Consultation, for a Change? Engaging Users and Communities in the Policy Process

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<ul><li><p> Blackwell Publishers Ltd. </p><p>, </p><p> Cowley Road, Oxford OX</p><p>JF, UK and</p><p> Main Street, Malden, MA </p><p>, USA</p><p>S</p><p> P</p><p> &amp; A</p><p> 01445596V</p><p>. 36, No. 5, O</p><p> 2002, </p><p>. 516531</p><p>Blackwell Publishers LtdOxford, UKSPOLSocial Policy &amp; Administration01445596 Blackwell Publishers Ltd. 2001Octover 200236510Original Article</p><p>Consultation, for a Change? Engaging Users and Communities in the Policy Process</p><p>Dee Cook</p><p>Abstract</p><p>The process of consultation has become integral to the development, implementation and evaluationof a raft of UK health and social policies. However, the current bewildering patchwork of area-based initiatives means that, in many localities, it is impossible to evaluate the outcomes ofparticular targeted initiatives, let alone make sense of local planning consultations, Best Valuereviews and (multi-agency) service reviews which run concurrently. The cumulative effects of thisconsultation overload threaten to swamp both local authorities and their service users. Consul-tation is itself a crucial yet deeply problematic process. There is an official view which holds thatan old model of consultationoften tokenistic and unrepresentativeis being replaced with anew one. This paper examines and challenges that view in relation to the key policy areas ofhousing, social services and policing. It also pays particular attention to, and problematizes, thenotion of hard-to-reach groups, which is so dominant in the discourse of consultation. Thepaper argues that developing appropriate tools and recognizing that consultation is a processnotan eventare essential starting points in addressing these problems. The next step is to reconcilethe principles of both evidence-based policy and user-led services into a strategic (and joined-up) framework. But, when all this is accomplished, we still need to question the political andfiscal contexts in which policy-making takes place and within which the process of consultation isitself bounded.</p><p>Keywords</p><p>Community; Consultation; Participation; Empowerment; Users; Hard-to-reach</p><p>Introduction: Contextualizing Consultation </p><p>Over the past five years, the process of consultation has become integral tothe development, implementation and evaluation of a raft of UK health andsocial policies. It has become increasingly important to be able to demon-strate how the results of consultations have been incorporated into (an ever-increasing number of) national policy statements, local implementation plans</p><p>Address for correspondence:</p><p> Professor Dee Cook, Regional Research Unit, Wolverhampton SciencePark, Glaisher Drive, Wolverhampton, WVIO </p><p>RU. E-mail:</p><p> Page 516 Thursday, August 29, 2002 10:54 AM</p></li><li><p> Blackwell Publishers Ltd. </p><p>and service evaluations. For local authorities (LAs) and health authorities(HAs) in particular, Best Value reviews, National Service Frameworks (NSFs)and Community Safety Strategies have placed upon them the obligation toconsult service users, carers, local communities and voluntary and commun-ity sector groups in the planning, evaluation and review of their services.</p><p>The New Labour governments modernization agenda implicitly requiresa new and flexible approach to consultation, as no one single feedback mech-anism is sufficient to address the diversity of client groups, needs and therealities of collaborative planning and service delivery within this mod-ernized and partnership-based agenda. At the same time, New Laboursemphasis on joined-up policies requires an equally joined-up approachto engaging with users and communities in turning policy into practice.Strategies addressing social exclusioninvolving, for instance, Neighbour-hood Renewal, Health Action Zones (HAZ) and Single Regeneration Budget(SRB) initiativesmean that</p><p>at local level, the array of nationally driven programmes is bewildering.( Joseph Rowntree Foundation </p><p>)</p><p>Given this patchwork of programmes, making sense of a plethora of localplanning consultations, Best Value reviews and multi-agency-delivered serv-ice reviews is no easy task. </p><p>The scale of this task is daunting enough, even in areas without the mul-tiple layers of New Deal for Communities, HAZs, European Social Fund(ESF ) and SRB-funded projects: this was evidenced in an invitation to tenderfor a research project issued last year by one local authority serving a ruralarea in south-western England. This research brief required an audit andstrategic overview of the LAs current mechanisms for consultation, which,at that time, numbered over </p><p> separate exercises. Moreover, the researchwas to be completed within three months! This example signals both theconsultation overload faced by many LAs and the unrealistic schedules forpolicy planning, implementation and monitoring which are imposed by cen-tral governmentand passed on to many contract researchers engaged withevaluation and consultation programmes at local level. </p><p>It is our experience as researchers (from the University of Wolverhamp-tons Regional Research Institute) engaged in consultation work within thiscontext that provides the impetus for this paper: what follows will explorekey concerns around consultation processes in relation to the specific policyspheres of housing, social services and policing. </p><p>Progress and Regress in Consultation</p><p>As already indicated, there is a widespread acknowledgement among thoseinvolved in social policy (whether academics, practitioners or policy-makers)that consultation is a crucial, yet deeply problematic process. There is an offi-cial view which holds that an old model of consultationoften tokenistic,unrepresentative and not engagingis being replaced with a new one.This progressive perspective is exemplified by the Joint Review Team</p><p> Page 517 Thursday, August 29, 2002 10:54 AM</p></li><li><p> Blackwell Publishers Ltd. </p><p>( JRT ) which evaluates the performance of all councils with social servicesresponsibilities. Their Annual Report for </p><p>/</p><p> summarizes problemsaround working with users and carers in the up-beat terms of familiarproblems, new solutions which are summarized in figure </p><p>. One of the keyaims of this paper is to examine the extent to which these new solutions are,or are not, being deployed, and to make positive recommendations toenhance good (and strategically sound) consultation practice for the future.</p><p>First, it is worth stressing in relation to the JRT view that the new solutionshave by no means replaced the old, but may (at the margins) be supplement-ing them. Formal consultation on plans is still required and used in relationto a range of policies. Nominal representation still characterizes manyconsultation processes. While old habits die hard, new modes of consultationare being developed. The JRT cites examples of good practice which areworth exploring further. These include, for instance, </p><p> users involvement in shaping their assessments and care plans viacopies of documentation being shared and signed by all parties; and </p><p> ensuring users get information on how to complain.</p><p>Through these practices, it is argued, social services are demonstratingcommitment to involving users and carers in decisions about their lives( JRT </p><p>: </p><p>). Equally, they could be seen as paper-based accountabilitychecks rather than effective tools for genuine (individual) user involvement.Our research has, thus far, shown that users knowledge of, and input into,care plans is minimal. While care plans may offer an effective tool for engag-ing users in service planning, there is little evidence of this happening on theground. Moreover, the care planning process itself depends upon a clearunderstanding, and effective communication, between user and providerwhich cannot always be assumed. In relation to information on how tocomplain, we have found that awareness of complaints procedures is verylimited among users of long-term care who, overwhelmingly, do not knowwhere to go and who to complain to about joined-up social and healthcare services (though, as we will see below, this experience is not unique to</p><p>OLD SOLUTIONS NEW SOLUTIONS</p><p>WORKING WITHUSERS ANDCARERS</p><p> Formalconsultation onplans</p><p> Nominalrepresentation onplanning groups</p><p> User-led services Direct payments Involvement in Best</p><p>Value Involvement in</p><p>commissioningdecisions</p><p>Figure </p><p>Familiar problems, new solutions</p><p>Source: Joint Review Team (). </p><p> Page 518 Thursday, August 29, 2002 10:54 AM</p></li><li><p> Blackwell Publishers Ltd. </p><p>the sphere of health and social care). Although complaints procedures doexist, the extent to which users feel able and willing to use them is alsoquestionable. We have found an underlying reluctance to complain whichappears to be rooted both in the belief that nothing will happen anyway,and in the fear of getting a reputation for complaining.</p><p>The story is similar in the field of community care planning in respect ofthose with supported housing needs: recent research in a large LA in thenorth of England concluded that users are effectively excluded from the careassessment process:</p><p>Most housing clients (especially the homeless) had limited knowledge ofthe community care assessment process and often did not understand(or were not told) which aspects of their circumstances were consideredin assessment. Therefore, they did not always disclose important informa-tion. The waiting time for services (once an assessment has been made)was long and many clients moved on. This combination of the lack oftransparency and the lack of timeliness excluded many users from theprocess. (Foord and Simic </p><p>: </p><p>)</p><p>Crucially, the authors found that it is not clear who owns many problemsand go on to argue that to address this fundamental weakness would requirethe following: effective joint planning, understanding of agency roles andboundaries and the incorporation of user views into planning (</p><p>: </p><p>).Once again, this research indicates that we are a very long way from thedreamed-of new solutions to the familiar problems of consultation.</p><p>Policy into PracticeOr Not?</p><p>Looking at the new solutions indicated in figure </p><p>, we need to ask whetherthey really are solutions at alldo they work? Here involvement in BestValue is, in itself, cited as a new solution. The core principles of the BestValue framework for services are the </p><p> Cs namely:</p><p> challenge compare consult compete</p><p>(Housing Corporation </p><p>: </p><p>)</p><p>But taking the example of consultations around Best Value in relation tohousing services, the success of user consultation is far from demonstrableand many issues remain unresolved. A recent evaluation of Best Value Pilotsfor Registered Social Landlords notes:</p><p>Tenants should be given the opportunity to contribute actively to thereviews of individual services and activities on a basis, and over a timeperiod, that suits them. The difficulties of ensuring participation in thisway are well known but a variety of participation mechanisms may</p><p> Page 519 Thursday, August 29, 2002 10:54 AM</p></li><li><p> Blackwell Publishers Ltd. </p><p>allow those who do not normally take part the chance to do so. Cru-cially, it is important that the progress of the work in which they havebeen involved is relayed back to them according to an agreed timetable.(Housing Corporation/University of Birmingham </p><p>a)</p><p>Here we see an implicit acknowledgement that the core old problems ofconsultation remain, namely:</p><p> how to identify the most appropriate and participatory mechanisms forconsultation</p><p> how to reach those who are not already engaged in the process how to close the feedback loop and relay outcomes of consultation to</p><p>participants how to avoid a sense of the one-off exercise and ensure users sustained</p><p>involvement</p><p>The modes of consultation discussed in this research on Best Value pilotsincluded: [at a minimum] keeping tenants informed; surveying tenants;holding special meetings; consulting using existing structures; consult-ing through recruitment to new bodies specifically concerned with BestValue (such as tenants working groups); and representation of tenants onBoards (Housing Corporation/Birmingham University </p><p>b). It is ques-tionable how new the mechanisms for engagement in Best Value reallyare, and whether such arrangements can lead to a genuine representation oftenants views. Many tenant representatives are self-selecting and, as onehousing officer quoted in the study noted, You tend to get one willing horsedriven continually. </p><p>But, at the same time, such consultations cost a great deal in terms of timeand money:</p><p>You cannot over-estimate the amount of effort required to get theamount of participation you need. (Housing Corporation/Birming-ham University </p><p>b)</p><p>Issues around user representation and the resourcing of consultation pro-cesses will be discussed further below.</p><p>Confusions and Contradictions</p><p>How to reach the disengaged, how best to consult, how to sustain engage-ment and how to close the feedback loop are only the start of the list ofproblems awaiting new solutions. If we take the area of health and socialcare, the complexities of service delivery serve to compound and confoundthose seeking to engage users in consultation. Where the provision of healthand social care is concerned, their boundaries are often indistinguishable forthe service user and the issue of public/private provision is confused.</p><p>Our research has shown that the use of multiple providers in deliveringlong-term care means that users cannot easily distinguish who is responsible</p><p> Page 520 Thursday, August 29, 2002 10:54 AM</p></li><li><p> Blackwell Publishers Ltd. </p><p>for providing what, and so the lines of accountability between social services,health and housing trusts seem blurred. While comments, complaints andcompliments forms do exist, there is often one for each commissioningagency. Users are not clear who to complain to because they are unsure ofwhat aspects of their care are provided by the key agencies. If provision isprivate (and, for instance, housing often is), there are problems in channel-ling complaints to the right place/provider. So where health and social careare jointly managed and delivered, and where there is a public/private mix,there are very practical issues for users, namely:</p><p> Who to complain to? Who will take action as a result? How will the results of these actions be relayed back? </p><p>Hidden beneath this layer of confusion is a deeper problem of the </p><p>purpose(s)of consultation</p><p>. Comments, compliments and complaints are all very differentthings and used for very different purposesby their authors and the agen-cies receiving them. The processes by which they are generated are notcoterminous with consultation, yet are often assumed to be so. Com-ments, compliments and complaints may be seen as part and parcel of theuser-as-consumers rights, but cannot be a substitute for a consultation proc-essconceived here as part of a broader user engagement in the planningand delivery of services. This confusion therefore signals a fundamental con-tradiction between consumerist and empowerment approaches to consulta...</p></li></ul>


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