Friday, May 22, 2015

Communicate the method as well as the madness when measuring the political pulse

If a week is considered a long time in politics, then the previous two will have felt like an eternity for some in the polling industry.

The pollsters will be relieved to see the back of the last fortnight. Traumatised by the release of the now infamous exit poll that sent shock waves around the country at 10pm on election night, the following 48 hours were no less nightmarish with the announcement of an independent inquiry into their performance by The British Polling Council. Many have spent the following days desperately scouring raw data for clues and trying to explain to clients, the public and angry politicians how on earth the prevailing wisdom of the campaign failed to sense a Conservative majority. Even some of the big players in the political narrative are now calling for regulation of the polls in the final stages of election campaigns.

Ultimately the polling industry finds itself in such an uncomfortable position because it has a lot to answer for. Never had their services been in such high demand as in the run up to this month’s election, dominating the day-to-day framing of debate in the media by analysts and commentators. The parties themselves danced to their tune of ‘neck and neck’ and a hung parliament, shaping their strategies accordingly. Newspapers succumbed to the apparent deadlock by commissioning their own daily measurements of the nation’s political pulse – and in doing so dedicated discussion, not to policy or to manifestos but to electoral and Parliamentary arithmetic. Yet in practice this apparent dead heat bore no resemblance to reality and was never the prospect it appeared. The influence of the polling industry over political opinion during this period – and could be argued over the eventual outcome – was unprecedented. What proportion of the electorate voted tactically out of a fear that an opposition party were in touching distance of victory?

Yet at its most influential the polling industry was also at its most vulnerable – there are more pitfalls than ever to avoid in the exercise of polling itself. This explosion of political polling comes at a time where people lead busier lives than ever, when much of the public are increasingly reluctant to answer any kind of survey – not least one seeking political opinions when engagement is supposedly at an all-time low, and further complicated by the unusual fluidity of the electorate amid a new, multi-party landscape. Why they got it so wrong and how wrong each individual organisation got it is under investigation by the psephologists. My principal concern is with the communication of their research results and methods to the electorate, as I think they got that wrong too.

The numbers themselves may be subject to critical scrutiny by the British Polling Council, but the messages that accompany the numbers clearly were not. It should have been more important than ever to ensure that the definition of polling – that polls are samples, not forecasts, and the methods by which conclusions are drawn – extrapolating from people that can be reached to the people that can’t – was communicated as convincingly to the public as the poll results themselves. At OPM we’re acutely aware of the importance of effectively communicating how our research findings have been reached and that the public dialogues we run, sometimes exploring complex scientific concepts, are accessible – allowing meaningful participation in debate. These same principles should be adopted in the communication of election poll results, helping to shape a more politically literate public.

Health warnings, disclaimers –  in other words, providing a context – may reduce the impact of headlines, but this will be far outweighed by the damage to the industry’s reputation if voting behaviour continues to be misrepresented on the scale it has been this month. It’s just not realistic to expect members of the public to appreciate how each polling organisation weights or models its raw data to arrive at an estimate of voting intentions by glancing at the latest headlines generated by the day’s polls. What the questions were (and how they were worded), how were they answered (typically by phone or via the internet), and who answered them, in other words – the methodology – must feature as boldly as the headlines.

I’m not suggesting that the accurate representation of forecasts is the sole responsibility of the polling organisations – it’s a matter for collective consideration. But polls themselves will no longer be taken on trust alone. The pollsters have no choice but to seek to remedy this confusion over how results are reported and interpreted if they are to recover from what was considered widely to be their worst night for 23 years. The last two weeks might otherwise only be the beginning.

Friday, May 1, 2015

Patients in control: ‘assume it’s possible’

Imagine walking into a GP surgery. For most of us, the first thing we normally face is a reception desk with overworked staff fielding phone calls in front of long queues of waiting patients.

What would happen if you took the reception desk away? Can you picture the waiting room as a place to talk to healthcare advisers, to find out about different wellbeing programmes without needing to necessarily even see a GP? The experience might feel something like going into an Apple Store and being greeted with a friendly smile and an iPad to search for options.

This is one of the latest ideas from the Bromley-by-Bow centre – reimagining the waiting room as a space to actively engage with patients, rather than a space where people are passively processed.

Operating in one of the most deprived areas of Tower Hamlets, BBBC is a pioneering community organisation – a vibrant hub with a café, arts workshops, offices, a nursery, garden, GP surgery and officers from the local housing association. The programmes that they run include helping people with long term conditions to take control of their lives, learn new skills, supporting people to find work and establishing social enterprises. The GP surgery (along with five others in the local area) refers patients to BBBC programmes through social prescribing.

 

BBBC

Bromley-by-Bow Centre

 

The philosophy underpinning this approach is not necessarily new or unique – The Marmot Review into health inequalities emphasised a social understanding of health, and more recently Dr Atul Gawande dedicated one of his Reith lectures to the importance of medicine shifting from a focus on health to wellbeing. There is also evidence from social prescribing pilots elsewhere in the UK of the success of the approach. But the BBBC has put a wellbeing approach into practice and made it sustainable – based on an unswerving belief in the power of stronger, and more networked communities, and people’s capacity to achieve their goals and raise their aspirations.

OPM worked with the Bromley-by-Bow Centre (BBBC) to create a commissioning simulation as part of the South East CSU Person-Centred Care project. This aimed to explore the tools and knowledge that CCGs might need to confidently commission programmes and services that put patients in control.  Participants had to imagine they were at a Commissioning Challenge event for a fictional CCG – although not dissimilar to what some CCGs are already doing. At our event, commissioners, patients, local authority representatives, clinicians and voluntary sector providers had come together, to work up an idea on how to reduce Type 2 diabetes and heart disease through a living well programme.

Simulations always risk being slightly contrived, but the aim was to go beyond commissioners’ usual environments, draw inspiration from the setting and think about how to join the dots between different organisations in local areas – all of whom could have something to contribute to a wellbeing approach that puts patients in greater control of their health.

What did we learn?

Creating the space for CCG commissioners to come together with local organisations and patients is essential to understand what each has to offer. Patients in control programmes will rarely sit in isolation – they are part of a menu of options, and commissioners need to think across the local system.

We found many examples and case studies of programmes that could be described as putting patients in control. But commissioning these are not yet the norm.

Participants talked about the importance of CCGs being less risk averse – finding ways to challenge entrenched cultures, and influence others internally and externally. This is not an easy task in a time of tight budgets and long lists of priorities.

Within this context, being able to demonstrate impact and outcomes is vital – we have blogged about measuring impact in the context of commissioning earlier on in this blog series on person centred care.

Despite these challenges, overall, we found that there is real desire amongst CCGs to use the commissioning process to ensure that there are person centred approaches in place. As one participant in the simulation said: ‘The aim should be for a Bromley-By-Bow Centre in every local area…’

In the words of the Centre itself: ‘assume it’s possible’.

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This is the third in a series of blogs to be published following the development of a set of online tools and resources by OPM in support of the person-centred care agenda for South East Commissioning Support Unit. The first is entitled: Person-centred care: putting patients in control and the second: Person-centred care: measuring impact.

Monday, April 20, 2015

We Need to Talk About Infrastructure: Event Highlights

We Need to Talk About Infrastructure, a recent seminar hosted by Dialogue by Design (part of the OPM Group), and co-hosted with the UCL Transport Institute – posed a simple challenge: when Government plans to invest £375 billion in infrastructure projects up to 2020, how can this be done with local communities, rather than against them?

The four speakers at the event all, in their own way, offered their own perspectives on these questions. Dr Jack Stilgoe, an expert in technology dialogues at UCL, challenged the audience to learn the lessons from other fields. In the late 1990s, scientists and technologists were failing to explain their research and innovations to an increasingly sceptical public. Policymakers came to believe that more needed to be done to not just communicate with and persuade citizens of the merits of certain advances (such as GM foods) – they needed to understand the public’s perspectives at the earliest stage possible. A model of infrastructure decision-making that attempts to understand the public’s reactions to it prior to recommendations about any particular scheme might therefore be more successful.

Professor Brian Collins, the former Chief Scientist for the Department for Transport and now attached to UCL, focused on the governance for infrastructure decision-making: we have a system of shared infrastructure where decision-making is fragmented and isolated. It is therefore sometimes unclear just who the public should be engaging with; the dependencies between different infrastructures are even murkier to citizens – a new road may be required by a decision to build a railway; but there may be no real opportunities for those affected by the former to adequately contest or challenge the latter.

Professor Collins also stressed that there was an absence of obligation in the conversation we have about infrastructure: citizens talk of their rights – for example, their right to quiet enjoyment of their communities, free from big developments – without a symmetric discussion of their obligations. In the context of shared infrastructure, is a conversation about citizens’ obligations to accommodate infrastructure necessary?

Will Bridges, Consents Officer for National Grid, highlighted the importance of close community engagement for the North West Coasts Connection Project: probably the most far-reaching plans to connect a power station to the Grid since its creation in the 1960s. For Will, the hard, technical knowledge provided by environmental and engineering assessments could only accomplish so much. The local knowledge that only communities, local interest groups and councils could offer was irreplaceable. He concluded that National Grid’s plans would have been nowhere near as successful without these crucial local understandings and perspectives.

Diane Beddoes, Chief Executive at Dialogue by Design, spoke to the practicalities of improving engagement, in the context of a collapse in public trust – where only 15% of the public have faith in the developers’ honesty, collapsing to 6% for government ministers and politicians. She suggested three possible innovations: firstly, the public rate technical experts far more highly, so the more in depth opportunities they have to discuss issues, the more successful engagement activities will be. Secondly, she identified ways in which digital technology could be used to go beyond simply replacing paper with websites, and instead create new tools – for example, by creating modelling tools that allow individuals to map the consequences of developers’ electing for one choice over another. Finally, Diane stressed the need of getting the design of engagement right: if questions aren’t clear, if processes are ill-suited, then not only will developers not get the information they need, but citizens will challenge the engagement process itself.

A single post can only ever offer the headlines from an event such as this: the perspectives of these speakers and the rich, informed views of participants challenged us and made us reflect upon our own practices. In the months ahead, we’ll return to particular issues raised in blog posts and a detailed report that draws out the lessons and recommendations that follow from reflecting on the event.

Wednesday, April 8, 2015

Engagement with the Gypsy and Traveller Community in Milton Keynes

Background

OPM conducted an engagement project on behalf of Milton Keynes Council, to explore issues faced by the Gypsy and Traveller community in Milton Keynes. The purpose of the engagement process was to create and understand a local definition of the Gypsy and Traveller community, to support the creation of an evidence base and needs assessment to inform council policy going forward, and, to build relationships between the council and the Gypsy and Traveller community in Milton Keynes.

What we did

We ran two half day workshops with the group, exploring issues including identity, community needs and council relationships. To recruit participants we used snowball sampling techniques to promote the project within a traditionally hard-to-reach group. Contact was made with both Irish Travellers and English Romany Gypsies and the workshops were attended by 24 Irish Travellers over 2 days.

The workshops were run in an informal manner to maximise engagement. We also avoided text heavy presentations in favour of image based hand-out materials, due to known literacy issues among some group members. Participants responded to this approach extremely well, and it led to a number of deep and interesting discussions. The images helped to focus our conversations on the most important issues. Participants gave positive feedback on the way that the workshops had been run.

 

MK image collage

 

During the course of the discussions, participants expressed an interest in taking part in more regular and direct engagement with the council in Milton Keynes. We helped broker conversations between participants and members of the council to identify practical ways in which this could be achieved.

Impact

We presented the main findings of the engagement process alongside best practice examples from around the country which had been identified by participants in the workshops to Milton Keynes Council at a special meeting of the Overview and Scrutiny Management Committee, resulting in concrete recommendations the council will be taking forward around housing, health, education and future engagement.

 

Thursday, April 2, 2015

South East London Commissioning Strategy Programme – Local Stakeholder Engagement Events

Background

The south east London Commissioning Strategy Programme brought in OPM to design and facilitate two local stakeholder events to inform the development of a new five year commissioning strategy for health services across south east London.

The six NHS organisations (Clinical Commissioning Groups – or CCGs) in south east London with the job of planning and buying local healthcare services, are working in close partnership with local councils, NHS hospitals, mental health and community service providers and with local people, patients and other key stakeholders to develop the  strategy.

Its aims are to improve health services for everyone in the London boroughs of Bexley, Bromley, Greenwich, Lambeth, Lewisham, and Southwark. The strategy will address those issues that cannot be solved by one area alone or where there is more that can be achieved by working together.

What we did

OPM invited key local stakeholders from the voluntary and public sector to these events to share their views on health services in south east London, and to learn more about the partners’ shared emerging vision for local healthcare services.

A large proportion of the participants at the events were from a Community and Voluntary Sector (CVS) or health service delivery background. Other participants included Healthwatch representatives and a small number of service providers.

Participants shared their views on the emerging strategy across seven key areas: Urgent and emergency care, Primary and community care, Maternity, Children and young people, Integrated care for physical and mental health, Planned care, and, Cancer.

Our engagement approach was designed for participants to learn about the background and strategy, and to share their views on emerging thinking. We wanted to test the thinking of the SE London Commissioning Strategy Programme to date, and identify what local stakeholders agree with and what needs more work.

OPM facilitated the events, with input from a Programme representative. The event mixed plenary sessions with facilitated table discussions, also providing participants with information sheets reflecting early thinking and clinical experts were at hand to give expert input on the emerging strategy, in particular the specific Clinical Leadership Group themes.

Impact

Participants at the local stakeholder events welcomed the overall direction of the strategy, but also raised a number of questions regarding its implementation. Issues such as joined up working and continuity of care, variability in quality of care and patient outcomes were discussed. A strong message coming out of the events was the need for involving patients in setting outcome and experience measurements and indicators for all services.

The local stakeholder events fed into the development of their five-year south east London commissioning strategies, and formed part of a wider programme of engagement across south east London around.

Thursday, April 2, 2015

Care Act Scenarios Workshop: with local authorities, residential care providers and service user groups

Background

The Department of Health commissioned OPM to conduct a scenario workshop into the potential impact of the Care Act on local elderly residential care markets, including residential care, nursing and dementia care. Based on earlier consultation responses received by the Department of Health, our work focused on the following two changes:

The purpose of the workshop was to provide a way for a group of people across the ‘whole system’ (in this case the elderly residential care market) to experience potential future scenarios in a safe learning environment.

What we did

We started with 21 scoping interviews with a range of Local Authority (LA) officers, care providers, groups who represent or advise service users and carers and experts in the English care market. These interviews were used to inform the design of the scenario event, held on in November 2014 in central London.

During the day long workshop, participants worked grouped as Local Authorities, care providers and user representatives and at other times came together for facilitated 3-way conversations. For example, participants discussed how increased transparency about rates would be likely to impact on user behaviour, how providers would prepare in response to this and what local authorities would have to bear in mind in to meet obligations under the Act.

 

DoH Care Act Sim image

 

We used market scenarios to stimulate the discussion, varying in potential impact of the reforms introduced by the Care Act (based on factors such as wealth, needs and market scale), as well as geographical location, square mileage, population size, rural or urban characteristics and ethnic diversity.

There was an Advisory Panel in the room, who were at participants’ disposal to consult for additional insight, information and clarification.

Impact

One of the key findings from the interviews and workshop was the need for greater clarity about the responsibilities of local authorities as a result of the Care Act, and the impact of the cap on personal care costs, and how this is metered. Our report is with the Department of Health’s Social Care Strategic Policy and Finance Team and is being used to inform the implementation of the Care Act.

Thursday, April 2, 2015

Locality Events for Achieving for Children, Richmond and Kingston Council

Background

In September 2014 the Children and Families Act 2014 came into effect changing how services are provided for children and young people with Special Educational Needs and Disabilities (SEND).

To support the introduction of these reforms, Achieving for Children, a newly set up community interest company providing Richmond’s and Kingston’s children’s services, commissioned OPM to deliver a series of engagement events.

These events brought together parents, school staff, and members of the Achieving for Children team to discuss the reforms and ask questions about the changes.

What we did

Seven events took place in school halls across the two boroughs throughout May and June 2014. A total of 269 people attended, of which over four fifths were parents. The format of the evenings combined presentations, small group discussions and question and answer sessions. This allowed participants to hear information about the planned changes, provide their feedback, and ask questions.

Although there was a lot of information to cover with many participants having detailed queries, facilitators were able to capture any comments and questions that were not heard during plenary sessions with the room as a whole. These questions were subsequently answered by Achieving for Children online, and fed into the final report. The sessions also used interactive voting to give a before and after picture of the level of knowledge held in the room.

Impact

Participant feedback suggested the locality events were successful in providing an opportunity for families and school staff to learn about the Children and Families Act 2014. Participants were keen to have further opportunities to learn more about the far reaching changes and felt that illustrative examples and FAQs may foster understanding. This is something that has been taken on board, with Richmond Council developing an FAQ section of their online guidance around SEND services.

Thursday, April 2, 2015

Barnet Libraries Review Focus Groups

Background

As part of an evidence-led review of its library service, Barnet Council commissioned OPM to run a series of focus groups to hear the views of a wide range of residents. The discussions focused on the current library service and what residents expect from library services in the future.

What we did

OPM ran nine focus groups during August 2014. We designed, facilitated and reported on the discussions. We captured the views of the general public as well as those from a range of protected groups, such as unemployed people and people with disabilities. Participants included both users and non-users of library services.

Participants discussed why people do or do not use libraries, what libraries mean to individuals and communities, their awareness and usage of library services and their thoughts on what works well and what doesn’t work well about the current service.

Participants also explored the future of library services, including their appetite for increased use of self-service/ technology in libraries and the need for support with this, the balance of service quality and local access and their appetite for getting more involved with the service as volunteers.

We reported on the views of different groups under each theme, as well as specific needs coming out of the discussions of the focus groups with older people, young people, people with mental health issues, people with learning disabilities, unemployed people, people on low income/living in areas of deprivation, and Black and Minority Ethnic (BME) residents.

Impact

The findings were used by the council to help develop future options for delivering library services in Barnet.

Wednesday, April 1, 2015

Tramlink extension to Sutton town centre Consultation programme

The London Boroughs of Sutton and Merton have an aspiration to extend the current Tramlink network from Wimbledon to Sutton town centre via Morden. To help inform a decision about the next steps, Transport for London (TfL) requested that the councils carry out a consultation to identify the general feeling in the community about the proposal. OPM Group was contracted to design and deliver this consultation programme in a short time-frame of less than 3 months in order to meet the TfL deadline of mid-September 2014.

We designed and produced engaging consultation materials including a dedicated website, response form, response postcard, posters, leaflets and banners. We also developed communication materials, including a press release, invitations to key stakeholders and social media updates. Throughout the 4-week consultation period we delivered a series of 10 successful exhibition events including both advertised drop-in sessions and local high street events to raise awareness of the consultation and encourage participation.

As a result we received over 10,000 responses. To respond to this very high response rate and still meet the deadline we quickly put together a team to analyse the responses using our bespoke system, and summarised the quantitative and qualitative data in a detailed report to the councils.

The summary report that we delivered to the councils was submitted to TfL in September 2014 and the feedback and insights from the report will be used to inform the next steps in the proposals. The councils are now awaiting the outcome of TfL’s decision.

Friday, March 27, 2015

Back to the Future: The Great Exhibition and NESTA’s FutureFest

NESTAs FutureFest earlier this month was in some ways a very old fashioned affair.

For all its future-gazing, it felt very much in the tradition of the 1851 Great Exhibition, with its mix of wonderment sideshows and learned talks by politicians, innovators, academics and journalists, including Green Party Leader Natalie Bennett and author of ‘The Establishment: And How They Get Away With It’, Owen Jones.  They alternately wowed us with futuristic inventions and heralded the end of the world as we know it.

This mix of physical wonder and mental stimulation is a winning formula for FutureFest and one that merits a bigger, more public stage to involve everyone in the debate.

The physical wonder came in many forms:  The ‘Immerse’ space offered futuristic thrills such as the ‘Blind Robot’ whose touch-sensing robotic hands danced across your face and hair.  Suzannah’s ride on Neurosis, the world’s first thrill ride powered by neuro data, left her brain sparking with possibilities and she went to the next learned talk on the collaborative economy more awake and more focused than any coffee hit could have provided.

 

FutureFest collage 2

 

The mental stimulation in the ‘Debate’ and ‘Explore’ chambers of the FutureFest space did not disappoint either, including these highlights:

‘Does the Future needs elites’: Adrian Wooldridge of The Economist stated the case for the role of elites as leaders who make society’s most difficult decisions.  He argued for a more structured elite, for example, taking infrastructure decisions out of the hands of politicians who are subject to electoral cycles and as a consequence defer long term decisions, such as increasing airport capacity and building power stations.

Opposing him was Owen Jones, decrying the revolving door of elites that binds them together in lucrative post-politics non-exec board posts.

Between them, Baroness Helena Kennedy QC made the case for bringing ordinary people more frequently into the decision making process, inspired by her work with juries where she was convinced that good evidence, put before people, equalled good decisions. (We’ve blogged elsewhere on what society could learn from the wider use of participatory events such as the jury trial).

In ‘All Together Now’, a truly adversarial debate raised the temperature in the ‘Debate’ space, as the panellists considered the potential (and potential hijack) of the sharing economy.

Dave Boyle’s co-operative ideals were pitted against the venture capitalist peer-to-peer service TaskRabbit, with Michel Bauwen’s call to arms for open source and knowledge sharing.

Discussing peer-to-peer services such as Airbnb, the panellists asked ‘what happens when your boss is an algorithm?’ In defence of the Co-operative (yet also acknowledging its failure to keep up with the times) Dave Boyle’s opening comments alone raised an applause that lasted for almost a minute…

As the weekend came to a close, lead-curator Pat Kane (yes, he of ‘Hue & Cry’ fame) suggested we are all biologically hard-wired to think about the future. Maybe there’s something to be said for making future FutureFest a bigger and more public spectacle on the scale of the Great Exhibition, to help excite conversations about our future democracy, lifestyles and dreams, so that everybody is along for the ride…