The dilemma of listening to service users

Wherever we go in the UK at the moment, people are talking about how we should all be doing a better job of listening to the people who use public services, and making more use of their skills and social networks in delivery. Whether you call it “user voice”, “community dialogue”, “lived experience insights”, “co-production”, or “public and patient engagement” you find the same two basic ideas cropping up: listen to people, and involve them more in delivery. In my blog last month I explored why some of these principles can be important even for an organisation like ours, several steps removed from on-the-ground delivery. They are particularly central in some of the more radical new approaches being explored in the UK, which I mentioned in my December blog. Late last year, we discussed some of these ideas with our 2019 Fellows of Practice. Most of them acknowledged that better citizen engagement in public services was a useful goal – but there were concerns. 

Local government think tanks seem to agree on the fundamental point. Last year, the New Local Government Network (NLGN), published an influential report called the “community paradigm”, arguing that no less than a “paradigm shift” was needed, to remake public service delivery around the idea of “handing power to communities”. On 20th February, the Centre for Local Economic Strategies (CLES) published a short response. This claimed NLGN had got it wrong. But actually, CLES agreed with the principle of greater community involvement: their principle objection was that it shouldn’t be presented as a substitute for greater public spending. NLGN may feel that this was a misinterpretation of their report, but any other differences in what the two think tanks were proposing are rather more subtle (as NLGN’s chair memorably pointed out on Twitter). In the world of practice, community engagement is hard enough to execute as it is; conceptual intricacies may be lost. 

Discussions around citizen engagement have a strong pedigree. Hirschman explored how citizens can express their dissatisfaction and drive better service quality in “Exit, Voice and Loyalty” in 1970. Lipsky’s idea that frontline workers act as “street level bureaucrats”, effectively making day-to-day policy decisions, dates from 1980. The renewed attention on the ideas feels like an attempt to find the right bureaucratic response to the disruptive political forces that have played out in the recent surge of nationalism in many countries – such as the vote for Brexit in the UK.

Some feel that these disruptive forces have come about due to a breakdown of the grand bargain between citizen and state. This makes a clear link between someone’s identity as a consumer of services paid for by the state, and their identity as a citizen who has shared social responsibility to society at large. So, “I get free public services, but in return must act responsibility and give back when I can” – look after an elderly neighbour, pay taxes on time, and so on. Losing our sense of being simultaneously a service user and a citizen can perhaps beget a sense of entitlement that undermines people’s appetite to help themselves, and each other. The famous Wigan Deal is an attempt to re-articulate this link in the UK, by asking residents to make certain basic commitments in return for a greater say over how the council spends its cash.

In some ways the idea of involving communities in the delivery of public services harks back to a neighbourliness or sense of duty found in nostalgic impressions of the past. It is also sometimes idealised in other cultures which are more communal in spirit. But communities in this sense do not exist automatically, even though the common use of the term “the community” to refer to service users makes us believe they do. Communities form, and endure, through a shared identity, like where people live or common interests they hold. But we live in an increasingly individualistic society: our economic system is not very good at creating or maintaining these types of coherent communities, that we think we remember from other times, or think we see in other places. If the communities do not exist or are weak, it will be difficult for the state to engage them. Yet the paradox is that the state draws its very legitimacy in the first place from a sense of coherence between the people who live together in a country. 

Some believe that devolving more power to local governments will help to bring back service user’s sense of civic responsibility, as it moves decisions about public services nearer to the people using them. If this is true, we may be out of luck. Our system in the UK is simply too centralised to support the degree of genuine devolution that might achieve this. Local delivery agencies are hamstrung by the government’s endless attempts to improve outcomes through command-and-control from Whitehall (the Kings Fund counted an average “re-disorganisation” of the NHS once every two years between 1974 and 2012). The new government is yet to show any signs of wanting to change this. In fact, some indications suggest it may prefer to do the opposite, and consolidate power centrally, to support the “levelling up” agenda and please the new voters credited with providing its majority.

Even if more localism is on the cards, pushing decision-making power downwards comes with risks and costs which cannot be ignored. As accountability is dispersed across more people and organisations, more failure points are created – which makes risk-averse bureaucrats and politicians tetchy, even if overall outcomes do turn out to be better.

Tangled up in these conflicting realities about how to really do “user voice”, some are tempted to conclude that to truly listen to people, we need new forms of democratic engagement. Flawed though they may be, democratic structures combine voice and accountability by definition. But democratic reform may be the most distant ambition of them all. In the meantime, public servants may have to work out for themselves how to usefully engage citizens despite the bureaucratic hurdles, and without succumbing to the risks.