Richard Thomas – the last Hurrah?

Richard Thomas’s Farewell Do

Two Partners went to Richard Thomas’s last appearance in public as the Information Commissioner. He is off to pastures new in the next 4 weeks. Some heavy hitters on stage like Jack Straw and some serious issues discussed. The discussion could have been even more participative and interesting had Jonathan Dimbleby not been gripped by the same conviction as he demonstrates on Any Questions – namely that his own questions are much more interesting than those composed by the stumblebums in the audience.

The Minister with an Advantage and in the Club

Jack Straw showed an impressive grip of modern life in spite of his recent acknowledgement of weakness in family accounting matters by waving around both his Boots Advantage Card and his key ring Tesco Club Card while making a point about the reputational disciplines and pressures that kept private sector database managers  both careful and honest – pressures and disciplines absent in the public sector with its monopolies on areas like social security and tax gathering. A civil servant could not loose a warehouse of personal data when it really was a building with miles of shelving and paper files but could do so all too easily when the warehouse has shrunk into a memory stick or CD. He acknowledged a point made by Richard about the false comfort of mass data collection. Ministers post 9/11 have undertaken to keep us all safe in a world of threats. This is a decent bit of political narrative but one where the Information Commissioner had to set some boundaries when MInisters latched onto monster databases as comfort blankets hoping that they could deliver on the safety thing by having all the digital bits and pieces of our identities and lives in one big box. Then surely they would actually know not only who the bad guys were but what they were going to do next. But the boxes have proved difficult and expensive to build. The point was made that if you are looking for the proverbial needle in the haystack why build a bigger haystack?

Google and 1984

Actually said the man from Google, we don’t care how big your haystack is. Google can still find your needle in a nano-second but even their database engineers baulked at the technical challenge of building on the scale needed to meet the ambitions of the politicians to reduce risk.  Jack Straw felt it was necessary to issue a robust denial of any suggestion that the government were looking to Orwell’s 1984 as a manual of statecraft in the digital age.

Citizen Not Much Involved?

The MAC take on this is how little people appear to be thinking about involving citizens in these debates. The great and the good, Ministers and advocacy group leaders occupy the platforms and argue the issues. The citizen does not appear to be involved and consulted much. One speaker summarised the citizen view as one where individuals were happy if their own privacy was protected and did not much care what happened to everyone else’s.

Government Best Seller

Pub Quiz Bore Fact of the day – the Data Protection Act is the best selling Act of Parliament. I don’t suppose the MP’s Guide to Claiming Allowances is actually on public sale and you may even have missed the boat if you decided to shop for a  member of the House of Lords instead.

Which? Richard

This is not of course Richard’s last Hurrah – he is off to head up something grand and paralegal. More interestingly for us old consumer hands is his position as Deputy Chair of the Council of Management of Which? Ltd or is it Consumers’ Association – the governance arrangements of CA have got a lot more complex since Partner Adamson was a member of the Council back in .. I will withhold this piece of data in full confidence that it is held somewhere on a piece of paper and who on earth could be bothered to look for that?

MAC Buds in May – why health is different from a PlayStation®

There has been only a couple of articles on our blog since the last newsletter – one was a review of Christine Hogg’s up to the minute history of public involvement in the NHS. I have bought my copy and would urge you to do the same if you are trying to make sense of the structures and techniques you need to do public involvement better and to understand why you are finding achievement so elusive. I read it to get some thoughts going for a training course for GP practices and their staff on understanding and engaging with customers.

Citizen vs Consumer

The point that struck home for me with my background working for Which? and other consumer bodies is the one where Christine argues that health is a more complex business than the consumerist model can accommodate. The example she chooses to make her point is that of mental health services users whose rights as citizens are more important to them than their role as a consumer of health services. Their choices are few and in some cases, they have to rely on their rights as citizens to exit the system or refuse treatment. She goes on to see a situation where expert patients and others who care for themselves ‘break out’ (in Christine’s words) out of the role of patient and become providers. She sees that service that is truly user-centred is the one where the users work with equal status with professionals.

Health is Different

This is a radical and ambitious view that goes well beyond the conventional consumer model of market influence where user and producer interract but remain separate. Christine’s view takes into account the fact that health is different from other things that people want. Jonathan Miller has written “Of all the objects in the world, the human body has a peculiar status: it is not only possessed by the person who has it, it also possesses and constitutes him. Our body is quite different from all the other things we claim as our own. We can lose money, books and even houses and still remain recognisably ourselves, but it is hard to give any intelligible sense to the idea of a disembodied person. Although we speak of our bodies as premises that we live in, it is a special form of tenancy; our body is where we can always be contacted ( Miller J The body in question Random House 1978 quoted in The World Health Report 2000 Health Systems: Improving Performance so ably edited by our Associate Angela Haden ) So being a consumer of health is different from being a user of a PlayStation®. We do not live inside something made by Sony – not yet anyway.

Better Customer Care

The reason for this revisiting of this debate is to explore my idea that the tensions embodied in the arguments about differences between being a user of a consumer good or service and being a consumer of health impact on complaint handling. A couple of the many things we have failed to blog about recently are the latest initiatives on complaint handling from the Department of Health and the Health and Public Services Ombudsman. The Better Guide to Customer Care represents a great leap forward in its simplicity, clarity and freedom from an obsession with process. There is an explicit overlap with the work of Ombudsmen and the six principles of good complaint handling. One of the unacknowledged things that make complaint handling – never easy – more difficult in the NHS is the difference between the complaint about health-related service received and the one about your electronic gizmo. As we have written before, emotion is the driver and the emotion involved in complaining about the place ‘where we can always be contacted’ is of a different order and magnitude than a complaint about an object external to us. The only example in the world of consumer goods and services when the emotional temperature came close to rising into the health temperature range in my complaint consultancy experience, was men complaining about repeated quality failures in their Range Rovers. The letters and calls made Jeremy Clarkson look like the soul of reasonableness.

While the Treasury’s advice about financial redress is worth reading, the question of money while it can no doubt help resolution, is not the clincher – recognition of how close to home any complaint about our health and the body we live in remains the best route to resolution.

Owning and Using Data

And if our body is our own, we argue in Andrew’s blog on Real Patient and Public Power, so is the data that we give the NHS by filling in questionnaires and being available to be measured and counted is data which patients and their families should be able to understand and use in any initiative to improve health and social care services. We would like to see the definition of expert patient extended to include an expertise in how user data can be put to work and create action for improvement and change.

Data Delusions

We are reminded how open to interpretation, questions on a checklist can be in one of the final publications of the Healthcare Commission as it morphs into the CQC – Listening, Learning, Working Together? The question mark indicates uncertainty about some of the findings – what the Healthcare Commission calls ‘mixed evidence’ about the standards of patient and public engagement. 98% of healthcare organisations claimed in their annual health check returns that they met core standard 17 which is the one about taking the views of patients and others into account when designing services. The snag is that there were a lot of negative comments from patient forums, voluntary organisations as well as the relevant local government committees (OSCs)  that trusts were failing to seek the views of patients and public. Mixed not to say contradictory evidence indeed. Which is the correct view?

Management – Delusions, Comfort and Safety

Christine Hogg tells us that it is a mistake to ‘believe that user involvement can be managed and voices captured’. She is worried that participation ’seems to be a management tool to be disposed of when it does not produce the goods’. Actually it is not being ‘disposed of’ that is the problem and of course the activity has to be managed – it costs money and involves resources so how else would organisations behave? No – what we have to be wary of is delusion. And the delusion amongst public and patient involvement managers is that the performance of the function – attended 10 meetings, produced 4 newsletters and ran a stand at the local fair or whatever and printed 5000 leaflets on topic X – is enough to tick the box. Delusion of this sort is after all a much more comfortable and safer place for managers to be than copping the comeback from relaying rude and disruptive comments from outside, uncensored and un-deodorised – a terrible assault on the sensitivities of one’s superiors whose lives are difficult enough without this vulgar din.

Thank you and farewell Health Commission – we knew you when you were still CHAI. How short institutional life is in the NHS, we Partners muse.

‘Real Patient and Public Power’ based on prising the lock off comparative data in the NHS

Access and Understand Data

Knowledge is power – but only if you know how to use it. MAC champions the ownership of data by the service users who generate it so they can make decisions and choices based on their and others’ experiences. This means they must not only have access but also the tools to make use of comparative data.

Avoid Unnecessary Deaths – Pay Attention to Patients and Families

More reports appeared in recent days into the deadly debacles in Mid Staffordshire: clinical, managerial and governance failings at the local Foundation Trust Hospital; shortcomings by PCT commissioners and pretty much everyone else – except of course the patients and families using the hospital who weren’t listened to in the first place.  As David Colin Thome’ makes clear in his report, “national approaches were being followed but local signs were missed”. 

He concludes: “Real patient and public power, information and choice are strong drivers for improving the NHS and making it a dynamic, responsive service rather than a service that gives patients the message that they should accept what they are given. Patients should be seen as equal partners in their own care described as ‘the meeting of two experts’ when a patient meets their clinician.”

Unlock the Data Treasure House

When these “two experts” meet they must have access to the same data.  To make this happen, we say prise the lock off the treasure house of data in the Information Centre’s “NHS Comparators” resource and provide public number crunching units so people can relate the comparative data to their local situation and inform their potential choices.