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State of the consultation: do we need so many public debates?

1 March 2007

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Elaine Guy
AMSPAR President

The public voice is currently in vogue, as can be witnessed by the petition currently running on the 10 Downing Street website where, at the time of writing, more than 1.6 million people have signed up to protest against the possible introduction of road charging. Many eminent people have signed up to this, including Messrs M Mouse and D Duck.

This is in the same week that the London congestion-charging zone has been extended westward. More than 90% of responses to the public consultation were from those registering their opposition to the proposals; clearly all these people had no valid argument to support their objections. And don’t think it only affects a small minority in London. Every delivery received by businesses within the zone has to pay the supplement to cover the van driving in. These additional charges are inevitably passed on to customers in order to cover costs.

So, is there any point in responding to consultations? Last year, government departments held nearly 600 public consultations. Of these, the Department of Health (DH) held 27. The DH clearly hopes to beat this figure this year as, at the time of writing (just six weeks into 2007), there have been 13 live consultations – six of which were already closed by 1 January.

These included “NHS emergency planning guidance 2005 – planning for the management of burn injured patients in the event of a major incident: best practice guidance – a consultation”. This is not to make light of a serious matter – but is it really necessary to hold a public consultation when a number of experts can put it together much more efficiently?

Mind your PECs
Of course there is a place for wide consultation where key structures and systems are to be put in place, and many interested parties have a key role to play. An example of this was the “Consultation on a review of primary care trusts’ (PCTs) professional executive committees (PECs)”, which closed on 7 February. The performance of recent PECs might charitably be described as “variable”, with many factors contributing towards this – not least the people serving on the PECs and the way they perceive their role in relation to the PCT.

Reconfiguration has provided an opportunity to address the role of PECs, and it is in the interests of all of us working in the health sector that we get it right this time. This means getting the right mix of professionals working within a clear framework that is adaptable to the varying needs of the locale. It should then be administered with proper support and training, and be open to public accountability.

Those serving on the PECs must also recognise and value the skills and knowledge of others serving. We all appreciate the years of study clinicians have invested in order to carry out their work professionally. Likewise, many managers have equal years of dedicated study in order to attain qualifications. There is no reason why a doctor would have greater expertise in management than a manager at diagnosing illness.

I’m sure many will have similar thoughts and will have passed these on to the DH. Will they be heeded?

Orchestrated debate?
I ask this in light of a recent experience of a public debate run by a polling company working on behalf of government departments. More than 300 people were invited, with the public greatly outnumbering experts working in the sector. Each table was asked to put forward three recommendations on four different topics. These were collated, and a number were selected for the entire audience to vote electronically for the ones they thought should be prioritised.

Naturally, nothing contentious app­eared in the selections for voting (despite the popularity at the table), and all the listed actions were already written in government jargon, and had been planted during scenario workshops and led discussions. More worrying was the fact that many were voting on bodies of which they had little knowledge. The government can now use this as evidence to support the implementation of policy.

We have only to think back to Patricia Hewitt’s great debate in Birmingham for the “Your health, your care, your say” consultation. The organisers freely admit that the audience was carefully selected and did not represent a cross-section
of society.

Listen without recklessness
This is not a plea to ignore consultations. Clearly, we have many experts working out in the frontline – from the receptionist to the consultant. We must always recognise, value and listen to every one of them. But let’s not burden people with extra bureaucracy when it is more appropriate to just get on and do it. This is being done by the NHS Security Management Service (SMS).

The SMS have two consultations going on at present, and have targeted appropriate bodies. The first is “Guidance on making NHS car parks safer”. This will highlight best practice for all NHS health bodies and staff. Key organisations have had input into this, and it is an increasingly important subject due to the huge rise in the black market of blue mobility discs (back to road costs again …).

The second concerns the “Security of prescription form guidance”. Last year, four boxes of FP10 SS forms went missing; the financial loss was estimated at £3.4 m. Had proper procedures for the safe receipt of goods been in place, this could have been avoided. These new guidelines will be issued in the coming months. I suggest we take heed of the content – unlike some.

Association of Medical Secretaries, Practice Managers, Administrators and Receptionists
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