« Previous | Contents | Next »
Listen
CHAPTER 8 THE ROLE OF THE PUBLIC
Summary
On a spectrum ranging from passive to active measures, the consensus among most groups of participants was that the involvement of service users and members of the public in the scrutiny of public services should be towards the more active end of the spectrum and that, for example, service users should be members of inspection teams. The prevailing view was that involvement should be at least at the level of consultation with service users and that simply providing information on scrutiny outcomes was not sufficient.
The benefits of service user involvement were seen as being: their independence from service providers, their understanding of the service and the personal importance to them of high quality service delivery. The two main barriers to public involvement were thought to be lack of interest and lack of time.
However, there were also concerns about public involvement. Lack of expertise/understanding was seen as a problem for some categories of service user and, in particular, for the general public. Less commonly, there was a concern about the lack of objectivity on the part of service users. It was felt that these problems could be overcome by using mixed teams of independent experts, service users and (in some cases) members of the public.
The suggestion that service users from other policy areas or other geographical areas should be involved in scrutiny teams, to provide an extra degree of independence and objectivity, was not well received. The dominant view was that scrutiny teams should include experts, service users and, in some cases, members of the public who were not service users. Appropriate training was viewed as essential and, on balance, the payment of lay assessors was accepted, in order to compensate them for loss of earnings and to ensure a good mix of assessors. Suggestions for giving better publicity to scrutiny reports included ensuring that reports are readily accessible at the service itself, posting them on the internet and in libraries, and paying for public notices in the press.
8.1 The past 20 years have seen major developments, in thinking and in practice, regarding the role of service users and the broader public in the provision of public services. These developments have stemmed from changes in public service management, the influence of consumerism, and more sophisticated forms of citizen engagement (such as those triggered by community planning).
8.2 It is possible to distinguish a spectrum of increasingly active models of public involvement. In relation to scrutiny, these might include:
- information provision ( e.g., making reports publicly available and publicising their existence)
- service user/citizen consultation ( e.g. consulting service users/citizens on scrutiny methods)
- service user/citizen surveying ( e.g. collecting information from service users/citizens)
- service user/citizen engagement ( e.g. use of juries and panels of service users/citizens and/or interactive electronic methods to provide more detailed advice)
- service user/citizen representation ( e.g., involving service users/citizens as members of scrutiny teams).
8.3 It is also increasingly seen as good practice to use several, or all, of the models outlined above rather than choosing a single model.
8.4 This chapter covers the role played by members of the public during the scrutiny of public services. Members of the public may be:
- direct service users e.g.NHS patients, school pupils, care home residents
- indirect service users e.g. parents of school pupils, relatives of care home residents
- the broader public who are not users of a particular service.
8.5 However, for the most part, the discussion focuses on the role of service users - both direct and indirect - rather than the broader public.
8.6 As with most other topics, the participants tended to focus on inspection rather than the other aspects of scrutiny.
Level of involvement
8.7 The consensus among most groups was that involvement should be towards the more active end of the spectrum described above and that, for example, service users should be members of inspection teams. While in favour of full, active involvement in principle, the parents of secondary school pupils suggested that providing evidence to inspection teams was a more realistic option. However, a parent of a child attending a nursery considered that consultation and evidence providing should be sufficient if the scrutiny system were good enough, making full involvement unnecessary.
… should be able to rely on those people that are doing the scrutinising enough that they can give you feedback … you shouldn't need to be so involved. (Parent of child in a nursery)
8.8 Likewise the Citizens' group, discussing the coastguard service where they saw themselves only as potential service users, felt that service users should be consulted and surveyed, but probably not involved in scrutiny teams.
8.9 Everyone thought that involvement should be at least at the level of consultation with service users; no-one thought that simply providing information on scrutiny outcomes was sufficient. Although it was generally acknowledged that some individual service users may not even be interested in receiving information about scrutiny outcomes, participants felt that the opportunity for greater involvement should be there for those who want it.
The benefits of service user involvement
8.10 The benefits of service user involvement identified by participants fell into three categories:
1. independence from those who run the service
2. understanding of the service
3. the importance to both direct and indirect service users of high standards of service delivery.
Independence
8.11 Although service users were acknowledged to have a personal interest in a service, they were also seen, at times, as being more 'independent' than the service providers or even independent experts, whose very expertise in the field might lead them to focus on particular issues or their own particular 'hobby horses'. In this context, service users were described as having ' no axe to grind'. One participant also suggested that service users could act as neutral arbiters between the service provider and the 'expert' scrutineers:
I think they can act as a sort of independent view if there is a table like this and the council on one side and the scrutineers on the other and somebody with a bit of commonsense in the middle and the council sitting there saying,' well we're doing our job', and the scrutiny saying, 'no, you're a load of crap', and the man in the middle says, 'just a minute you know, there is this, there is that'. (User of council services)
Understanding of the service
8.12 A key benefit of service user involvement was their understanding of service delivery and of their own needs. The following quotes illustrate the point succinctly:
Young people who have been in foster care, they know what's bad and what's good. (Young person who had been through the care system)
…we're here and we know really what needs to be changed. (6 th year secondary pupil)
8.13 The NHS patients group were strongly in favour of patients, through patient groups, having significant involvement in the scrutiny process:
…it is wrong of us to think that the only people who know about certain things are the people who have got qualifications or whatever. Patients, it could be a patients representative, but they may be as knowledgeable as the next man concerning the standards in a hospital (Recent NHS hospital patient)
8.14 The 'Expert Patient' model used in England was suggested as a possible mechanism for service user involvement, since individuals with long-term illnesses could be very knowledgeable about their own conditions.
Importance
8.15 The fact the quality of service delivery matters most to service users was cited as a reason for their involvement in scrutiny. Again, this was articulated most succinctly by a school pupil:
Pupils should be involved in school inspection teams because it's got a lot to do with them and it's them that it affects. (6 th year secondary pupil)
8.16 Related to this, it was suggested that parents should be involved in the scrutiny of nurseries because of their high expectations. The implication is that service user involvement would raise the standards required of service providers.
Concerns about public involvement in scrutiny
8.17 Despite the perceived benefits and the general consensus in favour of full involvement, a number of concerns were noted. Two of these mirrored perceived benefits, namely lack of expertise/understanding (which might apply to some service users but was more applicable to the general public) and lack of objectivity of service users. There was also a concern that those who chose to become involved would not be representative of service users.
Lack of expertise/understanding
8.18 A distinction was sometimes made between those service users who have useful knowledge or expertise - and could therefore make a valuable contribution as members of scrutiny teams - and those service users and members of the general public who do not, who might be consulted, but should probably not be members of scrutiny teams.
8.19 There was a view among the NHS patients group that members of patient representative organisations were better qualified to be involved in setting standards than the general public:
Groups are probably better. … I'm in a diabetic group, I talk to other people with diabetes. You pick somebody off the street and they'll maybe not have this. (Recent NHS hospital patient)
8.20 It should be noted, however, that participants in this group were recruited from various patient organisations and, as a result, may have been more likely than others to value the input of such organisations.
8.21 In discussing the coastguard service, the Citizens group also made a distinction between 'expert' potential service users e.g. fishermen who were seen as having enough knowledge to be involved in standard setting and other potential service users e.g. novice yachters who would not have enough knowledge. It was felt that the latter might usefully be consulted or surveyed if they had actually been involved in an incident and received help from the coastguard service.
8.22 Similarly, the users of council services group expressed the view that members of the public who were involved in scrutinising the council should not be just anybody, but 'would have to have some knowledge' such as 'somebody who has been involved in community or council work or something and has a bit of knowledge, perhaps, how these things are run'. They therefore ruled themselves out of involvement in such a body.
8.23 It appeared that there was more concern about the expertise of service users in relation to the scrutiny of services where everyone is a customer or potential user, e.g. the NHS, council services and the coastguard, than those where the experience of using the service is restricted to a relatively small group and where service users are perhaps more closely and more regularly involved with the service e.g. nurseries, secondary schools, services for looked after young people, care homes.
8.24 The suggestion that service users from other areas ( e.g. parents or pupils from another school or council service users from another council area), could be involved in scrutiny teams, to provide an extra degree of independence and objectivity, was generally not well received. The main concern was that they would not know enough about the particular service. For the same reason, school pupils and looked after young people did not favour members of the local community being involved in the scrutiny of schools or care services.
8.25 The exception to this was that the looked after young people did think that young people with relevant experiences should be involved in the inspection of children's homes and foster carers.
Lack of objectivity
8.26 The view was expressed that service users should not be involved in inspection teams because they have a personal interest in the particular service and would not therefore be objective. However, this was an exceptional view. More commonly, the view was that this could be overcome by using a mixed inspection team that included both service users and independent 'experts'.
Lack of representativeness
8.27 A further concern about service user/public involvement was that only a minority of people would be willing to become deeply involved in inspections:
…like the PTA, the School Board…we always say we like to get involved but when it actually comes down to it, it'll be the same faces and the same people because they all fall by the wayside. (Parent of secondary school pupil)
8.28 This posed the question - how representative of typical service users or members of the public would such volunteers be?
Barriers to public involvement
8.29 Regardless of the perceived benefits or concerns about public involvement, two main barriers to public involvement in scrutiny were identified: lack of interest and lack of time. In this section, unless otherwise specified, 'public' refers both to service users and to members of the general public who are not users of a particular service.
Lack of interest
8.30 Simple lack of interest was seen as one potential barrier to involvement. This was perceived as more of an issue in relation to the 'background' services (the coastguard and council services) where everyone is a potentially a service user, but the quality of service provision, unless it is very poor, tends to have rather little salience in people's lives.
Some people will not be interested until the bins aren't getting emptied every two weeks.
Until something is wrong and it's affecting me personally.
(Users of council services)
8.31 For some, e.g. the group of secondary school parents, lack of interest demonstrated a more general malaise.
… for a school population of six hundred … there may have been thirty parents at the meeting. Probably says it all! (Parent of secondary school pupil)
Lack of time
8.32 Lack of time was viewed as a major barrier to involvement at all levels. It was seen to affect the attention paid to scrutiny reports and the ability and/or willingness to be involved in scrutiny teams. When discussing the types of people who might become lay assessors, for example, having the time was a key criterion:
Probably suit a retired person I would have thought, or a semi-retired person… (User of council services)
… a lot of the people they would … be working and reluctant to take time off work. (Recent NHS hospital patient)
Ways to overcome concerns and barriers
8.33 Various suggestions were made to enable the public to become more involved in scrutiny. In terms of involvement in scrutiny teams (mainly as lay assessors), the dominant view was that teams should be mixed, with input from experts (independent from the service provider), service users and, in some cases, members of the public who were not service users. The experts could then guide the service users and members of the public and, to a certain extent, compensate for their lack of knowledge or expertise in particular areas. Appropriate training was also viewed as essential for anyone involved in inspections.
8.34 At the outset, however, it was felt that care must be take to ensure the selection of the 'right sort' of individual - someone with appropriate knowledge and skills (although, as discussed above, views on what these were varied) and with the right motivation, that is someone who would provide constructive criticism but had no axe to grind.
8.35 There was a view that the payment of lay assessors was necessary, to compensate people for loss of earnings and therefore ensure a good mix of people: but at the same time it was recognised that this might attract the 'wrong' sort of individual, someone motivated by payment rather than a desire to improve the service.
8.36 A number of suggestions were also made in relation to better publicising scrutiny outcomes and thereby encouraging more service users to read them (and then, perhaps, become further involved in the scrutiny process). Suggestions included ensuring that reports were readily accessible at the service itself, e.g. in care homes and nurseries; on the internet (one suggestion was for an independent site comparing outcomes from different councils, similar to house price comparison websites) and in libraries. All of these methods are currently used, at least sometimes, by scrutiny bodies.
8.37 In relation to the 'background' services, where service users and potential service users may rarely be on the service premises, it was suggested that the service in question should pay for a public notice in the press, alerting people to the key outcomes and informing them how to access the full reports. This would be separate from any reporting that the press might choose to do, which may be biased and may only happen if there is a story, possibly negative, that is thought to be worth reporting.
8.38 It is perhaps worth noting here that few participants had read any scrutiny reports before becoming involved in the research, but after discussion, most indicated that they were interested in receiving this kind of information. This does suggest that there is scope to involve service users, at least at the level of reading scrutiny outcomes, once they are aware of what information is available and what it means.
« Previous | Contents | Next »