Originally published 19 February 2013. This article is retained from the tCI archive. Law, policy or practice may have changed since publication.
Hands up who feels really well-informed about the European market for horse-meat? Maybe not too many of us – but certainly rather more than did so three weeks ago! One of the hallmarks of our Google-grateful age is that it is easier than ever before to feel clued-up, and our 24-hour news culture is happy to add layer-on-layer of seemingly-authoritative information to dispel any doubts. Oh, and there is a fair dollop of comment as well.
A charming feature of our democracy- and the bulwark of freedom of speech - is our ability to hold forth in the pub with the most prejudiced, ill-informed views but, of course, we don’t give decision-making powers to the same individuals. Representative democracy holds that if we elected the same people to office, we’d surround them with the paraphernalia of Councils or Parliaments, experienced local government officers or civil servants and brief them to the hilt. The idea then is that their decisions would be reasonably well-informed.
So here then is the paradox. We want these self-same decision-makers and opinion-leaders to be influenced by the rest of us, and we call it consultation. We do it for good reason, for we know that the public has information that often fails to make it to the top, and that the public ‘gut feel’ often captures an innate sense of what’s best.
But in many public consultations, the views expressed can come from a range of voices, and their knowledge of the subject may vary enormously. Let us take a single but topical example. The Institute has just looked at a very comprehensive consultation about making changes to NHS services in a particular part of the country. Very clear messages came cross, inter alia from:-
- Specialist clinicians – e.g. members of the Royal Colleges, with day-to-day experience of delivering healthcare • Employees of the NHS from the most junior to the most senior, whose jobs might be affected, and who understand how the system works in practice • Voluntary organisations – many with deep knowledge about community needs and social care/health services • Local people passionately concerned to safeguard services they value and which might change in ways they find unacceptable • Individuals who have been approached to add their signatures to an online petition regarding the changes.
.. and many others of course
The point is of course that all these come from a different perspective, and what they know varies. Some are acknowledged ‘experts’. Others have a very limited – though no less ‘valid’ experience to draw upon - which is one reason for the increasing popularity of the ‘expert patient’ idea. Is it too fanciful to suggest that the more one knows about the subject, the less objective one can be? But dare we analyse on that basis?
A researcher we know, looking at NHS data as above, decided that one way of analysis was to remove from the equation all those seeking to defend facilities at a local hospital site, and examine the views of all those who were ‘geographically neutral’. Interesting idea! Apply this to another contentious proposal – to build the High Speed Two line through some of England’s green and pleasant land. The views of those close to the route are, to an extent predictable. But what are the views of respondents who are not remotely nearby? Might their views on the desirability of the project be more objective?
A frequent problem for those tempted by such an analysis is to discover that there are not many such disinterested respondents. In other words, most consultees happen to have had a particular interest. That’s why they have bothered. No surprise then if the resulting analysis just reflects which grouping best organised their members to participate. But this need not happen. A best practice consultation is especially designed to hear as wide a range of views as are relevant – and this includes deliberately seeking opinions from the ‘silent majority’
Those who organise consultations have known for a long time, that one of the best methods of obtaining an informed debate is the deliberative event. The clue is in the title! Give people enough fair, unbiased information as to place them on an equal footing for the purposes of discussing – deliberating on - the merits of alternative proposals. It avoids many of the pitfalls of traditional public meetings, but can indeed be combined with other open events where the facts can be fairly presented and where debates can be professionally or independently facilitated. Not ultra-cheap to organise, but affordable by most public bodies. What price good quality data!
Then we can adjourn to the pub and continue to argue.... Trigger Points
- To what extent are your consultations merely a platform for competing interest-groups to out-organise each other?
- Can you do more to encourage participation by a wider – less committed range of stakeholders? Can you do more to foster an informed debate?
- Running open events, whilst still acknowledging the role of the public meeting, is the theme of a new tCI training course – Public Meetings and the alternatives. It includes ideas on how to insert deliberative elements into public events. Our course on Effective Data Analysis is also relevant.
- The particular problems of running consultations in the NHS, and for Social Care are covered in detail at our new Masterclass Managing Significant Change in Health & Social Care.
- And, finally, in the spirit of the times ... Trigger was once a horse owned by the cowboy – Roy Rogers. Probably available from selected supermarkets!
This is the 230th 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