Goodness knows there are many legitimate points to be made about the quality and nature of public policy at the moment.
Nevertheless, I feel it is incumbent on those who want to see positive change to public policy to do so in ways that are effective. I say this because I’ve seen a couple of examples recently that were, in my view, pretty ineffective.
The first is on a topic I agree isn’t right: the limbo in which the Access to Elected Fund finds itself. A source of funding that makes it more accessible for disabled people to stand for elected office is absolutely needed, and the ongoing uncertainty about whether it will be continued isn’t right. This said, there are better ways to make the point than to (a) call it
or (b) propose making a formal complaint to the UN about the breach.
The second is on a topic I am personally very supportive of (and indeed am part of the team working on it): Personal Health Budgets. In response to the scaling up of Personal Health Budgets from the current 4,700 to 100,000 the criticism is that this:
does not fit well with our politics of austerity.
It’s equally possible to say that the scaling up of Personal Health Budgets doesn’t fit well with England’s chances at Euro 2016, with Donald Trump’s continued presence in the Republican Party’s presidential nomination race or with the mystifying popularity of Strictly Come Dancing.
The point being that it’s an odd and wrong premise, and so a criticism that doesn’t make any sense.
(To expand: if the politics of austerity is wrong (the inferred conclusion) then Personal Health Budgets shouldn’t fit well; if the politic of austerity is right, then Personal Health Budgets are a means by which to get better outcomes, most often for less, from a system that doesn’t currently work as well as it should. Either way, the premise is a false one.)
It’s absolutely right that people are critical of public policy. The quality of debate and policy, though, only improves if interventions are effective, by which I broadly mean:
They make sense
They are in ways that are more likely to make the people who could effect the change engage with the issue
They perhaps offer options as to how to address the focus of their criticism
They maybe get involved in working towards a solution
They fundamentally recognise that it’s people on the other end of their criticisms – and so that it’s only by understanding how people change that decisions and public policy change.
Reform is a profoundly political process, not a technical one
The political coalition favouring reform has to be based on groups that do not have a strong stake in the existing system
While government reform reflects the material interests of the parties involved, ideas are critical in shaping how individuals see their interests
Reform takes a great deal of time.
These lessons are from Francis Fukushima and how to reform patronage-based political systems to modern, merit-based ones, but I’d say they’re equally applicable to most public service change processes – including, of course, personalisation across health and social care.
If we were to apply the four lessons to how things have gone with personalisation so far, I’d suggest the following:
Personalisation has focused too much on technical changes (e.g. Resource Allocation Systems, online directories of support), and not enough on political ones (including attitudinal and cultural)
There has been a coalition of people wishing to change the social care and health systems through personalisation. This coalition, however, hasn’t been sufficient, and certainly hasn’t yet engaged enough with groups that have a strong stake in how things currently are (particularly social workers, who broadly remain wary of personalisation)
The idea of personalisation is a strong one. Indeed, it’s probably driven reform in other areas of public services
Even if we took 1996 as the starting point for personalisation, we’re still only 20 years into this journey. 2007 is a more realistic starting point (with the advent of Putting People First), and for the scale of political, cultural and attitudinal change we know personalisation requires, a decade is nowhere near enough. If this is in doubt, ask any race, gender or sexuality equality campaigners in the UK, US or beyond.
If we looked at the topic of social care funding, I suspect we’d find even less evidence on each of the four lessons for political change.
In the context of the UK, the Department for Work and Pensions is to my eyes is an institution struggling to grasp the nature of the problems it is trying to solve and is structured – organisationally and culturally – in such a way as to minimise its chances of success.
It’s also the case, though, that “bottom up” approaches to systemic challenges don’t, by themselves, provide the solution we’re looking for. Questions of representation, fragmentation, strategy, tactics and consistency plague attempts of the grassroots to affect problems in the way groups want.
Over the last 2 or 3 years I think we’ve seen more and more people explicitly thinking beyond “top down” and “bottom up” when it comes to systemic or complex challenges, and more of the need to create spaces in which the right mix of people, organisations, power, expertise, experience, styles, cultures and so on are brought together. I suspect it’s more a case that some (areas? people?) have been doing this for a while and we’re at a stage where it’s being formalised through things like frameworks and fancy names. Nevertheless, seeing how other people articulate the approach they think is needed to work through these systemic, complex challenges has been useful in clarifying and sharpening my own thinking on this.
The SSIR article has been one of the best such articulations. It goes under the rubric of “System Leadership” and below are some of the choice parts from the article which describe best what system leadership and system leaders are and do.
System leaders have the ability to:
See reality through the eyes of people very different from themselves encourages others to be more open as well. They build relationships based on deep listening, and networks of trust and collaboration start to flourish. They are so convinced that something can be done that they do not wait for a fully developed plan, thereby freeing others to step ahead and learn by doing. Indeed, one of their greatest contributions can come from the strength of their ignorance, which gives them permission to ask obvious questions and to embody an openness and commitment to their own ongoing learning and growth that eventually infuse larger change efforts.
To do this, system leaders typically have three capabilities:
The first is the ability to see the larger system… Helping people see the larger system is essential to building a shared understanding of complex problems.
The second capability involves fostering reflection and more generative conversations. Reflection means thinking about our thinking, holding up the mirror to see the taken-for-granted assumptions we carry into any conversation and appreciating how our mental models may limit us.
The third capability centres on shifting the collective focus from reactive problem solving to co-creating the future… This shift involves not just building inspiring visions but facing difficult truths about the present reality and learning how to use the tension between vision and reality to inspire truly new approaches.
In order to be systems leaders, the SSIR authors note several “gateways” to be passed through by individuals. The two that struck me as most useful are as follows:
Re-directing attention: seeing that problems “out there” are “in here” also—and how the two are connected: Continuing to do what we are currently doing but doing it harder or smarter is not likely to produce very different outcomes. Real change starts with recognizing that we are part of the systems we seek to change. The fear and distrust we seek to remedy also exist within us—as do the anger, sorrow, doubt, and frustration. Our actions will not become more effective until we shift the nature of the awareness and thinking behind the actions.
Re-orienting strategy: creating the space for change and enabling collective intelligence and wisdom to emerge: Ineffective leaders try to make change happen. System leaders focus on creating the conditions that can produce change and that can eventually cause change to be self-sustaining. As we continue to unpack the prerequisites to success in complex collaborative efforts, we appreciate more and more this subtle shift in strategic focus and the distinctive powers of those who learn how to create the space for change.
Finally, there are two observations within the article that particularly help us to move beyond “top down” and “bottom up” alone and to the peculiar mixture of the two that we need. The first is to note that
collective intelligence emerges over time through a disciplined stakeholder engagement process—the nature of which could never have been predicted in advance.
This leads naturally to the second:
transforming systems is ultimately about transforming relationships among people who shape those systems.
Good policy is the considered course of action by which a supposed public benefit is accomplished, which otherwise would not be accomplished, by the best use of the resources available. It is grounded in reality and thought-through as to its consequences.
Green outlines some of the ways in which good policy making can be brought about:
Good policy-making is tough. The diligent policymaker needs to be clear about what is to be achieved, and will look carefully at the tools available: the “hard law” of statutes, the “soft law” of codes of practice and circulars, the priorities for a budget, the optimal allocations of spending, the requirements of new administrative processes, the need for political leadership and effective communication, and many other things. A good policymaker will, of course, base the policy in what evidence is available and he or she will be anxious to work out the likely intended and unintended effects, for a quality of a competent policymaker is simply to think things through.
… and he also notes why we may not see as much good policy making as we should.
The deeper problem is that there is often little political advantage in good policy-making. The voters and the press find the exchange of slogans and the performance of gestures comforting. Most people who take an interest in politics are preoccupied by the soap opera of the personalities involved, or in the exercises of tribalism and sentimentality which usually pass for national political debate.
or How I learnt to love statistics and be an Honest Consultant
Chris Dillow at Stumbling and Mumbling often notes how remarkable it is that so few people know or understand Bayes’ Theorem. C.P. Snow wrote his famous “Two Cultures” essay drawing on his observation of how few people know about something as fundamentally important as the Second Law of Thermodynamics, and that this is the equivalent of not having heard about the works of Shakespeare.
I’ve often thought the same about the Normal Distribution, often called the Bell Curve after its distinctive shape.
The Normal Distribution is a result of probability theory that we all learnt in secondary school maths, and shows how we would expect a random range of related variables to be distributed.
In the Normal Distribution illustrated above, the average of all of the values of a given set of numbers (for example, people’s height) is in the middle. In any distribution, over 68% of all of these values will fall within one standard deviation – the amount of variation from the average. Over 95% of all values will be within two standard deviations of the average.
(Applying this example to women’s height, we find that the average height for women is 5ft4in with a standard deviation of 3in. Thus, 68% of women’s height will fall between 5ft1in and 5ft7in, and 95% of all women’s height will be between 4ft10in and 5ft10in.)
The Normal Distribution is a really useful way of thinking about where single instances fit into an overall picture.
How could we apply the Normal Distribution to the idea of people’s experiences of public services? Let’s think of the horizontal (x) axis as a quality continuum, with the very worst experience on the left, through the average in the middle, to the very best on the right; and let’s think of the vertical (y) axis as a frequency continuum, from the very rare at the bottom to the very often at the top.
Thinking in this way, what we see is that people’s experiences of public services follow a Normal Distribution. The vast majority of people’s experiences are average or thereabouts; only very rarely (i.e., more than two standard deviations away from the average, or around 0.1% of the time) do people have either the very best or the very worst experience of public services.
I think this observation is important for two main reasons.
The first is about how politics, policy and campaigning is conducted. Although most people’s experiences are average or thereabouts, the experiences and examples we hear most about are, almost by definition, unusual. They exist at either end of the Normal Distribution. So politicians often talk about the very best case scenario in the new idea they’re introducing or in the White Paper case studies that are cited. Similarly, organisations present the best examples of the work they’ve done, promoting these through various communications channels or capturing them in funding bids or contract tenders.
In the above diagram, politicians and organisations operate mainly at point P on the Normal Distribution.
At the other end, we hear of nightmare stories of people’s experiences of services in the headlines of newspapers, or of scare stories from campaigners which highlight the very worst impact of this or that policy change. Newspapers and campaigners operate at point N on the Normal Distribution.
(Of course, each respective group can swap which end of the Normal Distribution they operate at depending on what purpose they are seeking to serve; think of politicians talking about “Broken Britain”, for example.)
The second reason it’s important to think about the Normal Distribution of people’s experiences of public services is to note that, most often, the very rare is what drives most activity. Trying to prevent or minimise the very worst in public services is the realm of regulators, legal teams and complaints procedures; trying to promote the very best is the business of funding bids, think tank proposals, job applications etc.
And it’s this difference between the ends and the middle of the Normal Distribution that creates the problem in the space of people’s expectations of public services. The gap between what the Normal Distribution says our experience is most likely to be (95% of people will be within two standard deviations of average) and what we think our experience will be – the space of N and P represented by newspaper headlines and political rhetoric – leads to expectations that, in reality, can very rarely be met.
A politician gives a speech in the space of P in which they say how things are going to be much better for us all. But, across a whole population, only 0.13% are likely to feel that full impact; the rest will have average experiences whilst some will have terrible experiences, so that both groups feel the promise of the politician hasn’t been delivered.
A newspaper reports in the space of N of an appalling case that occurred because of this or that change. Many will think that this is more than typical than it is, despite only 0.13% of the relevant population having that experience and the vast majority having an average or thereabout experience.
A commissioner commissions a new service from a provider based on the promises in the space of P the provider gave in its funding proposal. The reality is that the service provided is average, with some great outcomes and some very poor ones. This is exactly what the Normal Distribution could have told the commissioner, but they remain disappointed because of their original expectations.
Where does this leave us? I think that understanding and using the Normal Distribution could help us have a more honest approach to what people can expect from public services.
In an area that is “good” at what is does, what we’re really saying is that people’s experiences are generally slightly better than average; the Normal Distribution of such a place would like this (blue line) compared to the normal Normal Distribution (black line).
In this area, slightly more people have a better experience, slightly fewer people have a poor experience, and a very small proportion of people still have extremely good or bad experiences. The net effect is that the average experience of all people in the area is slightly better than normal; effectively, the Normal Distribution has been slightly shifted to the right.
In an area that is “poor” at what it does, the Normal Distribution would look like this (blue line) compared to the normal Normal Distribution (black line):
In such a “poor” area, slightly more people have a poor experience, slightly fewer people have a good experience, and a very small proportion of people still have extremely good or bad experiences. The average experience of all people in the area is slightly worse than normal; effectively, the Normal Distribution has been slightly shifted to the left.
The subtitle of this post comes from my personal feeling that an Honest Consultant is one whose pitch to a potential client would entail a discussion about the Normal Distribution and how the results of their work will make things a little bit better than average for most people in an area.
Such a consultant is unlikely to be successful in their work. But, in understanding and using the Normal Distribution and what it tells us about people’s experiences of public services, the Honest Consultant is at least managing the expectations of the potential client and the public they represent. If in doing so this reduces the gap between what people expect and what they experience, and so increases people’s trust and understanding of what public services can or can’t do, then the Honest Consultant’s use of the Normal Distribution will have been worthwhile.
The most interesting thing about Party manifestos is whether the plural of “manifesto” has an “e” in it or not.
A while ago I was following an exciting event unfold on Twitter: whether the faithful party membership at a Lib Dem conference voted favourably to amend one of its policy positions regarding the changes to Employment & Support Allowance. After the amendment was successfully passed, a supporter of the move tweeted something along the lines of “YES!” (a fuller reaction is here).
It was highly uncharitable of me I know, but the idea that that motion would then be taken on by the Party’s leadership, reflected in its wider policy position, used to inform debate within the Coalition, would be in any way influential on that debate, be adopted by the Coalition, transmitted through Secretary of State and Junior Ministerial priorities, reflected in senior civil service policy drafting and implemented through administrative bodies was, I felt, unlikely – perhaps even naïve.
And yet, at a larger scale, the amount of effort expended to specifically seek to influence Party manifestos remains considerable.
For me, the idea that any political party currently has any strategic and unwavering view of what they want to do and so can reflect and represent this in a manifesto is, frankly, laughable.
As a friend of mine put it, manifestos are:
a wet tissue of pipedreams, thinktankery, sops, obfuscation and outright deception.
Most times I hate myself for being so pessimistic and not offering solutions to this malaise as often as I should.
In this case, though, I hope I’ve at least got you wondering about whether to include that “e” or not.
Here’s a good question: when is a policy impact assessment not a policy impact assessment?
Answer: when you’re the Prime Minister around 10 months out from a General Election and want something to say about helping families.
This morning, as part of a suite of announcements related to families, the Independent is reporting David Cameron wants:
all government departments will have to assess the impact of policy on “supporting family life”. The assessment will sit alongside similar current tests for cost-effectiveness, equality and the environment, and Mr Cameron stressed that if they failed, they would “not be allowed to proceed”.
All very laudable, of course. But here’s what David Cameron had to say about equality impact assessments in a speech to the Confederation for British Industry in November 2012 (as noted by Neil Crowther):
We have smart people in Whitehall who consider equalities issues while they’re making the policy. We don’t need all this extra tick-box stuff… So I can tell you today we are calling time on equality impact assessments.
Today’s family impact assessment therefore begs at least 2 further questions to the title of this post:
What’s the difference between families and equality?
Are the people in Whitehall dealing with families stuff less smart than the people dealing with equalities stuff?
This seems like a straightforward question to answer, doesn’t it? Most primary school children could give you an answer, and even if they couldn’t they could quickly look it up in an Atlas.
But perhaps it’s not as simple a question to answer as we think. Scotland and Wales are countries, aren’t they(?), and yet they don’t appear on the list of countries recognised by the United Nations: the UN reckons there are 193 countries, including “the United Kingdom”. My Times World Atlas from 1986 says there were 173 countries. And football’s governing body, FIFA, currently has a list of 209 countries with football rankings.
So, in order to know how many countries there are we need to ask ourselves at least two prior questions: (1) What do we mean by a “country”?; and (2) Who are we asking?
Maybe the question is a bit complicated, so let’s ask ourselves an easier question by going up a level: how many continents on the world are there?
Erm, well. National Geographic reports: “By convention there are seven continents… [but] some geographers list only six [and] in some parts of the world students learn there are just five continents.” Which means the answer again depends on asking other questions, including: (1) What do we mean by a “continent”?; and (2) Who are we asking?
This “facts” business is tricky, isn’t it?
I share this by way of thinking about what we mean by “evidence” in the context of “evidence-based policy” and the recent example of Personal Health Budgets.
A significant announcement by Simon Stevens, the Chief Executive of NHS England, about Personal Health Budgets gave rise to some teeth-gnashing earlier this month.
The gnashing focused on the evidence base that underpins the effectiveness of Personal Health Budgets. Some folks, especially the well-known Ben Goldacre of Bad Science fame, are not convinced by the current status of the PHBs evidence. They think there should be at least a Randomised Control Trial (RCT) to test whether Personal Health Budgets work. Others, including advocates of personalisation in public services more generally, noted both the results of the existing evaluation of the Personal Health Budgets pilot and the value of all types of evidence, especially including the views of patients/users themselves.
Both groups therefore lay claim to “evidence-based policy”, which leads me to two reflections:
It’s hardly an original thought (indeed, there are entire disciplines dedicated to such questions) but we must remember there is value associated with all different types of evidence and research methods. The value derived, and of the associated evidence arrived at, depends on what types of answers you’re hoping to uncover, how questions are framed and what pre-questions and/or assumptions underpin the framing of those questions. Different people have different thresholds for evidence and research methods, quite aside from the fact that one type of evidence or research method that’s a gold standard in one discipline could be next to useless in another.
For me, this is the equivalent of the first pre-question we came to in considering countries and continents: What do we mean by “evidence”?
Let’s not even get into the “policy” bit of “evidence-based policy”. For example, when has policy ever been based on evidence anyway? Does policy making happen in a rational, evidence-led vacuum that is protected from the whims of politicians and public opinion which, heaven forfend, may not be evidence based? Notwithstanding questions of what we mean by evidence, it’s safe to say that not all policy is based on what evidence there is. This is therefore the equivalent of the second pre-question we came to in considering countries and continents: Who are we asking what we mean by “evidence”?
The up-shot of this in the context of the evidence base for Personal Health Budgets is that Ben Goldacre and advocates of personalisation are both right, and they’re both wrong. There cannot be a definitive answer to the question of whether Personal Health Budgets are effective until some other, perhaps unanswerable questions, are considered.
When the government’s new consultation principles were introduced last summer, it was noted that, though potentially good in principle (ironically enough), we’d have to wait for government to use them in practice to see what sorts of effect they would have.
A great post from Mike Harris on the Open Policymaking blog has summarised nicely what’s happened since.
At the time the new principles were announced, a few people called for some analysis on how long consultations lasted for under the new principles compared to the old rules. Mike’s post has an answer:
Between January and July 2012, 56.5% of the 253 government consultations held lasted more than 12 weeks, but between July and December 2012 only 26% of the 207 consultations did so.
Though a headline figure, that strikes me as worrying. It would be useful if more detailed figures were available on how long the 74% of consultations that were under 12 weeks lasted.
(Just because I’m that way inclined, I’ve submitted an FOI request to the Cabinet Office to ask them that exact question – will keep you posted with the results.)
Update: the data was actually in one of the Appendices to the Committee’s report on this topic! I should’ve read the appendices! Here’s the data, which I’ll analyse at a later date.
PQASSO is a quality assurance system that many Voluntary & Community Sector organisations – including DPULOs – think about. Below, Shopmobility Lochaber – a DPULO based in Inverness-shire, Scotland – share their detailed experiences of obtaining PQASSO.