Consultation survey for “Better Care Together” Health & Social Care for Leicester, Leicestershire, and Rutland

I recently received an email from Leicester City CCG membership services inviting me to read about “Better Care Together” on and respond to the survey.

Looking through the first page of survey questions, I decided not to give answers to the survey questions because they seemed to start from assumptions that I don’t necessarily agree with – so there was no way for me to express my opinion without agreeing to those assumptions.  The assumptions seemed to be that the thrust of “Better Care Together” was what I would want, so the questions were merely asking for an opinion on minor tweaks of direction. They particular assumed that choice in who provides a service is what I want; choice sounds like a great thing, but actually I believe what people want in health & social care is control over the service they receive.  People don’t know how to rank particular specialists or services – they don’t have medical or social care training or knowledge.  We just want a high-quality service near to where we live and work, and to have more control over how this service is delivered in our particular case so it is tailored to our circumstances and isn’t about someone with power or specialist knowledge telling us what we will get.

In some cases, I agree with the thrust of “Better Care Together”, but I don’t want this to be taken for granted when being asked for my opinion.

The other problem I have with the survey is that it doesn’t seem to offer a way for the opinions of respondents to bring about changes in major ways; this ends up feeling like a public relations exercise, rather than genuine consultation.  “Better Care Together” is already written, so our responses wouldn’t change it – they would only adjust its direction.

But also “Better Care Together” is written in generalisations, so it’s hard to imagine how it would affect the health & social care we receive – so it’s hard to see, without reading between the lines, how specific services will change: this leads to the likely outcome of most respondents being positive about it because the generalisations are hard to disagree with, but only when it gets implemented will we see what it actually means at the grassroots.

Both of these factors render the survey pointless.


My submission to the Lords Reform consultation

Please submit your own thoughts on how the second chamber of the UK parliament should be reformed:

Here is what I said:

My biggest concern is the low level and poor quality of democratic engagement in this country. This goes way beyond votes in elections (where turnout is too low), voting systems (which need changing), and Lords reform (which is 100 years overdue), important though they are. True democratic reform needs to tackle things like the poor quality of statutory consultations undertaken by local government: decisions have been made before the consultation is undertaken, there is no clear link between the responses and any changes in the decision, and people are left out because only a minority of people are able to give their thoughts using the limited methods available, and no other methods are tried to engage with the others.

The Single Transferable Vote system is the best and only legitimate voting system for government and parliament. And all members should face some sort of election – so if 20% of the second chamber are to be “appointed”, the electorate should get to choose from an independently-compiled short list of suggested appointees. Appointments without election might provide expertise, but they also create an elite which is undemocratic.

While voting is most important for choosing members of the second chamber, I do have a concern that this will lead to the same old party politics happening in the second chamber. My idea for the 20% appointees being elected from an independent list should help to balance this. (This list should be split between Anglican Bishops, representatives of other faiths, people with professional/academic expertise, and some random members of the public: a few should be elected from each group.)

But the remaining 80% fully elected members should not be able to be re-elected – so they won’t be campaigning from the chamber, which will hopefully remove some party politicking.

There should be fewer members of the second chamber. Every 5 years there should be an election for ONLY one third of the membership at one time – so only a (different) minority of members have to leave at each election, so expertise and confidence isn’t all lost each time. This gives a term limit for an individual member of 15 years.

The second chamber should be able to delay government legislation as it can currently, but with the additional limit that two-thirds of the membership of the second chamber must agree to do this to make it happen for a second time on the same bill. If members of the second chamber can’t be re-elected as I propose, and a third of them are replaced every 5 years, this is also a limit on the power of the second chamber to delay government legislation.

My submission to the NHS “listening exercise”

Thanks to 38 Degrees, I was able to have my say: with only 1 day left.

I want to make a contribution to the NHS listening exercise. I am deeply concerned that the changes that Andrew Lansley wants to make will end up damaging our health service irrevocably.

The government’s “duty to provide” a comprehensive health service must be kept. Dropping this duty would erode the foundations of the NHS.

GPs don’t know mental health: I know this from personal experience.  Mental health services have been among the first to suffer under successive “cost-cutting” exercises; this will get worse if GPs are commissioning Mental Health services.  Patients are referred by GPs to Mental Health service teams, and GPs then have very little to do with ongoing treatment; GPs therefore don’t understand mental health treatment or appreciate the value of these services.  The commissioning of Mental Health services should be undertaken by experts in the field – the Mental Health Service teams themselves.  The same applies for many other specialist areas of health care, which GPs have no hope of ever understanding well enough to effectively commission.

The NHS has been under constant reform for decades – David Cameron promised in the General Election, “no top-down re-organisation” but the new policy is a total re-organisation.  Constant reform hurts performance and morale, and any benefits of a particular reform take time to emerge, time that the NHS has never been given.  Any new reforms should be developed on an evolutionary not revolutionary basis, with clinical judgement at the centre, and with trials undertaken and reviewed.

Doctors and Nurses should be able to avoid the impression that decisions will be taken for financial rather than medical reasons – even the impression itself will lead to a loss of trust in the Doctors and Nurses (even if it’s a false impression).  Involving the private sector in the NHS will only add to this impression; that we’re getting the “best value” health care that puts profits in other pockets, rather than getting the “best” health care possible regardless of any other considerations.

I note that these proposed reforms have not been put on hold during this “listening exercise” – this indicates that the Government is not prepared to change their reforms, regardless of what people say.  I also note that I have not been given an opportunity to have my say; I have not been made aware of any events, surveys, publicity, letters, or articles in the press, until the 38degrees campaign.  This all shows it to be an “exercise” rather than true “listening” – where someone is prepared to discuss their case and have their mind changed by another.

Please cancel all these reforms, and instead begin a long process of trials and expert reviews, before making any changes which emerge from the trials as necessary on an evolutionary basis.

Please listen.

Lessons to be learned from the AV Referendum

Unlock Democracy » Blog Archive » Lessons to be learned from the AV Referendum.

I agree with most of the above article, though I’m not convinced that there’ll be another referendum on voting reform for a generation.  I hope to be proved wrong!

I’m still surprised by the size of the majority who voted against AV, given that the turnout was the same as for local elections even in places where there were no other elections happening at the same time.  I was expecting it to be a close result, either way, or for the turnout to be much lower.  I guess we’ll never know why it happened the way it did – there wasn’t a space for giving a reason for your vote on the ballot paper!

My big idea – for Power2010

The Joseph Rowntree Trust’s Power Inquiry 2005, which was Power: make it the issue has now become Power2010. They’re asking for big ideas, out of which a short list will be chosen, then voted on publicly, to form the Power Pledge. Political parties will then be lobbied with this, and invited to make this pledge part of their manifesto at the 2010 general election.

Anyhoo, here’s my big idea as I wrote it on to their site:

Ongoing continual engagement, from all levels of government (parish through to EU), through one body (so citizens know there’s one place & person to speak to about any issue), using multiple methods of communication (“Planning for Real”, citizens juries, focus groups, forums, surgeries, door-to-door, electronic, discussion over bingo, etc.), relevant to all sorts of people (age, background, ability, inclination, hard-to-reach, people who prefer writing or speaking or discussing or ticking surveys or meeting one-to-one, and more etc.), with direct links shown so we can see how what we say and what was said to us impacts on changes in policy and implementation.

This is all in contrast to the very poor quality of “consultations” that government currently undertakes. And this comes out of the theory and practice of Community Development.

And here’s what I wrote in the “why is this important to you” box:

I believe that Community Development offers an ethos and method for connecting policy makers and implementers with the people who are affected; and through this engagement, all of society benefits.

I see the various “consultations” that government undertakes with the people as very poor in quality and very limited in reach and impact. They generally only use one method of communication (which is therefore only relevant to one sort of person e.g. someone capable of and inclined to respond to a written survey), they only do it once at one time (so the fuller longer-term picture is missed), they don’t work to include all possible groups of people (so the hardest to reach are included least often, and the disadvantaged are ignored), and the people who are involved don’t get to see how much of an impact what they have said has (if it has any impact at all).

Long-term continual engagement, in the Community Development way, leads to relationships being built; through ideas and opinions being exchanged and changes (formed by the people and by the organisations with the power) being seen to emerge from this, communities develop. This brings benefits to individuals and to society far beyond the simple tick-box “accountability” that so-called consultations are supposed to bring.

When you “do a consultation”…

…ask lots of people, in different places, in different ways that engages with how they like to think and do things.

And stick around afterwards!

So they can see their comments being acted on, they get involved in the ongoing process, you get to hear more about them and what they want and need, you build relationships that help any future work, they become part of the project and feel it’s theirs so they support it and get more benefit from it.

Don’t “do a consultation”, have a relationship!