Like many of our readers, I spend a lot of my time trying to encourage public organisations and service providers to reach out and involve more people in their decision-making, to go beyond the people they normally hear from. People want to be involved and so you have to involve them, I tell them. How useful to have this view supported by Hands Up and Hands On, a recent report from Consumer Focus and Involve looking at localism and community empowerment. An impressive 82% of those surveyed agree that “people need to have more say in what is happening in their local area beyond local elections”. Oh, but hang on a minute! What’s this?
“However, the support for a greater say does not necessarily reflect a personal appetite to do more, with just 28 per cent of people saying they’d like to have an input in influencing local decisions (rising to 38 percent for parents of children under 18) whereas 71% say they are not interested“.
Not interested? How can this be? But perhaps it is true. Perhaps loads of people really are not that interested. It is certainly my experience as a school governor that whilst some parents will jump on you as you try to sneak out at 9.05am, many more when you talk to them, will be pretty happy with the way things are going and not that bothered about what the governors are getting up to in their name.
Where is everybody?
My daughters’ school is currently carrying out a consultation on whether to federate with another local school. So there I was a couple of weeks ago sitting on a little plastic chair in a circle in the school hall with my head on one side using my best listening techniques when it struck me as it always does on these occasions that whatever these vocal and articulate people were telling us about what they thought, we really were not getting a full cross-section of the views of the wider parent body. The total number who had attended our various consultation meetings represented about 5% . Of course, they are a great bunch – thoughtful, challenging, committed to the school, capable of being a bit stroppy from time to time but that’s all to the good – critical friends, the grit in the oyster, the Usual Suspects. But they are a very small subset of our parents and we have no idea of how representative of the views of the other 95%. Where was everybody else?
Frankly, they don’t give a damn
There is nothing unique about this scenario. The same could be said of pretty much every public consultation or user meeting that I have ever been to. Often at meetings like this people will tell you that there is great discontent out there somewhere. They are here to speak for the unhappy silent majority. But when you ask why these people don’t come and talk to you, either at the meetings or anywhere else, they tell you it is because they don’t see the point – and they don’t think it will make any difference. So which is it? Is it just that they are happy with the decisions that are being made on their behalf and frankly have loads of other things they’d rather be doing with their time or are they sitting in their kitchens nursing their wrath to keep it warm but too disillusioned to email, or talk to us, or come to a meeting or fill in the consultation response form? We would really like to know, but how do we find out?
Perhaps we need to accept that there will always be a pretty substantial group of people who really are not that interested in getting involved. And what is wrong with that? We are all entitled to say there are things we don’t give a damn about and let the state get on with its job.
How to catch the low hanging fruit
Nevertheless there is still the group that sits between the 5%-10% we hear from so regularly in and the reported 28% to 36% who do want to be involved but are not.
The report helps to highlight what is putting them off. So here’s our take on how to get to grips with their top five “barriers” to involvement.
- Lack of information – engagement mechanisms appear to be invisible. I’d say we need to find out what really works - and what doesn’t – and decide how we measure success or otherwise. Posters and PowerPoint presentations in draughty halls may tick the boxes but won’t really do much communicating. Word of mouth and personal social contact must be a big part of the answer and we need to find ways of measuring our efforts and our successes in this area.
- Lack of time (and fear of being sucked into the time and good-will eating machine that is the world of volunteering and involvement – my words not theirs). We need to be really clear about what we are asking of people; make good use of their time by sticking to timetables, running meetings properly, conducting and enabling conversations so everyone gets a say, ending things on time and not asking favours of people who are already doing too much.
- Lack of faith in local authorities – (which could presumably be extended to any local provider). Trust is the holy grail. But it takes a long time to develop it, especially if you are starting from a low point as many are, and it can be destroyed in seconds. The development and nurturing of trust should lie at the heart of every single contact. Don’t insult people’s intelligence, and don’t patronise them and don’t ask for their views if you have already made up your mind.
- Fear of the usual suspects. Are the people who come to meetings thinking they are standing up for the down-trodden, “silent” people actually the very ones who are putting them off in the first place? Should we politely ask them to leave? Probably not, though it is sometimes tempting, but we might have to ask them to be quiet and listen for a minute. We need these people working for us: they are key networkers and influencers in communities, whether we like it or not, so how do we make the most of what they have to offer? And we also need to create some “safe” spaces in which we can talk to the people who are less happy about standing up in meetings or manning the barricades.
- Lack of return on investment – working hard for a desired result and not getting it puts people off . To some extent this may be inevitable. People engage when it matters to them. When the battle is over they are likely to move on, especially if they have not got what they wanted. But is it possible to get people to appreciate the process itself and see it is fair and worth being part of even if they don’t get exactly what they expected out of it?
A new consultation on school inspections has raised the question of how much attention the inspection body Ofsted should pay to the views of parents.
“We…. intend to take greater account of parents’ views in helping us to decide when a school should be inspected. We are currently considering new ways in which parents’ views about a school will be gathered regularly and not just at the time when it is inspected. We propose to gather parents’ views by inviting them to answer a range of questions about their children’s school via Ofsted’s website. These findings will be considered as part of the risk awareness process.”
Hold on a minute – did they say listening to the views of parents would become “part of the risk awareness process”. Time to sit up and listen. Here is a government body appearing to embrace the idea that the users of a public service might have something really important to tell them about that service. This is not about going through the motions of listening for the sake of it but because they recognise that there is a real risk in failing to do so. And they want to do it “regularly”! Better and better.
Parent Opinion Website
Although we think the use of structured questions to parents proposed in the consultation document will be useful for inspectors in deciding whether to carry out an inspection, it would make sense to complement this with an independent “Parent Opinion” website along the lines of the well-established Patient Opinion website which invites individual stories both good and bad and allows health organisations to respond and to tell people what they have done as a result of the feedback. They sign up healthcare providers to subscribe to the service and take the information on board as part of their patient-centred quality processes as well as providing a response to the individual.
James Munro of Patient Opinion describes it appeal:
“At Patient Opinion we’ve learned a lot about how people want to give their feedback to health services, and what they expect to see. First, while many people may want to give critical feedback, they don’t necessarily want to “make a complaint”. This seems to be a distinction the health service struggles to grasp. Second, people want to know that they can be honest, without fear of being identified. They want to say both what was good, and what could be better. We’ve learnt that this honesty, and the mix of feedback that results, is important to both patients and staff. Third, people want to know that their feedback was heard – and by whom. And finally, they want to see that giving feedback can, at least sometimes, make a difference”.
It is easy to see how this could work for parents and schools.
Making OFSTED aware
When my daughters’ school started to fail in a huge number of different ways, it was the parents, particularly those who had been around for a while, who saw what was happening. We set up a Parent Forum to try to channel parents’ concerns into the management of the school. Parent governors struggled to make themselves heard at governors meetings by senior management and the local authority but to no avail. Eventually one parent sneaked off to phone Ofsted to ask them when they were next due in the school. She was told that because the last inspection which had taken place several years earlier had shown that all was well, they were not planning to come back for another three years. Thanks to her courage and persistence the inspectors turned up a few months later and set the ball rolling for major change.
Wouldn’t it be great if we could simply have gone on-line and given voice to our anxieties knowing that someone somewhere was listening? Well, we parents might think so but the teaching unions feel otherwise.
Teacher resistance – same old, same old
In response to the consultation Christine Blower of the NUT has said;
“The ability for parents to complain directly to Ofsted is already in place and has been very rarely used, which shows that parents are generally very supportive of their children’s schools”.
Two classics here: first, the implication that because no-one can find their way their way through a labyrinthine and intimidating process it means that everyone is happy (rather than reflecting how hard it is to complain) and secondly, the assumption that parents who complain are not “supportive” of their children’s schools – when in fact the complete opposite can often be the case.
She goes on:
“Parents will not want to be involved in triggering early inspections. To offer such an opportunity is unnecessary. What is important for parents is that they have a voice in schools and that their views are taken seriously. It’s not clear therefore why parents, who may have quite legitimate questions to which they seek answers, would choose this route.”
I wonder how Ms Blower knows what parents feel about triggering early inspections. I am not aware that the NUT spends much time talking to parents. Of course no-one wants their school publicly damned by inspectors but that does not mean they don’t sometimes welcome an inspection. It may not seem a “necessary opportunity” in the teachers’ eyes but in the absence of any other form of influence, it may feel very necessary to parents.
Cut back on the parent voice
It would be great to think that there are good and effective routes within all schools for raising concerns and sharing them with others but the simple fact is that that although there are many examples of excellent practice, it is certainly not universal. Hardly any schools have parent councils; new Trust schools, Academies and Free schools can get away with even fewer parents on governing bodies that maintained schools and complaints policies, as we have discussed before on this blog, are both bureaucratic and feeble. An open and easily accessible on-line forum could provide schools with an effective means of hearing what parents have to say- removing many of the practical, social and emotional barriers that stop so many parents challenging their school or even just making their voices heard: the meetings at children’s bedtimes, the other parents who speaker louder and longer, the childhood memories of being intimidated by teachers.
No hiding place
And then of course there is the usual reaction of public service professionals to the idea of allowing service users to express their views on the service in a public forum, a reaction we have seen before in health. Chris Keates, general secretary of the NASUWT union, said:
“To hold schools to account on the basis of chat room and internet gossip trivialises public accountability and the work of schools. Such a system would be open to abuse and manipulation and would therefore be an inappropriate and unreliable mechanism for triggering something as serious as inspection.”
No-one is suggesting that the on-line collection of data about pupil and parent views and experiences would be the sole way in which a judgement would be made about a school. But as one of a range of ways of testing the quality and impact of what you are doing, its value cannot be denied. It is insulting to parents to think that they are not capable of putting forward rational and balanced perspectives. Of course there will be some nastiness, some nutters, some fruity language but isn’t it about time professionals stopped being so squeamish about this sort of thing? Ignoring cross people only makes them crosser and the internet and social networking are out there whether the teachers and doctors like it or not. And while we are at it, why not have a similar website for the students?
Websites like Patient Opinion have demonstrated that the vast majority of people are careful about what they write and most of the organisations that engage with people through the website find the experience and the data they gather useful. In fact the schools might be surprised to find, as Patient Opinion does, that they receive a significant amount of positive and useful feedback. Some schools might even welcome it as a way of keep their finger on the pulse of their parents’ opinions.
The Moore Adamson Craig Partnership supports user and public participation, trains lay representatives and develops responsive health, care and education organisations.
The Health Select Committee, whose activities we have been following with interest on this blog, is sitting this week to look in more detail at the arrangements for commissioning set out in the new Health Bill. This morning’s session, which you can listen to online, focused on public accountability and we were delighted to be given a chance to give oral evidence.
One important feature of the MAC partnership is that all four partners are actively involved as lay people themselves – not just talking the talk but walking the walk too. And not just in health but in schools, transport, parks and even a residents’ right to manage body.
So it was with this combination of theory and practice in mind that I joined the table in Committee Room 17 today. What can those of us with years of hands-on experience of trying to make public engagement work add to the debate at this stage in the Bill?
New structures – a triumph of form over function?
Inevitably the conversation focussed on the structures and hierarchies of accountability as set out in the Bill. Who is answerable to whom and for what? How we will know if it is working? Chairman Stephen Dorrell said he felt giddy on behalf of the GP consortia who stand to be pulled in numerous different directions by the national Commisioning Board, the local Health and Wellbeing Board, possible Overview and Scrutiny and (lest we forget) the patients and the public. And certainly the Bill does nothing to clarify these arrangements. I doubt it is just the GPs who are feeling confused and bewildered.
Are the people up to it?
The discussion also entered classic patient involvement territory as the committee grappled with whether patients were really able to discuss issues more complex than the patterns on the wallpaper. Does the wallpaper matter? Yes, it does matter to patients if they have to spend a long time in your waiting room. Can patients rise to the challenge of higher level debate and involvement? Yes of course they can if it matters to them, if they are given the information they need, if they are asked the right questions and above all if they can see that they are making a difference. But those are big ifs. If these things don’t happen, they will walk away and probably tell their friends and neighbours that it was a waste of time.
So what is still missing from the Bill?
You can judge for yourself how well I put over our arguments but this is what I wanted to get over:
- We need a clearer distinction between patients’ involvement in their own care and patient and public involvement in decision-making. They are separate in many ways but they are closely inter-related. The learning from patient involvement in practices should be aggregated up to consortia level where it should be seen as important part of the intelligence on which strategic decisions will be based, not least commissioning decisions.
- We need to start thinking not just “No decision about me without me”, but also “No commissioning for me without me”.
- We need structures because they provide clarity but structures alone won’t make for involvement. Form must follow function. We need leadership, a change in culture, a change in behaviours and an understanding of patients as customers and the public as the moral owners of the health service.
- We need to ensure penalty-free participation and place a real value on what people bring to them in whatever from they bring it.
- We need good, well-trained lay people at all levels but the model should be “bottom-up” involvement. Start where the people are – in practices, in community groups, in the voluntary sector and go to them. Don’t wait for them to come to you. Patient participation groups may be useful but there are plenty of more imaginative ways of involving people. The purpose of involvement is to involve people and different people will get involved in different ways.
- We need to acknowledge that none of this will happen unless the capacity issues are addressed. Involvement of patients and the public in commissioning should be central to the business model in consortia not an add-on. The people who are getting involved (patients, public, lay people) need recognition, training, support and, above all, to be able to see that their input is making a difference.
- We need to find new ways to recruit new people including people who can help us understand how to overcome health inequalities.
- We need leadership: clinical leadership, managerial leadership but also lay leadership which we will find out there among the existing lay world (a world we urgently need to map), in the voluntary sector and in places we have not even dared to look yet.
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.
I used to teach in Kilquhanity, a real “Free School” set up in 1941 by the visionary Scottish educationalist John Aitkenhead. His view of Freedom was simple: ”You are free to jump into the water, but you are not free to stay dry”. We all need to need to take his advice and think hard about the consequences of our choices.
I was reminded of this today when I heard Paul Carter, Leader of Kent County Council (and one of the Conservatives own), telling the BBC that ordinary state schools will lose out as more “Free” schools and Academies are set up. Shadow Education Secretary Michael Gove rushed into the Today programme studios to tell us all that Paul Carter was fully behind the Conservatives plans but he was not entirely convincing. No matter how you do the sums (and Mr Gove did try), it is hard to see how we are going to be in a position to create the extra capacity that the Choice agenda requires against a background of reduced spending.
A few years ago as a governor in my daughters’ failing state primary I could see that things were seriously wrong but, despite the fact that all the parent governors had concerns, we were not listened to by the local authority. We set up a Parent Council to try to find a constructive way of channelling parental anxieties but again we were ignored. It was small satisfaction to know that when Ofsted finally arrived and gave the school a damning report, the issues they raised almost exactly mirrored the fifteen key issues which the Parent Council had identified and raised repeatedly with the school management over a three year period. The good news is that now, two years on, we are no longer in Special Measures and we have a well-run and happy school with a strong and effective Parent Council in place.
But something has been puzzling the new Head. Whenever we talk about the bad old days she asks us why on earth we did not just take our children out of the school. The answers are interesting: because it is our local school, because our other children had attended the school and we felt it was “our” school, because our children had friends there and, perhaps most important of all, because we did not want to simply walk away from a failing school and leave other people’s children to their fate – we had a strong sense that the school could be better and we wanted to help to make it happen. Many of us had invested our time and energy in the school for many years and we were not willing going to give upon it just yet.
Reading the manifestos of the three main parties, I am struck by the fact that all of them equate parental choice and involvement with parents wanting to move their children out of existing schools and into new schools and maybe even run those schools themselves. But what if parents don’t actually want a new school let alone one they have to run it themselves? What if they just want their existing school to be better? A recent MORI poll found that 62% of those polled thought that local authorities were the best people to run schools. Only 5% thought parents should be running schools whereas a third thought parents should not be running schools.
Politicians are right to say that people want to make a difference to their communities. But people have strong loyalties to local institutions. There may be parents who are desperate to set up new schools in their own image for their offspring but many more of us want to stick with our local community schools that have served our families and communities for years and simply be allowed to contribute to making them better. It is not a lot to ask and it is surely a better way to spend our money.
A recent blog by the estimable health economist at the Kings Fund Dr John Appleby on PCTs and managing markets pointed out that in the recent World Class Commissioning external assessments, most PCTs scored poorly on competencies around stimulating the market and market management. That rings true for my corner of South West London. I’m long enough in the tooth to remember when what we now call commissioning was just “purchasing” replete with shopping trolley analogies. We’ve come some way since then, but still have a long way to go to get to the stage of being real market makers able to shape services (and more importantly provider behaviour) towards outcomes that do something positive about narrowing health inequalities and improving the health status of individuals.
To do that we need to move beyond commissioning in terms of how we describe what we are really seeking to achieve. As “purchasing” was overtaken by “commissioning”, so the next iteration of the art should be “health investing.” After all £450m is no mean sum to have at our disposal annually. We should be able to do something creative with it to make things better for our 300k+ people who use services in our borough.
Just buying the same old, same old from the local providers won’t change things much.
As John Appleby says: “The fundamental question for PCTs is how, having identified their population’s health care needs and decided on priorities, they use their purchasing position within the economic framework of the NHS to get value for patients. “
There has been a spate of helpful “how to do it” guides for market management from perhaps not-too-disinterested management consultancies. These are all welcome – we have to start learning somewhere - but the best way I think is to learn market making by doing it. Perhaps that makes me a radical empiricist in my approach to market stimulation. I’ve just finished being part of the procurement team for our GP Led Health Centre at Clapham Junction and am now part of a team getting to grips with potential providers keen to help us do something about our scary childhood obesity problem. Everyone involved is on a rapid and time-hungry learning curve. Without doubt, sharing this experience within the PCT and with our local authority commissioning partners is building our competency as market makers and market managers in a very practical way.
Obesity and other “lifestyle-related” services was an area identified by external consultants as ripe for market stimulation and open procurement. Now that we are doing just that, I’ve been amazed by the number of quality providers from inside and outside the NHS who say – at least on paper, the real test comes in eyeballing the short listed candidate providers – that they want to work in this new way to address the outcomes we are seeking to achieve. If we become competent health investors we can have competition for the market and also competition in the market. That should give us much increased flexibility to address the health and well being needs of our diverse population and provide expanded choice amongst services.
PCTs must be smart health investors. Like any successful business - especially one looking to survive and prosper during the economic downturn - we must have good customer insight (intelligence from user experiences, learning from user and public involvement, complaints etc). But insight is not enough. We must learn to join up this insight with investor foresight (our aspirations and expectations, market intelligence about demand, provider capabilities and potential etc). Putting these two things together is the only way we will be clear about what journey we are taking and - crucially – whether our local population is with us on the same journey. We cannot simply assume everyone is going to the same place just because we have a strategy document about it.
One way to start getting to grips with being a smart health investor is to use an excellent new tool developed by David Gilbert and colleagues at InHealth Associates for the Department of Health - the “Engagement Cycle” The first thing I would like to use the Engagement Cycle for in our PCT is to audit what we think we know about user-focused views in our commissioning strategy.
I’d like to be assured on these points: How robust is this intelligence? How are we relying on it in our current plans reflecting the NHS operating framework? How are we refreshing, extending and communicating our customer insight and translating it into future commissioning plans? Where is user-focused intelligence helping us to go as a health investor? Is everyone on the same journey?
To have insight, you first have to have the right data from your customers. If you aren’t sure what customer experience information (CEI) is, how to get it and what to do with it, PriceWaterhouseCoopers have provided a helpful guide to CEI in health and social care. Then its a question of rolling up your collective sleeves and getting to grips with learning the health investing business. I guarantee you will not be bored.
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?
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.
10 posts since 30th September represents an all-time record as M-A-C engages with the issues and causes dear to our collective and individual hearts.
Our first ever post back in 2003 was about our central interest – user involvement. A theme echoed in this month’s output with Andrew’s post Engagement isn’t enough. Two posts later, we were taking a look at Ann Abraham’s approach to her then quite new job as Health Ombudsman. Complaints and the way they are managed and treated and what they mean for the organisations trying to deal with them are another abiding interest – see the piece on 24th looking at how common themes can emerge from different surveys of the complainant/ customer experience.
It is not all about the familiar themes – since 2003 we have broadened our interests to embrace two new areas – Policy Governance and parental involvement in schools. In the case of the model developed by John and Miriam Carver, Policy Governance® has taken a while to get off the ground in the UK. Most of the work and case histories reflected US practice and we have not had a good UK example of how this approach to corporate governance can help organisations here. Now the Southend University Hospital NHS Foundation Trust have led the way for others to follow. Val Moore reported on this on 27th October.
Finally, Caroline Millar reports on how the new models of participation – involvement, engagement – are impacting schools, parents and teachers. Her piece focuses on the consultation on complaint handling in schools and how parental problems are handled (or not).
We call ourselves a consultancy that specialises in the user interest. What keeps us interested and involved and in business, is how that interest can manifest itself in so many different contexts while the principles underlying best practice can be so similar. Different diagnoses, different solutions but underpinning them all are the common questions – what do users think of this? Has anyone asked them? Has anyone listened? Has anyone done anything with what they have heard? What happens when people have a problem? Easy really.
The final question that comes up when looking back over 5 years – has anything changed? Well Andrew inspired us all with a 2006 look at what the NHS will be like by 2015. We are almost halfway there and what has come true? Well the Department of Health seems to see things the Andrew Craig way. Allowing people to pay for their drugs was something Andrew took a look at in March this year when he pointed out that ‘topping up’ was something that Beveridge seemed to have explicitly anticipated when he wrote about the State leaving “room and encouragement for voluntary action by each individual”. As far as the management ethos of the NHS as a whole is concerned, we will wait and see how PG will change all that.
In the meantime, it is still worth repeating a little Olympic-flavoured M-A-C joke from 28th November 2006 -
A parable of NHS reforms
(Elements are borrowed from several sources and sexed up a bit by us)
An NHS rowing team raced against a Japanese team. There were eight people in each team, of similar fitness, but the Japanese team won by a mile. How could this have happened asked John Reid? Top NHS management established a committee of analysts, which reported that the Japanese had seven rowers and one captain, whereas the NHS has seven captains and one rower. The experts called for restructuring of the NHS team. The new team comprised four captains, two service managers, and a director who also did the rowing. After a second lost race to the Japanese, the single rower was dismissed on the grounds of incompetence, and the management team received a bonus for strong leadership. A new NHS boat is currently being designed , but is reported to be running behind delivery schedule due to IT problems.
Let us see what has changed by the Olympic year of 2012 assuming we have not had to make a choice before then between funding bread and circuses or the NHS.