Accessibility links

In previous blogs I’ve outlined how we’re changing to ensure Fellows are more involved in helping us achieve our aims. The results have been extremely positive - better ideas, high quality outputs, improved impact. Could what we have learnt be applied to public policy, and the NHS in particular?

We’ve spent the last year or so opening up our projects, ensuring that our Fellows are involved from our initial thinking to ensuring what we do has maximum reach and impact.  From small initiatives such as Fellows commenting on our reports to larger ones such as our heritage network we’ve learnt a lot about what works, from both Fellows’ perspectives as well as our own.  We still have further to go, but some of the lessons are:

  • Involve people early.  Even if you have little to say initially, it’s best to warm people up and let them know something will be on its way
  • If you can’t include everyone don’t try to.  With limited resources it’s better to spend time ensuring an appropriate group can be involved properly rather than a large number you can’t handle
  • People will always surprise you with their initiative, creativity and willingness to help
  • Respect that people are busy and therefore only engage when it can really add to the impact of the work, rather than doing it for its own sake
  • Even if people don’t agree with your decisions and actions, if you’ve taken time to ask them and been transparent in your decisions and why you’ve taken them, they will understand you’ve had to make difficult trade-offs.

For our Innovative Education work, we’re growing a network of Governors and school leaders who drive creative improvement and innovation in schools.  With limited resources we’ve decided to focus on schools themselves, where our network is proving invaluable in developing our thinking and bringing about change on the ground.  Working with people in this way is about trusting them rather than imposing our own ideas and expecting people to agree.

This is something that Governments find hard to do.  Used to deciding policy and then implementing it, the top down mentality is difficult to change, despite successive governments claiming they will do so.  For example co-production is still in the margins despite well over a decade of projects demonstrating its benefits.

An obvious criticism is that it is easy for an organisation like the RSA to involve people in this way but too simplistic for something as difficult as large scale policy development and implementation.  However there have been cases where this kind of approach has been applied successfully by public bodies. 

Take the example of Merton Council when they, like all other councils, were making difficult decisions about cuts to their support for the voluntary and community sector.   Most councils made this decision behind closed doors, announced what would happen, and then donned their tin hat hoping the inevitable backlash in the local press would wash over as quickly as possible. 

Merton took a different approach, outlining the problem to their local voluntary and community sector and inviting responses.  From this they elected to set up a panel to decide on the reductions to local VCS funding which included people from both the council and the VCS.  The situation was clear, the decision making was transparent and people were kept informed,  all while ensuring the bureaucracy involved was very light.  Of course there were still a few disgruntled people, but the feeling amongst the sector was far more positive than in other parts of the country.  (It was a great idea that I haven’t seen replicated elsewhere  - I’ve blogged before about the lack of replicability of good ideas).

This kind of approach could be used effectively in many areas of public policy.  Take the current NHS situation, while the arguments continue about the merits of austerity, almost all agree that with an aging population, healthcare costs more generally rising and expensive new treatments, funding is going to be heavily squeezed in the NHS, ring-fenced budget or not.  The Government approach has managed to alienate most NHS staff and created a them-and-us situation, with everyone fighting for their bit of the NHS and junior doctors currently being balloted for strike action.

Here’s an outline of an alternative model for how the Government could decide what to do about the NHS:

  • Outline the financial and other challenges the NHS faces into the future, along with some of the boundaries for possible options – not through a long consultation document, instead through an easy to find and use website that’s widely publicised.
  • Spend time gathering feedback from a range of groups, both NHS employees but also patients and the public more widely.
  • Disseminate the feedback widely in an easily digestible form so that everyone can see the possible solutions offered, the preferences of the public, and what the experts suggest.
  • Form a panel consisting of the Minister and a range of other stakeholders who are brought together to openly decide the way forward

While not radically different to a consultation, improving how the consultation is carried out and adding the step of a panel openly deciding the way forward would immediately take the heat off government.  The decisions made would almost certainly be better.  It would have more support from those inside and outside the NHS.  It would increase understanding of the difficult trade-offs faced.  Finally it is likely to produce a whole range of spin-off benefits from showcasing great local initiatives to sparking new conversations.

The downside for the Government is that they would have to give up some power and put themselves into the hands of a wider group of decision-makers, something they never find easy to do.  However, given the difficult position they are in on the NHS, perhaps they should embrace this approach, they may be pleasantly surprised.

8 Comments

Join the discussion

Please login to post a comment or reply.

Don't have an account? Click here to register.