Examination of witnesses (Questions 40
- 60)
TUESDAY 30 NOVEMBER 1999
MS JO
LENAGHAN, MS
JANE STEELE,
MS ANNA
COOTE and PROFESSOR
STEPHEN HARRISON
Chairman
40. I think this could be the cue actually for
getting Jo in.
(Ms Lenaghan) Yes. We specifically developed a model
to address those concerns. We have played around with different
methods in terms of holding them two days during weekdays, two
at weekends; we have paid people. I do think it is fair to say
that we find some types of employment are easier to get out of,
particularly in the public sector. People who work in health,
for instance, are easier, too, but I think Professor John Stewart
has always said, "Let the perfect be the enemy of the better",
and you need to look in the future at a wide range and we will
be in the future going for an optimal range.
41. I want to take you up on that because it
is something that I am very interested in and it happens in all
sorts of organisations, it happens in all sorts of consultations,
it happens on health authorities and public appointments generally.
How do you get round the issue that people in ordinary paid jobs
who are not public servants, who are not working in the voluntary
sector, cannot spend two days on a citizens' jury?
(Ms Lenaghan) The only way you get around that idea
is that we give it the same status as any other jury. If the Government
is serious about encouraging citizenship and public involvement,
then we have to back that up, and if we were successful in getting
things like jury involvement as having that status, then most
employers would welcome that and see that as a contribution to
the local community. Until then we have these artificial mechanisms
like paying people, and we try and handle that as best we can
but without it becoming statutory or there is a certain cultural
shift, as happened in Germany, but we are not going to be that
perfect.
Helen Jones: But at the moment you cannot do
that, can you? You can pay people but that is not the issue here.
The issue in many areas, like mine, is whether they keep their
jobs.
Chairman
42. Could I just follow this point because it
is interesting. I wondered if the view of things now about civic
obligations that should be enforced is one that is shared amongst
a number of you?
(Ms Coote) My view is that we are an awful long way
off that and before we need to go to that extreme there is a lot
more that can be done in terms of varying not just the way you
arrange a four-day jury but having briefer events. There are so
many methods that are available to us now and most of them have
been tried and tested in this country already and we know quite
a lot about them, but before we start waging a full-scale campaign
to get the Government to make attendance on citizens' juries compulsory—I
think we might be a little bit of a way off that—we should
think about two-day juries, maybe with one on a weekday and one
on the weekend, and evening events. I must say that, on the whole,
even with the four-day events we have never had difficulty getting
a full range of citizens across the socio-economic mix.
(Ms Lenaghan) Our main problem is actually getting
younger unemployed people. Our problem is not getting middle-class
people in well-paid jobs.
43. We know you have no problem getting middle-class
people in well-paid jobs.
(Ms Lenaghan) But the hardest group to get involved
actually is unemployed young people and that is because of the
low self-esteem and again the impact that being on citizens' juries
can have is actually improving self-esteem. I understand your
concerns that typically if you look at our work it is not because
it is such a huge problem to pay people. I think Anna is right.
Rather than community issue groups where people meet every evening,
three or four times every two weeks or so, where you can get around
those issues, I think we should not get too hung up on things
like citizens' juries. There are other ways of involving people
in more deliberative ways to get around these problems, but I
still think our point in the long term is valid.
People have to participate whether they want
to or not.
(Ms Lenaghan) We make it easier for people to participate
whether by making it more possible by providing financial incentives
so they can pay for a baby-sitter, holding them in venues people
can get to, holding them on topics of interest. What we have to
do is to make it easier to encourage people to participate, if
they want to, not force people.
44. Can I be clear on that. Earlier on you said
you wanted it to be treated like jury service.
(Ms Lenaghan) That is one way you could go. If you
wanted to be at that stage that would be the ideal thing. You
said, "How do you tackle the problem of people working getting
involved?" The only other way you could do that is like the
legal jury, to be one hundred per cent perfect.
Chairman
45. It would be interesting to have a citizens'
jury to look at that.
(Ms Lenaghan) It would be. That was the final recommendation
of my paper, submitted yesterday, that if there was a Select Committee
on the role of public involvement we should really ask the public
what they think about public involvement. Do they want to be involved?
What kind of methods do they think would suit them? It is all
very well for us as experts to say we think that the public should
do this but, to be honest, we should ask the public.
(Ms Steele) I would just like to pick up on a couple
of points that have been made when we started talking about the
citizens' jury point. Those are but a small example of a whole
wide range of methods. Probably citizens' juries are a very small
part of the whole enormous volume of participation that is taking
place but because they are interesting and innovative they get
a lot of the attention. The two main points are, we really have
to concentrate on making sure organisations understand how different
methods can be used to answer different sorts of questions. While
I think an enormous amount of understanding has developed around
that and a lot of skill, as Anna was saying earlier, there is
still a long way to go on that for organisations and really choosing
the right method to suit the questions that you as an organisation
are being asked about is one of the most important things. That
is the first step towards making sure that the information you
collect can be used to inform decisions, which is the other enormous
question mark that we have. We really do not understand well enough,
I think, the way in which decisions are influenced. The essential
first step towards making sure they can have an influence is getting
the right method and then getting the commitment of the decision
makers to that. If decision makers do not really understand the
process that is going on, what sort of information they can gather,
and what role that might play, then they are going to be sceptical
about the information they receive. It needs their commitment
to make the whole thing work right from the beginning.
46. What you said at the beginning about not
getting hooked on one thing because it seems more interesting
than others, I put it to you like this: it might be that for real
people having a really effective complaint system for a public
body might actually be a much more effective form of participation
than knowing that that authority is engaged in running some interesting
experiments in focus groups and citizens' juries, might it not?
(Ms Coote) A complaint system is a downstream place
for public involvement.
47. What do you mean downstream? People are
downstream, are they not?
(Ms Coote) They are but they only get to the point
where they are making complaints, in some circumstances anyway,
because they have not been upstream fashioning the services. Do
you see what I mean? I do not agree. A good complaint system is
a very important thing to have but I think it is far too easy
for organisations to think, we can get this bit right. The reason
you have the complaint sometimes, very often I might suggest,
is because you have not involved the public, particularly service
users, further enough upstream.
(Ms Lenaghan) It is not either/or. I think the key
matter here is to get away from all types of models and look at
how we make decisions, what is the whole strategy. You want the
downstream and the upstream but have effective complaint procedures,
decision makers having informed decision making procedures as
well as the public. In terms of impact, how it is actually changing.
Can I suggest that the Committee can look at the work by Marion
Barnes at the University of Birmingham and Sharon McIvor, who
both carried out short- to medium-term evaluations on the impact
of jury level models. That is the key question: does it make a
difference? They are quite costly in time and resources. Both
those reports point out it is not just the impact on the actual
policy but the impact on the decision making process. If you as
a Committee decided you wanted to commission some public consultation
you have to say: "What is the question? What do we really
want to ask? Do you want a referendum or a focus group or a citizens'
jury? How much time do you have?" By going through that you
would be actually breaking down the questions for yourself much
better. You would go along and have a dialogue with the public
and you would have to think, "Oh God, we have to respond
to them. We are on an equal footing, this is not the way it is
supposed to be." Then the whole process changes in itself,
it is much more diffuse and so the impacts can be quite important.
Even if at the end of the day they say similar things to the authority
I do not think we should dismiss that. Sometimes people make the
right decisions and it is important to have consent and to go
through that interesting process.
(Professor Harrison) If I can answer that, we should
not be obsessed with making decisions at some high level of the
organisation. Organisations work from the bottom up as well. If
you think you have problems, exactly as Anna Coote was saying,
and complaints, they are often problems that could have been solved
or avoided by interaction with users in everyday matters lower
down the organisation. One does not have to view this whole idea
of participation that is up here in our organisations, it can
be much lower down than that. That is, again, a reason for not
becoming focused just on juries, valid though they are.
(Ms Coote) Can I just add on the point about the preparation
that an organisation has to make in order to engage the public
in one of these deliberative ways. I have seen them not only greatly
improve the way they think about what they are doing, it makes
them much more reflective and careful. Also the experience makes
them see the public in a different way. Instead of assuming the
public are stupid and ignorant and selfish, incapable children,
they wake up to the fact that they are dealing with intelligent
adult human beings. That is an enormous addition to the democratic
fabric, I suggest.
48. Is there not a difference between when you
start off with a question, a problem, an issue and then, as it
were, you want a learning exercise to take place so that you can
eventually come to some conclusion as opposed to what is people's
normal experience of consultation/participation, which is why
it has a bad name? It starts off with a solution which is then
consulted upon but is essentially being defended by the people
who devise it. It is not open or engaging.
(Ms Coote) That is why they give organisations three
days to answer. All these poor little voluntary organisations
get a great tome like this on their desk and they are asked to
respond in three days because nobody really wants to know. That
is a very different process.
(Ms Lenaghan) As advocates we should admit there is
a lot of bad practice going on as well. IPPR were, and still are,
being approached by people saying, "We want to do a jury."
We say, "What is the question?" They say, "We want
to do and be seen to be doing a jury." This comes back to
being clear about your purpose and matching your purpose to your
method. I have to say that in the paper I submitted the reason
why we have some concerns is that even in government departments
they are saying, "We want to be doing a jury", doing
this, that or the other, rather than starting from what we are
trying to do and what is the best way of doing that. Anna Coote
in her work said, "If you want to run a PR exercise and do
a PR campaign well, please have a question. We will listen to
people and then think about having a public consultation."
All that has become muddled up. When you asked Professor John
Stewart about the timescale, why has it all kicked off now. I
think a lot of it is because Anna Coote got her teeth into it
in 1994 with John, who got the books out. We have been very successful
in putting forward the models, everyone knows about juries and
focus groups, but we have lost people on the way with the whole
importance of what it is that we are trying to do. I think we
need to go back to basics a bit there.
Mr White
49. So it is nothing to do with the politicians
in the early 1990s who saw the reaction against the Conservative
government and taking the public along with us was a better way
of dealing with the problems that we solved, nothing to do with
the sort of research that you did?
(Ms Lenaghan) No, I was just making a flippant remark.
I just meant it in the sense of—
(Ms Coote) I paid her to make it.
(Ms Lenaghan)—some of the publications that
we brought out which tapped into concerns in important areas.
Particularly John spoke about local authorities but one of the
key areas people were interested in was health, and Stephen knows
more about that. I think that was due to a lot of the concern
at health authority level where we knew that they were not elected
and yet were being asked by the Conservative government to make
very important, rational decisions, and people were saying, "Who
am I to be taking these kinds of decisions?" and that also
led to the anxieties. People were looking for new ways of tackling
those gaps and I think we were there to meet different needs.
Chairman
50. I do not know what colleagues feel but reading
some of the literature around all this, what I wanted to see was
some examples of what works. I know we have all the caveats in
about fitness for purpose and you have to choose and the whole
thing. We know all that and it is all very important. I can agree
with all the words that I read in all this but what I was desperate
for was examples of what works. Anna has given two examples, Walsall
and Lewisham. That was very interesting but I would very much
like to hear if anyone is carrying around with them some examples
of what works. I think it would be very useful if the Committee
could hear about them.
(Ms Lenaghan) We can send you lots from all over the
place. We were in the Public Involvement Programme. Anna spoke
about similar models which have been published. Camden might be
a useful one to look it. Two years ago they looked at how to re-examine
the Swiss Cottage Centre, which is a place in the centre of the
town. They wanted to know from local residents how to improve
that space and they held a citizens' jury on it. There was also
a local opinion poll done on it and just two weeks ago they held
a big exhibition in the library setting out those options that
came out of the jury, trying to get wider public involvement in
that. So it is not all the decision-making process; you could
probably follow through there quite easily, but there are lots
of reports and things that we can send you. I think we assumed
that you already had that.
(Ms Coote) You know about the Public Involvement Programme's
website, which should have all this on it, a great deal of it.
Really, where do you want to start? I can tell you about the jury
in Fife; I can tell you about a deliberative forum done as part
of the Millennium Debate of the Age. They all have their advantages.
If you are looking for something that is very clearcut, they are
not that easy to come by. I think Stephen made the point that
it is all quite subtle really.
(Professor Harrison) Yes. There is the question of
exactly what do you mean by "what works". My examples
would be at a much more micro-level than Jane's. There is the
mental health residential unit where residents are involved in
selection of the staff, for instance, and another mental health
user unit where the residents are involved in agreeing to which
other residents can be admitted. That is participation, if you
wish, at a much more micro-level.
Chairman: I can feel us getting into deep water
with those examples.
Mr Browne
51. May I ask some questions. They arise from
something that Jo Lenaghan said earlier. I have forgotten exactly
what the link is but I will ask the questions anyway. We have
been encouraged by you and we have also been encouraged by the
professor either to start the work or to encourage the Cabinet
Office to start the work, to set out some general set of principles,
presumably to try and provide a framework of rules or something
for this participation to proceed. You all appear to me from the
evidence that you have given to us to be practitioners in this
area. You are not just looking at this and researching it. You
are actually practising it, or it would appear some of you are.
You talk about involvement in projects. Do you have a general
set of principles which inform your practice at the moment, and
do you have a specific set of principles that inform your practice
in relation to all the individual kinds of participation that
you have spoken to us about, all the individual processes of participation?
And do you, when you practise this, do what we are all being encouraged
to do now and encouraging the Government to do, that is, set yourselves
a set of outcomes against which you will evaluate your practice,
and if you do, can you share all this information with us and
that might give us some starting-point in setting up these general
principles?
(Ms Coote) The two works that Jo referred to were
evaluations of work that we had done. When the King's Fund did
its first series of juries with health services they commissioned
an evaluation from Birmingham University. The IPPR more recently
commissioned an evaluation from Marion Barnes also, so we have
done evaluations ourselves. You asked, do we have a set of principles,
and I am sure there is a lot more work that could be done on it
but just to give you a sense of what I think the basic minimum
should be that, as I have set out here, every operation should
have a clear and explicit rationale, that the choice of methods
ought to be open and justifiable, that you do not exclude relevant
groups and so on. I will not go over them because they are in
front of you, but I think the point about this is that if there
is going to be a set of principles they ought to be applied not
just to a one-off exercise but to a strategy. In almost any set
of circumstances, the decision-making body ought to have not just
a decision that says, "Okay, let's do a jury, let's do a
referendum," but to have an approach to involving the public
in a series of decisions they have made.
52. I agree with all that but what I am interested
in is, you all seem to know each other very well and you all talk
as if you have worked together at one stage or another. Have you
evolved in this area a general set of principles that inform your
own practice?
(Ms Steele) I think there are various things that
have been published that do set out principles and guidelines
and there is a lot of common ground between them. I think the
thing that brings that together quite well most recently that
I have seen is the management paper that came out from the Audit
Commission about ten days ago, which drew, I think, on a lot of
the stuff that had been published previously and set out some
good guidelines and good practice about how you go about this
exercise, how you choose what method you are going to use to suit
the questions you need answers to, how you evaluate what you are
doing and know whether it is having an effect or not. It is quite
strong on that. So I think that is quite a useful point to start
from if people are looking at what the principles should be and
to spread them more widely.
Mr White
53. But is not one of the problems that we still
have the case where there is a whole series of pilots and we have
not translated the pilots into a national scheme yet?
(Ms Coote) I think the time is right.
54. How do you do that?
(Ms Coote) I agree with Jane about what the Audit
Commission have done. I had forgotten about that. They have this
wonderful chart, have they not, which you can put on your wall
and you can read across and say, "We are trying to do this,
here's a good method," and so on. So there is enough work
there. If you were to say, "Give us a draft framework,"
we have got it. It is something that is not written down but it
would not take more than a couple of days to put it together from
what we know already. Guidelines—we do not want to be too
prescriptive on this. It is a matter of giving people the guidance
and I think it is all there in different ways. The NHS have put
some stuff together, of varying quality but it is all good stuff.
55. Is not the problem still that it is down
to the individuals doing individual bits? There is no strategy
for taking it right throughout the whole organisation, whether
it be local government, central government, the NHS?
(Ms Coote) Yes.
(Professor Harrison) Yes, and there are some good
reasons for that.
56. How do you actually get that strategy?
(Ms Lenaghan) I have suggested in one of my papers
that the Government, people like the Cabinet Office, should pull
this together. The DETR has also produced within its own department
its own guidelines and strategy. That does not exist in the Department
of Health and one of my concerns is that the Primary Care Groups
are being asked to go out and involve the public and yet they
have been given no guidance as to how to do that, no resources
and no capacity. Lots of GPs have lots of other pressures on their
time as well as being expected to involve the public. So I think
that that is one area where central government should be giving
them guidance. One of the ideas suggested was a database so that
if a GP did want to do a jury or focus group they could say, "Who
else has done work in this area? Who can I speak to? Is there
a list of information that can help me before I go and waste all
my money re-inventing the wheel needlessly?" So there are
lots of things out there and if we find it ambiguous because we
cannot keep it in our head and we know this stuff and we know
that, but would we make our living out of public involvement,
be a jobbing GP, and everybody else is expected to do that, where
do they go to, where is the one centre of good advice that they
can access? It is not there.
(Professor Harrison) I do not have a scheme but I
think there are two necessary conditions that you might think
contribute towards a scheme. One is that we need to get away from
allowing one to discharge one's managerial responsibility by symbols:
"We have done the jury bit, okay. We have done the participation
bit, we can tick it off." Secondly, we have a to allow local
variation. If we are going to say there is going to be local consultation,
local participation, we have to accept that there may be different
answers in different localities and not insist on having a national
standard for whatever it is.
(Ms Steele) I think people do need advice rather than
prescriptions. One of the key things about this is that as individual
managers or organisations or whoever get involved and start taking
this forward they have to have a commitment and ownership of it
rather than having just a framework and a blueprint that says,
"Do this and it will be okay." If people have to develop
their own commitment and understanding—
Mr Browne
57. I do not think anybody is suggesting—I
have not misunderstood what you have told us. Both Professor Stewart,
and I cannot remember which one of you it was, suggested that
we should encourage the Cabinet Office to produce a general set
of principles to guide public participation, that is the context
in which I ask the question. It was not that I asked you to encourage
us to be prescriptive. I recognise the diversity of approach is
the value of this process. If you cannot help us to draw these
guidelines up then who can? If you cannot do it for us then who
can?
(Ms Lenaghan) We can. We can pull it together in a
few days. We will probably need one seminar to agree it between
all of the various practitioners and stakeholders. I am sure we
can do that. It is almost there. In a sense we have started this.
Anna Coote two or three years ago identified some principles of
good practice and we were shouted down because people felt it
was too premature. At this point we should let 1,000 flowers bloom.
My sense is we are reaching the point now where criteria, principles
and guidance could be appropriate and helpful and it would be
worth revisiting her original work and pulling it together.
Chairman
58. Is the suggestion the Cabinet Office might
be the place where a framework, some principles are devised or
that it might actually produce some toolkits?
(Ms Coote) I do not think it is very difficult to
get to the principles. I think we would all agree it is quite
easy to get to the principles and to get to the general guidelines.
I think producing some toolkits would be useful as well, partly
because it is slightly unnerving to see the way that a number
of different government departments are going about this, especially
since it is the same members of the public. If you are there in
a locality, you can be involved by the local government, by the
health authority, by the PCG, and so on, but there is no common
ground. To make sure that common ground exists that is what is
needed.
59. Is the whole point about joined-up government,
to use that dreadful phrase, that you should have things like
joined-up participation too?
(Ms Coote) Absolutely. Jo Lenaghan mentioned the primary
care groups. We are forming the view at the King's Fund that primary
care groups probably should not be involving the public in that
way but they should look to the health authority to do it, possibly
in partnership with local government. You disagree with me?
Mr White
60. I have Buckinghamshire Health Authority.
(Ms Coote) Primary care groups should be asking their
patients, who are the users.
Chairman: We shall have to end. Can I just thank
you very much for all of that. I know we have had to race through
a lot of things, and I am sure you are frustrated with our ignorance.
It is really very kind of you to come and stir us up like this.
If you want to send us more things you think we should see by
all means do so. It has been very interesting and helpful. Thank
you very much for coming along.
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