I am really tired of ‘conversations’ about health
I was pleased to see the recent blog by David Buck at the Kings Fund “Health Inequalities we need a national conversation” calling for more collaboration and clarity between Public Health England, NHS England and the Department of Health. I share his frustration at the continued lack of co-ordination and leadership shown by these big (and comparatively well funded – compared to local authorities) national institutions.
I do however, take a different line.
First, I am really tired of the way national agencies and government launch into these national ‘conversations’. So was concerned to see (thanks to David drawing attention to it) that Public Health England have started one of these.
Remember the “NHS Listening Exercise”? What about Tony Blair’s “Big Conversation”? Or David Nicholson’s Call to Action? None grabbed me, maybe some of you reading this thought they were tremendous and made a real difference – if so please leave a comment!
Thus far I have been unimpressed by these attempts to establish a national dialogue with citizens and local players. They too often feel like a half hearted attempt to engage with the public and front line who already have quite enough to do with getting on with local challenges.
Having said that Public Health England do seem to have a more considered process which involves focussed interviews with Directors of Public Health, Councillors and local voluntary organisations.
Of course it is important to bring local voice and experience powerfully to national agencies. I just think that dialogue should be built around substantial long term relationships which recognise independence of view rather than fixed term conversations.
As a trustee of Citizens Advice I am impressed by the model that this organisation uses – but they are not unique – There is a long list of NGOs who provide evidence based challenge to policy – they include MIND, CPAG, Barnado’s, Disability Rights UK etc. Some of those get funding from government and its agencies to the irritation of right wing think tanks like the Institute of Economic Affairs who pejoratively brand these organisations “Sock Puppets” in their recent publication “The Sock Doctrine”.
One of the important services provided by Citizens Advice is to capture the evidence of need that emerges through front line delivery by its 350 or so member Citizens Advice Bureau across the country and interpret this, using it to bring suggestions for policy improvement and sometimes direct policy challenge. Through doing this they directly contribute to making policy better, society fairer and democracy stronger.
I think DH, PHE and NHSE in particular should look across the communities and people they serve and check that they are providing sufficient resource to advocacy organisations ranging from local government to the voluntary sector to ensure that they are exposed to continuous evidence based policy challenge. If they were to do this consistently and in a co-ordinated way they would not need one off ‘Big Conversations” instead they would be continuously exposed to powerful debate and dialogue from organisations who are directly connected to citizens and front line services.
Second, a little comment on David Bucks three national agencies and his suggested actions.
- NHSE – fully support his call for a greater focus on what primary care can do to tackle health inequalities – as I pointed out in an earlier blog the NHSE inequalities strategy is to put it politely – weak. I do think it is unfortunate though that the two areas that David focusses on are both to do with physical health – the role of of primary care in addressing poor mental health is crucial here.
- Public Health England – I am not convinced that David is right in calling for PHE to do more on health impact assessments of other government departments – for the reasons I outline above I think it would be better that PHE funds local government and NGOs to do this work – this will give much more independence and transparency to the challenge.
- Department of Health – I struggle to have expectations of the Department of Health. While I take David’s point on the Social Value Act I think that local commissioners just need to get on with it and guidance would probably better come from the sectors concerned.
We need to push government not rely on government departments giving us permission.
What do you think?
Entirely agree Mark
These so-called conversations are a sham and yet another aspect of the London-centric delusion that the country can be run from the South East by people with no experience of life (except as tourists) outside the M25.
This centralisation of conversation ignores and shuts out local voices whilst the “big players” carry on amongst themselves. Meaningful conversations need to be local/regional, although the long and now accelerating erosion of Local Government is another facet of the problem.
Perhaps when they have lost Scotland and Wales, they might wake up to the implications of their shrinking domain?
Keep up the good work
Mike
A very timely blog Mark since today the Oldham Commission has published it’s report on Whole Person Centred Care and one of the major calls is for …wait for it…a ‘National Conversation’ about health and social care!
I remember at university Christian Unions used to do a ‘mission week’ (didn’t happen at my uni though). This was where someone who lived on the same corridor as you would suddenly take an interest in you an awkwardly invite you to an event with free food at it. Seems strange to have special initiatives for conversations that should be part and parcel of everyday.
This then links to leadership. There are plenty of papers and reports out about what the problems are, social, funding, structural etc. In my view, I’m not looking to leaders to tell me what the problem is; we’re interested in solutions. We don’t really know how much money integration will save, or what difference payment systems or commissioning models actually have on improved outcomes. So I agree with you – they are problems that need to be ‘got on with’ and we’ll see what works. To try things out needs bold and decisive leadership!
National Conversations are obviously not conversations if they are part of a ‘due process’ approach particularly if the evidence for ‘listening’ is taken from quantitative surveys and feedback. There is a flaw always embedded it seems to me in so far as the agenda is often not explicit and we, the public, have become used to the process having little of no influence.Maybe this is just a weary jaundiced view based on very little experience. At a meeting on improving teaching with a local politician who had ideas about tinkering to make efficiencies I asked what his base line service would look like. He had an excellent grasp of favourable outcomes, but was stumped when I ask as to why it wasn’t funded to that level as an act of political will. Conversation wasted! Small example, but I fear part of an enduring culture.
If I am in a leadership position and I think something is wrong and want to do something about it then I do not have a conversation I have a plan. If I am in a leadership position but don’t want to act on something that other people say is important then I would have a conversation. It sounds like I’m taking concerns seriously, while we waste time and avoid action and accountability.
When running In Control a senior civil servant told me “The job of civil servant is not to do their job.” Conversations are the means by which they manage that trick.
An interesting point. I was thinking that there must be many ambiguous situations where you think something needs doing but you don’t know what to do next? The civil servant is deliberately and knowingly not acting, but there are many cases of inaction which are due to not knowing (what to do next). In these cases, especially on what are sometimes known as the wicked problems, conversations are what is needed.