Archive for July, 2013

111 – what message is it sending?

July 31, 2013

I recently wrote about the challenges faced by the NHS over increasing use of A&E services. The recent controversy over NHS Direct withdrawing from 111 telephone services is likely to send a further message that people are ‘better off heading to A&E.’

We need the insight to understand the values that may motivate people to use these services in the way they do.

When NHS Direct was launched in 1998 it was marketed like a 24 hour consumer based service like a bank. This would have appealed to those with outer directed values.

The 111 service had the potential to appeal to those who hold security and safety values. However all the news coverage will have worried them about the actual ‘safety’ of the service. This will make it harder to persuade people to avoid using A&E when they might not need to.

The A&E Crisis and the recent controversy over 111 telephone services, means the recently launched engagement programme ‘The NHS belongs to the people: a call to action’ should be seeking communicate across values sets to:

  • engage people over their views so those who are keen to be involved;
  • gather real insight into what will motivate people to use a different mix of services;
  • reassure people who will be worried over any changes however non-controversial they might be

Only through a multi-segmented approach to communications, insight and engagement will everyone’s views and motivations be taken into account.

Charlie Mansell is Research and Development Officer for The Campaign Company. If you want to see what your own primary values set is, why not take the simple Values Questionnaire here.


The London Olympics – what legacy?

July 31, 2013

Last weekend saw celebrations of the first anniversary of the start of the London Olympics and the question often asked is what impact has this had on better health?

At the time the Olympics were used to encourage take up of healthy physical activity. Figures currently show there has been some decline since last year, though still an improvement from 2005 when London won the bid.

Perhaps the problem has been  defining the improvement? There was a strong perception of some improvement in national well-being and community spirit during the Olympics itself, which has been confirmed by the latest ONS well-being results. There has also been an increase in some forms of activity such as cycling with in London easier access to cycles through the Cycle Hire Scheme which celebrated its third anniversary this week. Should we instead measure from 2005 to 2017 as a recent Lloyd’s Bank report has done?
Perhaps the most powerful legacy is still in the balance? Everyone at the time commented on the impact of the Gamesmaker volunteers. The post Olympics research showed they illustrated how organisations could make make volunteering work well through:

A specific, time-limited challenge: Games Makers weren’t asked to sign up as volunteers for ever, just to do their bit to help make this historic event happen and run smoothly..

Playing to strengths: Games Makers were carefully screened and matched to the roles that suited them best and made the most of their skills and personalities…

Something in return: The Games Makers were well briefed, properly trained and kitted out with high-quality tools for the job…Most of all, they were made to feel a vital part of something important, and got the satisfaction of knowing they’d done a job well.

Thus in order to see the whole potential legacy, one needs to be clear about:

  • the time-span one is measuring;
  • measuring the impact on well-being as well as sport participation;
  • and recognise that increasing social capital through connecting people together by volunteering can be as important as the specific sporting participation.

Charlie Mansell is Research and Development Officer for The Campaign Company. If you want to see what your own primary values set is, why not take the simple Values Questionnaire here.

A&E Crisis – can we change behaviour?

July 24, 2013

News reports over the last few days have talked of an ‘A&E crisis’  with MPs saying staffing issues and rising attendances were among the main causes of the problems. They state that just 17% of hospitals had the recommended level of consultant cover, while difficulties with discharging patients and a lack of beds at times meant the flow of patients through the system has been disrupted.

Addressing staff issues in acute hospitals or creating more out of hours services to provide more local care at home would be powerful solutions but the costs and arguments over GP contracts could mean either approach might take a long time to resolve before ‘winter pressures’ happen in a few months.

Perhaps a behavioural approach to addressing A&E attendances could be less expensive and implemented more quickly. It may not be a full solution to such a big issue on its own, but along with addressing the other issues above, it might add to the tool-kit for acute providers and GPs

Clearly where paramedics, a GP or a nurse makes a referral that is a clinical judgement. That is not the problem; it is exactly what an A&E is there for. However often the decision to take an elderly person to A&E will be taken by able-bodied adults who are low users of health services and have low knowledge of the condition. They may for example not be used to the symptoms of a diabetic episode or another chronic disease that A&E’s were not really designed for. Naturally people are seeking reassurance and a trip to A&E is perfectly rational in those trying circumstances. However often the visit is unnecessary. The NHS needs additional ‘reassurance’ mechanisms and these able-bodied family members are the key target who need to be engaged with on this issue.

What could be done to address behaviour in this area?

  • Close family relatives of regular A&E attendees could be segmented and engaged with after a visit to hospital. These people not the patients are key determinants of such a visit that may not be clinically determined
  • They could be given a number at the hospital on top of the NHS Direct and 111 numbers they will have. This at the very least alerts the hospital to a potential admission. Fundamentally a reassuring conversation may help a person who is contacting the other numbers to get a further opinion.
  • Feedback should be given to the family member immediately after an unnecessary visit in order for them to learn lessons from it. Lack of feedback often means someone might well bring their relative to the hospital again.
  • Online family networks could be developed so family members could learn more from others in similar situations so they gain a greater understanding before taking a decision to go to A&E
  • GP’s could also develop a better relationship with family members on long-term patients who go to A&E’s, so they again feel better informed

Clearly there are some forms of behaviour change, sometimes applied in less sensitive areas, such as incentives or forms of naming and shaming that would go against the ethics of the NHS that could not be applied here. However a behavioural approach is worth looking at with pilots and randomised control trials conducted to see what worked. The point being this is much more likely to be done quickly rather than wait for relatively slow moves on staff reconfiguration or GP contracts to change

Charlie Mansell is Research and Development Officer for The Campaign Company. If you want to see what your own primary values set is, why not take the simple Values Questionnaire here.

Power, Organisation and Values

July 5, 2013

Matthew Taylor of the RSA spoke at the Local Government Association (LGA) conference  – which The Campaign Company (TCC) attended this week – on the issue of different types of social power. He said:

Defined simply, power is the capacity to achieve desired objectives. It can be expressed in various ways: through coercion, explicit persuasion or an ability to shape norms and assumptions.

He was reiterating the definitions he came up with at his RSA Annual lecture last year. Taylor defined three sources of social power, hierarchy in authority, individual aspiration and social solidarity. These three types also correspond to the three mains forms of social organisation: Hierarchies, Markets and Networks. Taylor indicated those three forms of power have different directions of engagement too:

First, the downward power of hierarchical authority associated most strongly with the state. Second, the lateral power of solidarity and shared values generally associated with the idea of community. Third, the upward power of individual aspirations, which tends to be associated with markets.

Taylor has also set out the challenges they face:

  • Hierarchy in authority is all those people who think they can tell us what to do and the frameworks that compel people to conform. However levels of Trust are lower. Society is much less deferential than it used to be. Technology has also now strengthened the individual against the hierarchy.
  • Individual Aspiration is a will to achieve and is all about individualism. However the relatively recent rise of this has created a vacuum, and led to society being perceived as more narrow and materialistic. This approach to power nowadays stuggles to justify the myth of ‘homo economicus’ – that we are all maximising utilisers – which has been comprehensively rebutted by behavioural economics.
  • Social solidarity is about our responsibilities to each other. However there is also a decline in ‘congregational institutions’, such as political parties and trade unions. Social diversity has been partly implicated, possibly due to mobility. We have to trust and like people very different to ourselves. We have also seen the fracturing of class  and there is also the rise of the super-rich.

Taylor argues that the way to address complex social problems is to bring all these approaches to power together. He argues we live in a society where we are not producing solutions which mobilise all this power. For example why is social mobility the answer to solving inequality, as it does not address injustice or lack of inclusivity? Taylor says that where we do not use all forms of power, we risk failure:

Wicked problems are, by definition, tough and multifaceted, so we need to draw on all forms of social power to tackle them. When progress seems impossible, we revert to a fourth way of thinking about power and change: fatalism.

Reading this set of definitions I was struck by the similarity with values segmentation:

  • Hierarchy in Authority has similarities with safety and security driven values
  • Individual Aspiration is similar to outer directed values
  • Social solidarity has a lot of similarities with networked inner directed values

As we have argued before on the development of local social capital, and through our recent research for Newham Council, this is no surprise to us as forms of social organisation do seem to impact on values. We already seem to see the interplay between values and social networks and other forms of social organisation. We would expect power relations to do this too and be influenced by values in turn

Perhaps Matthew Taylor’s key insight here is that we need collaboration between:

  • all 3 types of social power;
  • all 3 forms of social organisation;
  • those who hold differing values across the 3 mains values sets;

in order for us to seriously address big societal problems.

However TCC knows from its work that often a Values Gap prevents that from effectively happening. For example the values of a public sector organisation making it difficult to engage with the very different values held by many of its residents.

Perhaps in order to start addressing big societal problems we first need an asset based approach to map communities for their power relations, social organisations/networks and also their values.

Charlie Mansell is Research and Development Officer for The Campaign Company. If you want to see what your own primary values set is, why not take the simple Values Questionnaire here.