolved of their responsibility to find out for themselves what the generality of parents think or want?  And we should not forget that many schools struggle to find any parents who are willing or able to sit on their governing body at all (and having spent four years as a governor myself I could suggest a few reasons why that might be).

Who’s Sorry Now?

Over the past three and a half years I have been closely involved in setting up and running a parent-led Forum at my daughters’ school.  We had some successes but overall we felt that no-one appeared to be interested in our experiences or those of our children and that the school saw no real reason to respond to our concerns.  Last February we asked parents to identify the top ten areas where we felt things needed to improve.  They were all the same things we had been complaining about since the Forum’s very first meeting. Once again the school ignored us.  A few days later the Ofsted inspectors arrived and wrote a damning report which (surprise, surprise) identified all the same failings that the parents had been rabbitting on about for years (plus a few more that we could feel but not quite put our unprofessional fingers on).

When a school is in “Special Measures” it can seek the Secretary of State’s permission to get rid of the governing body (in many schools the only place where parents can have their voices heard on matters of strategy) and replace it with something called an Interim Executive Board (IEB).  This is what has happened in my daughters’ school  and in our case the chair and the majority of the membership was made up of paid staff from the local authority – the very local authority that had got us into this mess in the first place.  There is no requirement to include parents on the IEB or even for it to listen to parents and yet the IEB has all the same powers as a properly constituted governing body.  They can change pretty much anything they like and even, as in my daughters’ school, appoint a new Head Teacher without consulting anyone.

In whose name?

Anyone who knows anything about what happens when a school “fails” its OFSTED inspection, will tell you that what follows is a period of huge stress and anxiety for everyone involved – including parents - and yet at this very time when major change is taking place, parents can be effectively cut out of the process.   Our Parent Forum had to ask numerous times over a period of several months before the IEB even agreed to publish its minutes and we have not seen them yet although it is almost a year since the governing body was taken over and then disbanded.  We have also been asking to see a plan for the future of our school – what is going to change? why? when? and how will we know whether the raft of changes and new initiatives has made a difference?  No sign of that yet either although according to the school it was drawn up last July and they have been working to it since then.

The government is talking about streamlining governance arrangements in schools which probably means small governing bodies with people appointed for their skills rather than being elected by staff or parents. Pretty much like our IEB.  In governance terms this makes a lot of sense, creating small focussed and professional bodies with the skills to run these important institutions properly.  But our experience of such a body shows that little importance seems to be put on hearing the voice of parents – which is strange. These days, a skill set that does not include the techniques of gathering and acting on user and stakeholder opinion can be dismissed as dangerously introverted and incomplete. It is an old-fashioned management concept that refuses to share power and sees the participative approach as a threat to the quality of decision-making.

Whose Schools? (See where we started)

One way to address this might be to make Parent Councils or similar bodies compulsory in all schools and require governing bodies to listen to them.  Properly run and resourced Parent Councils, perhaps with their own dedicated staff, would foster new dialogues between parents and school senior managers and governors.  Institutional changes aside, we need to bring about a change in the culture of our schools and local authorities so that they understand that they are running schools for the benefit of children, their families and wider society and that they will only succeed in doing this when they by working in meaningful partnership with parents and carers and hearing what they say.

A New Song for the NHS – turn me loose and set me free!

“Cause More Trouble”

That was one piece of advice from David Nicolson, Chief Executive of the NHS speaking at a Department of Health conference 8th July to those representing the patient interest. The venue was the cathedral-like space of the Lawrence Hall in the Royal Horticultural Halls before an audience of specialists and enthusiasts working in the area of people participation, involvement, engagement – the vocabulary changed as fast and as frequently as the sky over Wimbledon. Many of them had gathered before in halls to be assured that the future of patient participation was now safe and on a good road only to be disappointed by the reality down the line. Does the NHS this time have a new story and a new song that will not just promise a new dawn but deliver it?

NHS – the New Story and why not? – a Song as well

The speakers assured us that this time it would be different and I was tempted to believe them. What has changed for the better? The NHS now has a draft Constitution which will fix the customer at the centre of the system. That system will be based on World Class Commissioning. The Constitution will define the expectations and service aspirations. The commissioning process and the associated systems will assure compliance. Not a national target in sight and now we have local service designed and commissioned with local people and their needs in mind. Hence the Merle Haggard lyric celebrating the new freedom that will flow from commissioning and delivering for the local community. Going with the show biz flow, we conference attenders did get a playlet that dramatised the present and the future, daring to look 5 years into the future. Alas one thesp running to embrace this vision, fell over Meredith Vivian’s dog. I was cheered by this note of realism that reminded us that there would be obstacles in the road to the future but nevertheless the show went on.

The ducks seem to be all lined up. The juggernaut is rolling. Satisfaction with the NHS as measured by Ipsos MORI has never been higher. PCTs have never had so much money. The presses at the Department of Health have been rolling without pause or interruption – in the period between 9th May and 3rd July the Department pumped out no fewer than 7 publications including the final report by Lord Darzi.

This link will take you to the consultation on the constitution. The closing date is 17th October this year.

Ben Page of Ipsos MORI provided a valuable corrective to the mood of euphoria in the form of some facts about the gap between the promise and the reality. Almost everybody thinks being involved is a great idea – 82% according to his data support the idea of being involved but at the end of the day about 2/100 actually turn up. But everybody likes organisations that offer the chance of getting involved and Ben told us why South Tyneside had been recognised this year as the Best Achieving Council. Their ads showed the engagement process the Council favoured “We Asked, You Told Us, This Is What We Did”. Closing the loop and reporting back on what happened as a result of a consultation or engagement programme is emerging as the key ingredient in sustainable engagement programmes. Ben made the point that the best regarded local authorities were on the whole the best known ones. Information is a vital precursor to engagement.

Keep telling that story or indeed singing that song.

100 already – a quick century for the Wandsworth LINk

Wandsworth’s Local Involvment Network launches today

Since our announcement last month, M-A-C has been busy working with the Wandsworth Care Alliance to launch Wandsworth LINk. The website www.wandsworthlink.org.uk went ‘live’ this morning.

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