consultation, for a change? engaging users and communities in the policy process

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Blackwell Publishers LtdOxford, UKSPOLSocial Policy & Administration0144–5596© Blackwell Publishers Ltd. 2001Octover 200236510Original Article

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

Dee Cook

Abstract

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 consultation—often tokenistic and unrepresentative—is being replaced with a“new” 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 process—notan event—are 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.

Keywords

Community; Consultation; Participation; Empowerment; Users; Hard-to-reach

Introduction: Contextualizing Consultation

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

Address for correspondence:

Professor Dee Cook, Regional Research Unit, Wolverhampton SciencePark, Glaisher Drive, Wolverhampton, WVIO

RU. E-mail: [email protected]

SPOL_268.fm Page 516 Thursday, August 29, 2002 10:54 AM


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.

The New Labour government’s 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 Labour’semphasis on “joined-up” policies requires an equally “joined-up” approachto engaging with users and communities in turning policy into practice.Strategies addressing social exclusion—involving, for instance, Neighbour-hood Renewal, Health Action Zones (HAZ) and Single Regeneration Budget(SRB) initiatives—mean that

at local level, the array of nationally driven programmes is bewildering.( Joseph Rowntree Foundation

)

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.

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 LA’s current mechanisms for consultation, which,at that time, numbered over

separate exercises. Moreover, the researchwas to be completed within three months! This example signals both the“consultation overload” faced by many LAs and the unrealistic schedules forpolicy planning, implementation and monitoring which are imposed by cen-tral government—and passed on to many contract researchers engaged withevaluation and consultation programmes at local level.

It is our experience as researchers (from the University of Wolverhamp-ton’s 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.

Progress and Regress in Consultation

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 consultation—often tokenistic,unrepresentative and not engaging—is being replaced with a “new” one.This “progressive” perspective is exemplified by the Joint Review Team



( JRT ) which evaluates the performance of all councils with social servicesresponsibilities. Their Annual Report for

/

summarizes problemsaround working with users and carers in the up-beat terms of “familiarproblems, new solutions” which are summarized in figure

. 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.

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,

• “users’ involvement in shaping their assessments and care plans viacopies of documentation being shared and signed by all parties; and

• ensuring users get information on how to complain”.

Through these practices, it is argued, social services are “demonstratingcommitment to involving users and carers in decisions about their lives”( JRT

:

). 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

OLD SOLUTIONS NEW SOLUTIONS

WORKING WITHUSERS ANDCARERS

• Formalconsultation onplans

• Nominalrepresentation onplanning groups

• User-led services• Direct payments• Involvement in Best

Value• Involvement in

commissioningdecisions

Figure

“Familiar problems, new solutions”

Source: Joint Review Team ().



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.

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:

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

:

)

Crucially, the authors found that “it is not clear who owns many problems”and 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 (

:

).Once again, this research indicates that we are a very long way from thedreamed-of “new solutions” to the familiar problems of consultation.

Policy into Practice—Or Not?

Looking at the “new solutions” indicated in figure

, we need to ask whetherthey really are solutions at all—do 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 “

Cs” namely:

• challenge• compare• consult• compete

(Housing Corporation

:

)

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:

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



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

a)

Here we see an implicit acknowledgement that the core “old” problems ofconsultation remain, namely:

• how to identify the most appropriate and participatory mechanisms forconsultation

• how to reach those who are not already engaged in the process• how to close the feedback loop and relay outcomes of consultation to

participants• how to avoid a sense of the “one-off ” exercise and ensure users’ sustained

involvement

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

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.”

But, at the same time, such consultations cost a great deal in terms of timeand money:

You cannot over-estimate the amount of effort required to get theamount of participation you need. (Housing Corporation/Birming-ham University

b)

Issues around user representation and the resourcing of consultation pro-cesses will be discussed further below.

Confusions and Contradictions

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.

Our research has shown that the use of multiple providers in deliveringlong-term care means that users cannot easily distinguish who is responsible

SPOL_268.fm 20 Thursday, August 29, 2002 10:54 AM


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 is“private” (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:

• Who to complain to?• Who will take action as a result?• How will the results of these actions be relayed back?

Hidden beneath this layer of confusion is a deeper problem of the

purpose(s)of consultation

. Comments, compliments and complaints are all very differentthings and used for very different purposes—by 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-consumer’s rights, but cannot be a substitute for a consultation proc-ess—conceived 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-tion (Dowling

).To summarize, then, the messages from the range of research discussed so

far indicate that:

• the (official) promises of “new solutions” to the challenges of consultationare not borne out in practice;

• the basic questions posed in relation to this problematic process areequally applicable in a range of policy settings.

Further exemplars of “new” solutions are lauded in other policy areas,including a range of activities used to engage looked-after children in con-sultation. The innovative mechanisms for their engagement include “FunDays”, informal discussions in play-scheme settings, interactive softwarepackages for engaging

–

-year-olds and peer-administered care exit inter-views ( JRT

:

; Social Services Inspectorate

:

). Concomitantly, theJRT also signals progress in the “development of children’s rights and inde-pendent advocacy for children” which would serve to both underpin andenhance their role in consultation. Clearly, these would be extremely laud-able developments, but how typical are these innovations and how embeddedis the recognition of children’s rights on the ground?

Research evidence shows that there is a very long way to go in this direc-tion and suggests that many of the allegedly positive changes are, in practice,subverted by deeper political and managerial imperatives:



current government policy, despite its advocacy of children’s rights, isintroducing the Quality Protects initiative, which sets out the perform-ance indicators by which local authorities will be assessed. These, forthe most part, focus on easily measurable, quantitative dimensions ofservice—the number of placement changes, for example. This is incontrast to the children’s concerns with qualitative issues, which aremuch harder to measure. (Munro

:

)

In addition to this very basic policy paradox, there is another fundamentalissue at stake here in considering how we can best engage with, and respondto, children as users. Munro’s research indicated the kinds of issues whichconcerned looked-after children. For the purposes of this paper, some of thekey issues are around:

•

The social worker

: the disruptive effects on children of high staff turnover,lack of reliability of social work staff, and children’s desire for a more“empathetic” and less “technical” interaction with social workers.

•

Participation in reviews

: feelings of powerlessness and frustration were com-mon as plans made were not implemented, decisions were overturnedwithout explanation, and there was a perceived “lack of a say” on who isinvited to reviews and a lack of information on the roles of those whowere present.

•

Advocacy

: lack of knowledge about any complaints system.•

Confidentiality

: that if everything “confided” is written down, assessed anddiscussed in joint fora, there can be no sense of respect or privacy for thechild.

(Munro

:

–

)

On the basis of this research (and other critical work in this field; see Pinkney

), it is clear that it is not enough merely to allow children to attendmeetings about their future—in any event, they are frequently frustrated andintimidated by these professionally dominated proceedings. In terms of“what children want”, it is stressed that looked-after children themselves givepriority to a social worker’s relationship skills. However, social workers areoften unable to respond to children’s expressed needs in terms of forging arelationship with them. Increasingly subject to managerialist structures anddocumentation, social workers are often left with less time to meet the needsof looked-after children. Consequently, while the Quality Protects initiativesets out the performance indicators by which LAs’ performance will beassessed, Munro argues that “the children in this study may have shown abetter understanding of what is in their best interests than current policymakers”. But, as she succinctly puts it, “who has the power to listen to thechild’s voice?” (

:

). Here, as in other areas of social policy, we haveto ask fundamental questions of consultation and participation processes.One of these is:

“if we are not prepared to do anything about the responses, why askthe questions in the first place?”



Consultation and “Hard to Reach Groups”

One of the key challenges facing those seeking to consult users on policyissues is how to access the views of those who are not proportionally, cur-rently or usually engaged in consultation processes. This broad challenge is,in turn, filtered into the more specific and contentious problem of accessingwhat are termed “hard-to-reach groups”. This loose and ambiguous term isboth misleading and counter-productive when used in a pejorative way. Forexample, the research brief for our recent study of anxiety about crime in arural (and fairly prosperous) area of southern England explicitly aimed toexplore “fear of crime amongst hard-to-reach groups”. The definition of thisterm by the LA commissioning the work included (for example) travellers andthe gay community. However, in discussion with people within these groups,their response to our research team was a very firm “

Who says

we are hardto reach?” This disjunction between official and users’/subjects’ views ofthis term is echoed in other research, most notably in the field of policing.

The police, as other service providers, are required to consult with usersin formulating, implementing and evaluating their policies. A recent HomeOffice-sponsored study addressed this issue and noted that “hard-to-reach”in this policy context traditionally referred to

a range of minority groups who for various reasons are seen to haveproblematic relations with the police. ( Jones and Newburn

:

)

The guidance for Community Safety Partnerships established under theCrime and Disorder Act

offers a comprehensive list which includes thefollowing examples of “hard-to-reach groups”:

young men, the homeless, drug users, the gay community, members ofminority ethnic communities, children, those who suffer domesticabuse, and the elderly. (

:

)

This list seems to me to include a very significant proportion of the popula-tion of England and Wales. Leaving aside the deep-rooted problem of treat-ing such groupings in a crassly homogeneous way, what is being suggested isthat, despite their diversities, such groups possess their shared “hard-to-reach”label because they have something in common—

they

are seen to have problemsrelating to the police. But as one officer in the study astutely commented:

I’m not sure that these groups are hard to reach; some groups are veryvociferous, articulate and organized. It’s more a case of us not likingwhat we hear, or perhaps just not asking them. (

:

)

The question here is, therefore, who has the problem? By definition, is itthese groups, or the police, in failing in their engagement with them? Theresearch authors conclude that the term

hard-to-reach

was itself stigmatizingand, moreover, that “in many cases ‘hard to reach’ actually means ‘hard toengage with on a positive level’ ” (

:

).



In relation to policing, as in other policy fields, there are concerns over therepresentativeness of those who are regularly consulted. They are often olderand established “community leaders” and may enjoy good relations with thepolice whereas younger and disadvantaged members of the community may bemore hostile. From this critical perspective, consultation with “the same faces”is tokenistic and unrepresentative in terms of the community as a whole. Onthe other hand, some officers in this study felt that police consultative meet-ings could often be hostile and critical—features which may not support theclaims about passivity of consultees or “capture” of the consultation process.

In addition to the problem of representation, there are important concernsabout the

purposes and expectations

of the consultation process on the part ofthe police and the communities they serve. The gap in the perceptions of the“Aims and Objectives of the Service” are summarized in table

. The visionof consultation implicit in the police perspective is essentially a reactive one,which is located within the terms and operational priorities set by the policethemselves. By contrast, the community perspective seeks a proactive role forconsultation, which derives from an active engagement with an agenda notof the police’s making: for example, encouraging awareness of culture anddiversity and encouraging police action on community-defined problems.Consultation is thus rendered a problematic and contested process which, asone community worker noted, may display both tokenism and instrumental-ism on the part of the police:

The first is a kind of PR exercise telling you how wonderful they areand what they have done. The second is when they need your help,as a community leader, help to prevent a riot! It is never the kindof consultation that says “you are the community, where have wegone wrong, tell us how to do things better and how we can improve”.(

:

)

Table

Aims and objectives of consultation: policing

Police perspective Community perspective

• To identify local issues and problems • To influence local policing policy and/or style• To inform the delivery of policing

services and the development of policing methods

• To encourage action on specific problems

• To inform communities of forthcoming operations

• To elicit police recognition of community dynamics and cultural differences

• To inform and educate the public about policing

• Accountability and conflict resolution

• To promote support for and cooperation with the police

• To obtain access to police resources and facilities

Source: Jones and Newburn ().



Within this contested framework, the “tick-box” approach to police consul-tation (purely for managerial accountability) and the “cascade down”approach (for operational accountability, i.e. “we will tell you what we aregoing to do”) are both rendered redundant. Instead, a more flexible responseand two-way dialogue are essential if genuine consultation is to take place.

The recommendations of this study of police consultation and relationswith “hard-to-reach groups” reflects this view in stressing the need to:

• question what is meant by “hard-to-reach”;• review the aims of any consultation process in a systematic way;• pay attention to what communities want from consultation;• sustain relations beyond consultation (see it as a two-way process);• develop flexible, local consultation frameworks.

(from Jones and Newburn

:

–

)

When transposed into other policy areas, these findings signal the need toavoid the term “hard-to-reach” which is not only stigmatizing, but falselyassumes homogeneity among the individuals within the groups so labelled.We should, rather, focus on positive attempts to identify and engage thoseindividuals and groups who are not currently or usually participating inconsultation. Techniques for so doing will vary depending upon the scope ofthe consultation exercise and service provided, but will most usefully involve“bottom-up” approaches using community-based networks to gain initialaccess, thereafter snowballing contacts within communities and using “face-to-face” contacts, attending drop-ins and informal events, focus groups andconducting interviews in community-based or home settings. But these areresource-intensive activities, and ones best undertaken either by users/com-munities themselves, or by external and independent bodies, includingresearch consultancies and university researchers.

The alternative? In our experience, the alternative to investment in con-sultation is a regression to “top-down” approaches relying on sampling knownuser populations, postal surveys, formal meetings and “representative” struc-tures which have demonstrably failed in the past. Crucially, it is essential toconceive of consultation as a

process

and not a one-off

event

and so acknow-ledge that it needs to be negotiated, sustainable and strategically managed.In relation to policing, as to other policy fields, productive consultation pro-cesses will involve eschewing the reactive, managerial accountability modeland instead develop a proactive model of consultation which moves fromtick-box tokenism to genuine user engagement in policy and, potentially, touser empowerment.

From Consultation to Empowerment?

The new and progressive view of user engagement with policy consultationposits a transformation in the process from consultation (for feedback aboutservices), to participation (to develop services) through to empowerment (tomanage services). Thereafter, the three processes reinforce one another (asrepresented in figure

, from the JRT Annual Report

). As we have



already seen, the discourse of consumerism produces a procedural conceptionof “rights” to information, complaints and redress. But these “rights” are notbased on the ability to affect policy outcomes (Gilliatt et al. : ).Empowerment would achieve precisely that result.

The empowerment approach “has the fundamental aim of ensuring thatusers and carers not only have more say but more power in the policymaking process” (Dowling : ). But how realistic and desirable is it toask users and carers to define their own needs and manage the servicesnecessary to meet them? It is at this point that the discourse of user empow-erment collides with the other key driver of contemporary health and socialpolicy—evidence-based policy (Ham ; Tilley ). Tilley welcomes the NewLabour stress on the positive role for research and evidence, arguing thatevidence is useful for informing decisions about policy and practice, but

Figure

From consultation to empowerment

Source: Joint Review Team ().



contends that “the evidence-led agenda promises too strong a role for evid-ence” (: ). Using the principles of “realistic evaluation” (Pawson andTilley ) he instead proposes theorizing based on contexts, mechanismsand (sometimes unintended) outcomes which are not predictable or general-izable. Instead of the random controlled trials (RCT) as a “gold standard”,the upshot of realistic evaluation research will be “a tested theory or set oftheories that provides an improved grasp of what worked, how and withwhom within the programme” (Tilley : ).

So, if evidence-based policy and practice is not inevitably the bedrockupon which services should be developed and delivered, where does thisleave the principle of “user-led services”? If the “experts” are not always bestplaced to guide policy, what about the users? There is an important legacyof attempts to foster user-led policy in the field of health: for example, theOregon Project, which was a forerunner in public involvement in priority-setting in health care packages. Despite its weaknesses (including “inflation”in terms of expectations of the basic package), what the Oregon experimentachieved was the recognition that “experts” needed to take into account theviews of the community when making decisions about health care provision(Ham ). On the debit side, the project was dependent on the strength ofthe economy and although it could be implemented in a favourable eco-nomic climate—a downturn could signal a threat to its sustainability.

Another example of user-led services is the PATH project—People Assess-ing Their Health—located in an isolated region of Canada which experi-ences difficult socio-economic conditions. Here a “low-technology” approachwas adopted to engage the community, and

community health impact assessment was used to increase publicunderstanding of the determinants of health and empower citizens toplay an active part in decisions affecting their health. (Mittelmark: )

The key lessons learned from PATH were that a highly participative processsuch as this could “make people shift their thinking beyond the illness prob-lem of individuals to a consideration of how programmes and policies couldsupport or weaken community health” (: ).

In the UK context, the biggest consultation on health priorities was con-ducted in when million leaflets were issued asking “What are the topthree things you think would make the NHS better for you and your family?”A British Medical Journal editorial commented: “We need a culture of involve-ment not policy making by million leaflets” (Anderson and Florin ).But, thankfully, there are other more engaging exemplars in the UK context.The Community Health Project (CHP), established in in a deprived,multicultural area of London, has worked to deliver services, engage in com-munity outreach and empower users through partnership (Edmans andTaket ). Their approach has confronted many of the issues already dis-cussed in this paper and has worked towards identifying “a framework forcommunity involvement in health and regeneration”. This framework rests



on an acknowledgement that “communities are not homogeneous, and thereis a need to work within all sections of the community” and will involveoutreach efforts to both “hard-to-reach” [sic] sections of the community andalso those “who may not wish to be reached” (for instance, the street home-less and asylum seekers) (Edmans and Taket : ).

The key elements of this framework are very instructive, and are applic-able in relation to other policy fields, namely the imperatives to:

• work at the most local level• involve community in decision-making at all stages• conduct capacity-building and training• recruit locally to paid posts, wherever possible• have a participatory action research approach• adopt innovative and multiple ways/processes of working• adopt a holistic approach• recognize, respect and work with diversity, in an empowering fashion• recognize that it takes time

(Edmans and Taket )

The final point is particularly moot: at a time when the cumulative effects ofconsultation “overload” threaten to swamp both LAs and their service users,it is difficult to take time out to think strategically about the process, and torecognize that answers cannot be provided overnight. Central governmentneeds to recognize the impossibility of the demands and the schedules whichthey are placing upon local authorities and their partners, whether this is inthe sphere of health, social care, policing, community safety or Best Value.

As a research team, we are committed to a more genuinely “two-way”form of consultation which moves significantly beyond tokenism and tick-boxapproaches towards the empowerment of service users, their carers andadvocates in determining, shaping and evaluating the nature and qualityof services which they receive. In practice, this involves resource-intensivemethods such as community networking (and snowballing contacts), focusgroups and personal interviews in addition to any “paper-based” consultation,if and where this is appropriate for users, carers and advocates. We are alsoacutely aware that users do want and deserve to receive something fromconsultation: put simply, having given of their time and energy, consulteesare entitled to receive feedback on:

• the results of the consultation exercise;• the action that was taken as a result;• if the action they recommended was not taken, reasons why not.

“Closing the feedback loop” is essential to ensure the validity and sustaina-bility of any consultation process. The relative success or failure of our efforts,as researchers, in all of these respects will be the subject of a further paper.But, finally, it is worth reflecting on the wider theoretical and policy contextwithin which we, and others, are engaged in user consultation processes.



Postscript: The Limits of Consultation

As stated at the outset of this paper, New Labour has set great store by thetwin policy goals of modernization and joined-up government. Consultationis integral to both processes. But how seriously is consultation taken at theheart of government? In respect of the New Labour flagship Social ExclusionUnit, Ruth Lister observed:

The speed with which the Social Exclusion Unit has had to work hasmade it difficult for it to engage with those affected by the problems itis tackling. (Lister )

Moreover, she argues that the government’s resistance to a more particip-atory approach in relation to anti-poverty and social exclusion policies athome runs counter to its “human rights perspective on participation” in theinternational context (Lister ). I would further argue that while govern-ment does indeed “talk the talk” on consultation, it has yet to persuade manythat it will “walk the walk”. If the objects of social policy—service users, thepoor, powerless and disaffected—were to find their voice, the talk itself maybecome unpalatable. This was certainly the case when, in the generalelection campaign, the prime minister was challenged on health care by anangry partner of a cancer victim.

Limits to consultation are set by politics. In terms of current healthcarereorganization, the “spatial”, managerial and financial consequences of suchradical changes may limit opportunities for user consultation:

Mergers will increase the size of the population covered by PCG/Tsand may correspondingly reduce opportunities for local stakeholders(whether statutory organizations or local communities) to be engagedand involved. (Glendinning et al. : )

Glendinning and colleagues go on to argue that these mergers are morelikely to be motivated by opportunities in terms of “commissioning leverageand managerial resources” and not the needs of LAs and local partnerships.Once again, this is likely to subjugate genuine participation in favour of morebase political and managerial objectives.

Limits to consultation may also be fiscal: first, the range of policy possibil-ities upon which users are consulted, the mode of delivery of their servicesand the range of services they receive are all products of fiscal decisions onexpenditure which are “non-negotiable” for users. While it can be arguedthat users had their say in the May election, critics would argue thatthe proposals to extend Public Private Partnerships (PPPs) to core serviceswas not highlighted as a key policy proposal (Catalyst ).

Second, in relation to Community Safety policy—a cornerstone of anti-exclusion and anti-crime policies—borough-level community safety partner-ships (led by police and LAs) are required to produce “local solutions to localproblems”, but these solutions are not resourced from central government.Rather, it was argued, LAs would need to invest in community safety in



order to reap savings from reducing the costs of crime (Cook ). Undersuch circumstances it is difficult to see the point of consultation on the “localproblems” to be solved if the problems, or funding their solution, lay beyondthe scope of the locality itself.

Finally, in relation to the flagship “Neighbourhood Renewal Strategy”,there are serious doubts about the extent to which the community engage-ment and capacity-building, which is vital to its success, is being adequatelyrecognized and resourced:

community empowerment or “capacity building” is a resource-intensiveactivity . . . The National Strategy for Neighbourhood Renewal willplace a heavy emphasis on involving communities in the planning,implementation and management process. But this won’t happenunless it is properly resourced. It needs: support from central govern-ment down to individual community development workers; coordinatedaction at national, regional and local level; new, inclusive and holisticforms of local management; significant shifts in institutional cultures;and targeted funding. ( Joseph Rowntree Foundation )

The arguments put forward here would suggest that consultation, participa-tion and empowerment are processes which are problematic and challengingfor researchers, practitioners and policy-makers alike. Developing appropri-ate tools and recognizing that consultation is a process, not an event, areessential starting points. The next task is to reconcile the principles of bothevidence-based policy and user-led services into a strategic framework. Sucha framework is essential in order to meet the demands of the modernizationand partnership agendas in a joined-up way. But, when all this is accom-plished, we still need to question the political and fiscal contexts in whichpolicy-making takes place and within which consultation is bounded.

Acknowledgements

Many thanks are due to my colleague, Dr Ruth Wain, both for her helpfulcomments on drafts of this paper and for her invaluable and innovative workin community consultation.

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consultation, for a change? engaging users and communities in the policy process

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