Listening to politicians - Those seeking to implement change in our public services should study the views and attitudes of our elected representatives

It is so fashionable to denigrate politicians and to counsel them to ‘listen to the people’ that it may appear counter-intuitive to suggest that just for once, we should listen to them.

Civil servants and Managers attending Institute training courses, Masterclasses or Roundtables frequently complain that one of the biggest challenges they face is overcoming “the politics.” By this they do not necessarily mean party politics – but typically the extreme reluctance of MPs or Councillors to agree with controversial changes, especially if constituents want to oppose them.

This fear is found all over public services. New schools, their amalgamation, library closures, the planning of house building, new infrastructure projects, the way we organise police, ambulance, fire and rescue … and so on … all attract political intervention. But nowhere is this more visible than with the National Health Service. Even though this and the previous Government committed to public consultation before any significant changes, MPs queue up to express their disquiet about both the process – and of course, the substance of decisions.

When the House of Commons debated hospital closures on 11th March, it proved fascinating watching. The BBC had (mistakenly) suggested that this was about a Government clause to the Care Bill that would allow the closure of hospitals without consultation. It was never quite like that, but it emboldened many MPs to express their concerns about the engagement of local people. Why not read what they said? Anonymously! Who said it … doesn’t much matter. Nor what party they represent. Let’s just accept these quotes as the perceptions of Parliamentarians – obviously selected to be most relevant to Topic readers.

• “The way to achieve change is to involve the public early on, give them a meaningful say and build confidence in the clinical case for change.”
• “We all agree that reconfiguration is necessary. Of course it is better done in consultation with local communities and professional groups.”
• “We often debate this matter in the House, and we all agree in principle with the concept of reconfiguration until it is the local hospital in our constituency that is affected.”
• “There was a long and tragic history …of the public, patients and local clinicians not being properly engaged in the process.”
• “Time after time, consultation does not appear to work on the ground.”
• “…that consultation was utterly flawed and it led to the decision to downgrade my hospital…”
• “We too had a consultation that was a disaster….Unfortunately people do not trust consultations and when they happen they cost a fortune.”
• “The process and the consultation were atrocious…. Multiple public meetings were run in a chaotic and haphazard fashion …online consultation did not include a direct question about the closure …It damages trust not only in NHS leaders who are meant to be leading change but in our democracy ”
• “…these consultations are a fiction and a sham that do not make any difference to the progress of events in the NHS. In fact they cruelly mislead the public into thinking that they have any say at all.”
• “the argument on reconfigurations will not be won by politicians or even by senior Managers in the NHS. There has to be a clinically led argument from GPs upwards.”
• “ ….politicians of all parties must strengthen their backbone and be prepared to look at each case of reconfiguration on its merits, and then take difficult decisions if they are in the interests of patients. …. They should be determined by local commissioners in consultation with local people and with the health & wellbeing boards ….”
• (About …consultants) “The people to whom they were least likely to listen were the local clinicians, whether GPs or hospital doctors, and the local residents and patients. Those people were invited to the consultation groups – although not to the public meetings – but they were then told what they could and could not discuss. If they tried to discuss anything that was not on the facilitators’ list, they were threatened with expulsion. If that is the consultants’ idea of public engagement, it does not commend itself much to the public.”

And finally, “Local people often know intuitively what is right…People do not trust central Government…”

Now it could be argued that these views are unrepresentative; they all have axes to grind, or have had unusually bad experiences in their own constituencies. Or maybe that this is just the way of the world and that the best consultation on the planet would never persuade elected members that their voters were being fairly engaged. And that this is not just an NHS issue – and applies to controversies on planning and other difficult matters.

On the other hand, it may be that such views are widely held, and that our democracy has problems taking tough decisions if opinion leaders like MPs feel so strongly about the processes we use. The irony is that almost every speaker in last month’s debate agreed that they needed local consultation; they just lacked confidence that it was being done properly!

We may not want to listen to politicians, and we may hate their grandstanding on contentious matters. But this can be an useful wake-up call for everyone involved in public engagement, and offer us a chance to address some serious and fundamental issues. In a word the process needs to restore credibility.

TRIGGER POINTS

• What is the nature of your relationship with local elected politicians? Does your organisation pay enough attention to them?
• Have there been historical failures of engagement/consultation that may need to be properly settled for the sake of future relations?
• Do you always approach MPs etc as part of the pre-consultation process?
• Would it help your consultation if it was subject to Quality Assurance from the Institute? Contact Jan Warner on 01767 318350 for further details.
• Rhion Jones and Elizabeth Gammell are working on their next book “The Politics of Consultation” and are compiling material. Does anyone have any case studies?

This is the 257th Tuesday Topic; a full list of subjects covered is available for Institute members and is a valuable resource covering so many aspects of consultation and engagement