The Campaign Company Blog

Making the most of your Governors

The latest analysis commissioned by Monitor indicates Foundation Trusts are making real progress in bringing local accountability to the NHS. This is fantastic news for hospitals and healthcare services and the communities they serve. Real people are finally feeling they are having a real influence on decisions that affect their healthcare. But what makes for a successful Trust? The answer lies in the Governors...

A successful Trust recognises that it's Board of Governors are, or should be, at the heart of their future plans. If FT's are about giving people on the front line more freedom, and patients more choice, then Governor's have a crucial role to play. They become the watchdogs where the Government has stepped back, and they become the hospital's advocates to the public, assisting in patient choice.

But this is a new role, even those that have been in place longest have really only been operating under their current set-up for a few years at most. Many have never done anything like this before. Indeed, it is questionable whether there has ever been a role like this before!

Monitor highlight that 4 out of 5 Governors are now clear about their roles and responsibilities, around half have exercised their statutory powers and many feel that they can adequately represent the needs of their constituents. But the real key to the success of the Governors is in the relationship they are able to build – and maintain – with the Trust Board.

At TCC we have found that empowering Governors to be effective in their roles requires offsetting high aspirations with realistic management of expectations. A committed, enthusiastic group of Governors is useless if their Board doesn't listen to them. Likewise, a Council of Governors ready to make executive decisions on the remuneration and allowances of the chair and executive board, for instance, is ineffective if they don't understand the roles and pressures of those they are keeping in check. It is vital that Governors are supported in their roles by the Trust Board, that they are given all the information and tools they need in order to be effective.

The next step, inevitably, will be to mobilise the Governors in helping create an engaged and active membership base for their Trusts. Where the focus has been on numbers, more numbers, attention is now shifting to engagement. Sustained membership recruitment will always be a concern for Trusts as patients continue to exercise their choice or move away from the area, and it will be the role of the Governors to keep their interest and to keep them involved. Creative communications techniques that are effective at getting information moving in both directions will be crucial where budgets are already stretched.

I can get some satisfaction.....but is that enough?

Ask Ben Page, of Ipsos MORI - the company who tend to do a lot of local government polling - what he thinks is required and he will say that the polls his company conducts for Council's show that if local government focuses on improving communication with the public, they will show increased satisfaction with services and the evidence he provides is compelling.

However the proposed Community Empowerment Bill is likely to raise the bar over not just satisfaction requirements across services but also develop the duty to involve. As reported in an earlier posting it provides the opportunity to create a "balanced scorecard" for the public and other stakeholders to judge local government and health commissioners, not just in terms of satisfaction, but also in terms of real involvement in developing and improving services.

This is important since over the past 20 years local government services, whether education, health and social care, environment or housing is managed in a much more arms length way. The role of the corporate centre in local government has therefore become more of an enabler and increasingly a performance measurer and improver. However the Bill now provides the opportunity for the corporate centre to develop a much greater empowering agenda.

Some might argue that people are broadly satisfied and only a minority want to get involved more - again that is what the polls that measure satisfaction in local government seem to show.

Who are this minority? Ask Ipsos MORI again: they are social and political influencers. By their nature they impact on the opinions and participation of others. Local Government needs to engage with and involve this minority as they can influence the views and social behaviour of others - a key area for local government and health commissioners in the coming years.

Communications on its own will not achieve this. Personal engagement on the doorstep, in the community and on the phone can both identify who the influencers are and develop a deeper ongoing relationship with them.

Over the coming months we will expand on this theme to demonstrate why there should not be a "poverty of aspiration" in empowering people and why a draft Community Empowerment Bill provides a unique opportunity for those in the cross-party consensus who do not have any low expectations of the public, to develop the involvement agenda much further!

 

 

Time to end the poverty of aspiration over engagement?

There does seem to be a worrying trend from people who should know better to attack the proposals in the Community Empowerment draft bill as not being of great relevance to an apathetic public. This was the case made by David Walker of Guardian Public Magazine writing in Guardian Society today.

Sometimes you expect to come across a poverty of aspiration within poorer communities but it's depressing to hear it from the editor of a journal read by many public sector professionals.

The argument seems to go: "If people claim to be generally satisfied with their public services just let sleeping dogs lie".

Just as modernisation is occurring in specific services such as health and education, the community empowerment bill is promising similar modernisation in public engagement. This will create a new "balanced scorecard" for public services that doesn't just measure public satisfaction, but also measures public involvement.

Of course we also need more emotional intelligence from public servants in dealing with the public - that requires additional training programmes as well as feeding back to staff the views of the public in real time . However that still doesn't far go enough. And we shouldn't be satisfied with a 33% turnout at local elections. But there is a clue in the fact that during the Poll Tax era it reached nearly 50% and that in the recent Boris v Ken contest there was a significantly increased turnout of in the mid forty per cent mark in London. We know people will engage if the issues are important and the choices are clear.

David Walker  compares "cold" local election voting and "X Factor" reality shows. But he draws the wrong conclusions. Why is reality show voting (when it is done properly and not rigged!) popular? It's because people actually feel empowered in the context of what they are taking part in. They are not just passively watching but collectively creating programme content and in effect "writing the script for the following week" by determining who comes back. How often does that happen in local government? Just as important as the immediacy, is that the results of their voting appears in the popular magazines they read and also provokes a conversation the next day around the water cooler. Where is the equivalent infrastructure in the public services that encourages this debate around a decision? You can't simply do it with a glossy leaflet!

He also confuses antagonism for creative tension over the issue of "personalisation v collectivism". I think he is far too pessimistic. This creative tension dates back to when humanity first created societies of towns and cities which allowed both public spaces but also individual endeavour.Of course there will be political choices that need to be made over resources for places like sport centres. But why is there a contradiction between this and allowing local communities to build up a wide range of locally owned community assets? Why should such choice be restricted to an existing building or facility? It could also include land for development too where the debate could be what they use it for. More affordable eco-housing v a new community centre? If local democracy is just seen as a remote Council making decisions for people, of course voter turnout will stay at 33% but we know that regeneration and stock transfer ballots are far higher so the potential is there to help people feel they have a much greater stake in their community.

The Community Empowerment Bill gives us an opportunity to build on the current relatively rare three-party consensus that exists to do something quite exciting in the coming year. Whilst we need to be realistic, we should not start off pessimistic.

Parents CAN be persuaded to give daughters cervical cancer jab

The Guardian recently published an article stating that "1 in 5 parents refuse daughters' cervical cancer jab". You may not be aware that this refers to the Human Papilloma Virus (HPV) vaccine which prevents cervical cancer. An immunisation programme will be rolled out in schools to all Year 8 (ie 12-13 year-old) girls this autumn.

To key to ensuring maximum take-up is getting parental consent. The research quoted, is based on a phone survey of @2000 parents and shows that there is a clear body of work to be done to raise public confidence in immunisation. Our own research confirms this but also provides the solution to raising confidence!

We have been using a social marketing approach in Barnsley, to test awareness of HPV vaccine among parents and adolescents but also to gain insight into the behaviours and attitudes of parents and young women so that we can develop a targeted communications programme that will get 90% take-up of this vaccine in Barnsley.

The results were fascinating (e-mail me at aline@thecampaigncompany.co.uk if you want to find out the details) but the key finding in Barnsley was as follows. If you give parents the right information AND you engage them in conversation about the issue then they WILL consent to their daughters having the vaccine. The only circumstances they would refuse would be if there were any doubts about the side-effects. So that's the way forward - reassure and engage parents in the right way. If we use this approach, 400 lives a year will be saved. 

Empowerment to the People!!

Richard Wilson Director of Involve has posted an article on the Guardian Blog about the "empowerment gap" and gives an excellent overview of how the government has sought to tackle it over the last decade.

I commented on it and made 3 points, which I expand on in much greater detail here:

• As Richard points out there has been a lot of progress, but as a result of many of these initiatives being driven by individual government departments through the relationship with relevant local agencies there has been uneven empowerment development across public sector bodies within localities. So for example, some sections of local government (eg, planning) may be far ahead of other departments in the local authority as well as compared to other local bodies like Primary Care Trust's (PCT's). There would be nothing wrong with this if it were a conscious decision arising out of collective local priorities, but this has actually emerged through many, sometimes unconnected, decisions made at various times in separate Whitehall departments. The next stage could be to develop a combined empowerment agenda at Local Strategic Partnership (LSP) level, to enable local public sector and voluntary bodies to advance together and become collectively more accountable to the communities they serve. Ways to achieve this might include: LSP's to jointly commission single public engagement units in each local government area which would benefit from economies of scale with duplication of savings ploughed back into more engagement; agreeing common local standards to various consultations; strengthening the scrutiny function in local government as well as perhaps even developing a formal scrutiny function for MP's over their own local public services?
• Capacity building is vital and part of this requires greater investment in community leadership support and training at a local level. This should not just be aimed at Councillors but should also be targeted at less well-off communities. TCC has already done work on developing local community champions for communities covering specific policy areas like recycling, but also in a wider role. This approach can help develop the local leaders of the future and widen their representativeness and diversity. This would be a broader approach than rely simply on the electoral process in a locality to throw up a small number of individuals who might then receive training from their local authority. Early intervention here can widen the pool of local leaders thus helping to build wider local trust in institutions.
• TCC, in working with PCT's, has discovered that in reviewing services there is an issue around "low expectations" whereby people may say a service is fine because they have no way to compare it with the equivalent in another area: eg you may find that people say they are happy with GP services, even when they do not compare well with somewhere else. This can also be linked to the wider "Delivery Paradox" whereby people say they are satisfied with their local service, but feel the same service is as a whole declining. So far the government has generally relied on league tables and delivery incentives from the centre to drive up some improvement, but if expectations are low in the first place, there is much less local pressure from below on organisations to improve. Greater local democratic accountability is clearly part of the solution, but is probably not enough on its own. Training up "expert residents" in local communities to learn more about what is happening elsewhere and be able to assert themselves as part of a wider community champion scheme might be a way forward to help build a critical mass for higher local expectations. We have formal twinning between Council's in different countries across Europe and even with the developing world, why don't we have twinning within the UK so Council's twin with other Council's to share knowledge and good practice with much of the work being done online to ensure value for money. Most local authorities will have historic connections with many others across the country so the decision over who to twin with could be quite an interesting process in its own right. Twinning could also be taken further so good practice is shared between twinned LSP's and therefore services in areas like health are twinned too.

Increased social capital makes for a more socially cohesive society. Community Empowerment provides an opportunity to challenge complacency at the local level, whilst making people feel they can influence more at a national level.

As Richard says in his article, we don't need countless repeat measures to tell us that. What we need is to use the current broad political consensus in this area to make some clear progress in wider local empowerment in the coming years!

Private Optimism, Public Despair - What can we do?

It has been long known that there is a general perception gap between what people might think of their local hospital and what they think of the NHS in general.

Matthew Taylor, Chief Executive of the RSA, writing in the New Statesman has talked about these difficulties but goes much further with an important and insightful article which looks to the future. He says:

"This perception gap is not restricted to public services, as a recent BBC poll on families confirms. Some 93 per cent of respondents described themselves as optimistic about their own family life, up 4 per cent from the previous time the survey was conducted, 40 years ago. Yet more people - 70 per cent, across race, class and gender - believe families are becoming less successful overall."

He also adds to the point by Polly Toynbee, that we have blogged, on the lack of advocates to tell good news in the public services when it happens:

"In the burgeoning industry of reputation management, it is generally argued that people are much more likely to tell others about bad experiences of services than good ones (5:1 is the usual ratio)."

He argues that trends such as the rise of individualism and the decline of some forms of collectivism combined with the rise of pretty much self-organising global capitalism moving at a rapid pace have created this private optimism and public despair, adding that:

"Globalisation is the gravity of modern society: an unstoppable force that will knock us over if we try to defy it."

Since the collapse of the cold war two systems in 1989 no single person or authority is in control even if some parts of the world are more powerful than others.

He points out that people still see the same broad problems as they did 100 years but now see rapid change as a challenge and seek greater comfort in those close to them.

However, he strikes an optimistic note saying that people are more affluent and healthy and yet there is a danger of some missing out on the celebration:

"Progressives want the world to be a better place. We bemoan its current inequities and oppression - yet if we fail to celebrate the progress that human beings have made, and if we sound as though the future is a fearful place, we belie our own philosophy. Instead, we need to address a deficit in social optimism that threatens the credibility of our core narrative."

Addressing social optimism is clearly a project for everyone. We have previously blogged about Richard Layard's case for increasing overall happiness and David Cameron has talked about the government having a mission to improve people's general wellbeing.

Matthew Taylor makes the case for a New Collectivism to tackle what he describes as the social optimism deficit:

"It is in working with others on a shared project of social advance that we can be reconnected to the sense of collective agency so missing from modern political discourse. It is the attitude of the spectator that induces pessimism, the experience of the participant that brings hope. The problem is not that change brings fear and disorientation (there's nothing new in this), it is that we lack the spaces and places where people can renew hope and develop solutions."

It was challenges like this that brought TCC into being and where we try to assist organisations. He then refers to the sort of change making we should all be attempting together:

"The institutions of the new collectivism must be devolved, pluralistic, egalitarian and, most of all, self-actualising."

This is the sort of approach that this blog argued for and it good to see the arguments so well set out here. He gives a number of examples of where this happening:

"Today, there are signs of a yearning for new ways of working together. There is the growing interest in social and co-operative enterprise and the emergence of new forms of online collaboration. Gordon Brown's citizens' juries are a tentative step in the right direction, albeit without much fun or risk-taking..."

and

"Tackling climate change offers a fascinating opportunity to interweave stories of action at the individual, community, national and international levels."

TCC is working in places like EC1 in London on increasing recycling whilst linking it firmly to the whole issue of climate change through initiatives that engage with young people.

He concludes by making a call for people to build the institutions of the new collectivism:

"Despite the huge impersonal forces of the modern world, people are prepared not only to believe in a better future, but to work together to build it......This potential will be fulfilled only when we provide spaces for collective decision-making and action that speak to the same vision of collaboration, creativity and human fulfilment that progressives claim to be our destiny."

Many of these new institutions of this new collectivism already exist: NHS Foundation Trusts, New Deal for the Communities (NDC's) aspiring to run community assets, social networking sites like Ning, Facebook and Myspace. These are a different set of institutions to perhaps those of the 1945 welfare settlement, but they are a potentially strong mixed economy of institutions nevertheless, and they and other new institutions need support to build a collaborative new collectivism for the future.

In addition there is also challenge for long established institutions, such as local government, to respond to this agenda and to ensure they can relate more effectively to the places where people are optimistic such as within the family unit, whatever size or shape it now comes in. That also means they have to make themselves more accommodating to the places that people are optimistic so they can engage within that space.

Institutions, in whatever form they come and new or old are the arguably finest piece of (social) technology we have created. The Saturn 5 may have put men on the moon, but it was the institutions of the state and their agencies and contractors that put that immense machine together, and educated and trained the men for that mission. Institutions or whatever age encourage collaborative and collective action so as Matthew Taylor has stated the more we strengthen them through peoples involvement in them the more likely we are to rebuild trust and social optimism.

Spieling about health

A fascinating article in today's Times ''Spiel at the wheel?'' discusses how taxi drivers are being harnessed as word of mouth marketeers, with an interesting example about one cabbie promoting the delights of a holiday in Bangkok following a 5 days all expenses trip to Thailand! And - as people become more and more overwhelmed by traditional forms of advertising confronting them in every aspect of their day to day lives - new and different approaches such as 'word of mouth' marketing are having increasing appeal.

This is absolutely our experience at The Campaign Company. In our work with NHS organisations - particularly foundation trusts - we have done considerable work helping Trusts build their membership communities. (Working with over 50 Trusts we've recruited over 160,000 public members - about 1 in 5 of the current public membership) We've found that traditional forms of advertising - the leaflet, the poster, the join on-line form have limited impact. People are much more responsive to a direct ask - particularly one-to-one. And we take this a step further by encouraging 'member get member' recruitment and the development of 'Membership Champions'. Someone who has already joined will be be a powerful advocate to their friends, family and those in groups and organisations they belong to. They'll know how and when to get attention and be able to hone the message to the person they are talking to - because they know them well. And they will be listened to - because they are trusted and known to them - the 'word of mouth' approach in the FT context!

And in their foundation trust members, NHS Trusts have a fantastic resource at their disposal - these people are so well placed to become the 'word of mouth' advocates not just about membership but about the Trust itself - health marketeers! And as 'Patient Choice' becomes more of a reality - Trusts must embrace their FT members as a key element of their marketing mix. These are the people out there in the community; they are the people in the pubs, clubs, workplace, playgroups, bus queues, school gates. Of course - not every member is a 'word of mouth' marketeer - the trick for the Trust is to learn more about it's members - segment and stratify - and find those who are. Then it's about building the relationship - giving them the information and then sinply 'getting them talking'!

And taking this a step further - these people are just so well placed to pass messages back - let the Trust know about the things going well - but more importantly provide quick feedback about things not going so well.  Bad news always spreads so much faster than good news - so Trusts need as many mechanisms as possible to get that valuable 'early warning'! 

Hospitals need advocates!

Interesting statistic referred to by Polly Toynbee in the Guardian last week:

"Research shows patients tell at least 10 people about a bad treatment but only one or two about a good experience. Bad anecdotes ricochet around for years, yet polls show 80% of hospital patients report good treatment."

This illustrates the problem a local hospital might face in promoting the good work it does for the community. One problem can obscure the masses of good work we all know they do.

TCC has worked with many hospitals to recruit members as they become Foundation Trusts. However we believe members role should not just be passive. Foundation Trust members have the potential to sing the praises of their local hospital to everyone they know as well as expressing their general support for the NHS as an institution.

The research that Polly Toynbee refers to shows the need for Foundation Trust members to be engaged and, along with staff and patients, act as a strong advocate for the good experiences that hospitals deliver day in, day out.

Closer to Home - Taking to the Streets!

Last week, we took to the highways and byways of north Cumbria to find out what local people thought about the proposed changes to the healthcare services in their area. 

After a successful day in Carlisle, the team travelled south to Penrith on Tuesday, before making our way through the lakes to Millom on Wednesday.  This was followed by a beautiful coastal drive to Whitehaven and then Workington before finishing up the week in Maryport.

While many claim society is becoming more apathetic by the day, we were met with the same response we get in all of our engagement with local communities : people want to be consulted!!  They are pleased - and sometimes quite surprised to be asked for their views - are are keen to find out what changes are planned and have their say.

We spoke to hundreds of local people in GP surgeries, libraries, shopping centres and hospitals about health issues ranging from acute hospital reform to GP home visits.  The overwhelming sentiments were:

• People in Cumbria want services closer to their homes
• People do not want to travel as far to visit their relatives in hospital
• People support the PCT's commitment to Community Hospitals

Above all, it was fascinating to talk to interested local people about issues that affect them so closely.  Thanks to everyone who found the time to talk to us - it's much appreciated!

In line with the PCT's commitment to engage with as many people as possible, we will be returning to north Cumbria in January to visit some even more rural areas such as Brampton and Keswick - Watch this space!!

What about the FT Governors?

The Local Government Association is today calling for 'NHS Trust directors (to be made) accountable to the elected representatives of the area' - Call for council power to fire hospital and police chiefs .Tonight Gerry Robinson is once again fixing the NHS in Rotherham on BBC2. What these two stories have in common is that they both ignore the potential role and mandate of the elected Governors of NHS Foundation Trusts. And who can really blame them? It must be a cause of anxiety for all FT enthusiasts (of which TCC is one) that FTs are finding it difficult to establish themselves as reference points when it comes to either democratic accountability or as an instrument to drive up service standards.