Participants or customers - the people and public services

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I was prompted to thing about these two different relationships by the publication of the "Smart Cites Health and Wellbeing Discussion Draft" by some folk called the "Smart Cities - Health and Wellbeing, Leeds Task and Finish Group" who are, it seems part of the wider "Smart Cities Forum". First lets get the biggest problem out of the way.

We recommend that we rapidly explore and then build city scale facilitated networks, focused equally on well-being and health, the terms of reference for the networks being clearly established to identify and deliver the benefits of smart technology – for all parts of our community applying the concept of Solution Shops & Value added Services, within the boundaries of new institutional thinking which aligns interest. 

Now forgive me if I'm being a bit thick but this recommendation is simply gibberish. I mean what is a "city scale facilitated network" and, more to the point, what on God's earth are "Solution Shops". Now I'm sure the folk who wrote the report - and the names of the guilty are listed (including not just one but two 'Smart Cities Policy Leads' from the Department of Business, Industry and Science - and they say there's no scope for savings) - meant well in writing their jargon-ridden, barely-comprehensible 'summary' but they have revealed again that public service design is an echo chamber that completely fails in the aim of getting the wider public involved in the 'co-production' of those services.

During the subsequent interaction on Twitter, one participant provided a link to the 'Our Cities Network' and pointed out that in Rio de Janerio over 150,000 people are involved in this network. Which is fine until you appreciate that the population of greater Rio is over 13 million (and within the old city limits, some 6 million) meaning that this brilliant participation only engages between 0.1% and 0.2% of the populace.  Nearly everyone in Rio isn't part of the network, aren't part of the in-crowd who:

...(put) pressure on decision-makers, contribute their ideas and share their talents in order to build cities that are more inclusive, sustainable, creative, collective and that are always becoming better places to live.

The assumption here - and it is a common one - is that greater levels of 'participation' result in better policy-making. Those defending the 'Our Cities Network' will, I don't doubt, observe that the 0.1% participation is better than the 0.01% participation before the initiative. But is it? I'm making a guess here but probably a safe one - the members of the 'Our Cities Network' are better educated, older, wealthier and more likely to work in public service, academia or the 'creative industries' (plus those who make a living from selling things to the other members of the network). The demographic profile of those participating is completely different from that of the City as a whole. So the process of participation becomes, rather than 'co-production', an extension of the existing echo-chamber around public policy. We get policies that these middle-class people want themselves or think that poor people (who aren't in the network) might want.

The second aspect of participation is around the exploiting of data - the Smart Cities work stands and falls on the government permitting this:

We recommend the government considers changes to data legislation to enable appropriate data sharing and linkage between different government departments, health and social care bodies and statutory agencies based on more proactive and explicit consent models.

This is a long way from government acting through consent and with the willing participation of the public it serves. More to the point is raises some more questions about the use of 'Big Data' in designing public interventions. Now this isn't just about Vince-Wayne Mitchell's research into horoscopes but also reflects the fact that, just as the participation in Rio seems good but isn't, the data is not structured - there's just a lot of it. By way of illustration we have Boston's 'Street Bump' app which used a smart phone app to identify damage to road surfaces in the city - loads and loads of data all to be crunched thereby allowing the City Council to respond better. What could go wrong?

“Why?” Jake asked the audience gathered in BAM’s Harvey Theater. Why were there more potholes in rich areas? A few answers came from the crowd. Someone suggested different traffic patterns. Then the right answer came: wealthy people were far more likely to own smart phones and to use the Street Bump app. Where they drove, potholes were found; where they didn’t travel, potholes went unnoted.

Just because you have lots of data doesn't mean you have better information, it just means you have lots of data. The health and social care system generates lots of data. But it's data about old people and ill people and most of us aren't old or ill right now. Just as the liver doctor thinks liver disease is a massive problem because that's all he sees, the use of Big Data in health runs the risks of policy-decisions about all-population health or wellbeing issues being determined by analysing only the part of the population who are ill or old (or, indeed, ill and old).

So the use of modern technology to create 'facilitated networks' and manipulate 'Big Data' doesn't actually extend participation even if the process is designed (as with the Our Cities Network) with the specific aim of securing participation. To use a local, mundane example in Bradford - for the current consultation on budget options I was told officers were 'pleased' that 30 people had turned out to a public meeting in Bingley. It's not that I think these processes are without value but they are the city level equivalent of a focus group and should be treated as such. The problem is that people 'participating' are led to believe that their 'engagement' means they can influence the policy-decisions being considered. No focus group participant knows anything other than they get £20 of M&S vouchers in exchange for an hour or so chatting with a dozen others about something.

The real point here is that the population are not participants in public service delivery let alone 'co-producers' - they are customers and see little difference between the behaviour of the council or government department and any of the many large private businesses they buy from. We pay our local taxes and we get our bins emptied, the litter picked up and the potholes fixed. We pay taxes and receive education for our children and a health service when we're ill. We do not consider ourselves participants in the provision or delivery of these services - we are customers of those services.

If you want people to participate in creating, designing and delivering public services then you have firstly to do so at the scale of their understanding (this isn't to dismiss them but to observe that they aren't usually interested beyond securing what they need or want - and who's to argue with that). This means working as close to the individual level as you can.

Secondly people have to be in charge. Not in the 'empowering communities' manner but really in charge. The problem is that most people don't want to be 'in charge' of bins or schools or doctors any more than they want to be 'in charge' of the supermarket, the electricity board or the train company. What we want is for those services to work for us, to allow us to have what we need (and most of what we want) without us having to fuss and bother about it. And most of the time public services do just that and we are happy to carry on being a customer.

If we want to fuss about how to use smart technologies to get people better services that's great. But it isn't about getting more participation, it's about customer service, developing and extending the services we provide and behaving a lot more like Waitrose and a lot less like old-fashioned public agencies.  This means changing how we speak - dropping the management babble and academic over-elaboration, using short sentences, words with fewer syllables and phrases that folk might have a fighting chance of understanding. Imagine if the John Lewis Christmas ad was written by public sector professionals!

And we need to start treating the public as consumers - asking them (with real research using proper samples and good design not a self-selected audience in a draughty community centre) what they want and what it should look like. Rather than trying to pretend we can create some sort of on-line agora - bear in mind the demos of ancient Athens was only about 30,000 at most - we should build a relationship with the audiences we serve using the communications techniques that successful big consumer-focused businesses use.

In the end most people, in the manner of Ms Garbo, just want to be left alone. They have no interest in being 'consulted', in 'empowerment' or in 'participation'. What they want - and what we should try to give them - is high quality services that meet their needs and go some way to satisfying their wants. Emptying someone's rubbish bin or treating their bad back isn't a question of ideology but one of efficiency and effectiveness. Instead what government fusses about is variously saving the planet, reordering society, scaring the socks off people and coming up with new and innovative ways to waste the money people hand over in taxes. Instead of trying to get people participating when they really don't want to participate, we should should be doing the much simpler task of asking - through good research - what people want and setting about giving them just that.

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Schools, hospitals and money...give me just a little more choice!

We live in a world of choice. Think for a brief moment about how many different types of cheese you can buy in your local supermarket. Consider the aisle filled with varied and exciting bread. And ponder on a world where one relatively small space can contain over 45,000 different products from, it seems, everywhere in the world. Still further, if you live in Bradford at least, a different journey can also take you to market stalls and shops selling great locally sourced fresh vegetables, fantastic hand-crafted sausages and super fresh caught fish.

Note as well that, when it comes to that convenient portable communications device we all love, there's a still more bewildering choice of handset, of contract and of places where we'll get some informed help making our decision. It truly is a wonderful world, a world created by that simplest of simple ideas - one that's been around since the dawn of time - free exchange for mutual benefit. Or if you want it put a different way - the market.

Yet when it comes to three things that are pretty fundamental to everyone's lives - education, health care and money - we're told that free choice is a bad thing and instead government must decide on the nature, quantity and distribution of these essential requirements. What makes this so very odd is that we can see how free choice in free markets improves the lives of everyone, yet we continue to tell ourselves that somehow markets would be a bad thing in these three vital areas.

Instead of the liberty of markets, what we choose instead for the provision of schools, hospitals and cash is a thing called 'government'. And what a thing that is - confused, secretive, lying, deceiving and troublesome. I was talking the other day with some public health folk and (I forget the precise details) the matter of 'who runs the NHS' arose. Scales fell from my eyes as I appreciated that no-one actually runs the NHS. For sure there's a chap called Simon who has the title 'Head of the NHS' or similar but he doesn't really run this vast many-headed hydra except that, because there is no consumer sovereignty in health care, there has to be a process for allocating the money set aside by government to pay for said health care. And Simon is in charge of that process.  He doesn't run hospitals, he has no say over primary care, he doesn't train doctors or nurses - he sits atop a pile of other people's money and uses it as a bully pulpit.

The same goes for schools - there's no-one in charge and no market either (although there is a chimera of choice in the ability of parents to 'express a preference'). We have Michael who is in charge of Ofsted, we have a collection of 'Directors of Children's Services' in 'Local Education Authorities' and we have the management of individual schools (governors and school 'leadership teams'). As with the NHS these people aren't 'in charge' of the system and there is no fair or efficient system - nor can there be outside of a choice mechanism - for the distribution of either funds or for the making of 'allocation' decisions.

For both health and education we use bureaucracy moderated by the unseemly rabblerousing that is political debate as a proxy for the market. But the systems are too large for effective central direction so some things are 'devolved' to different parts of the system. Except that two things remains - one is what we might call the Widdecombe Principle and the other is our expressed preference for consistency.

The first of these two things refers to Anne Widdecombe who explained that central direction would never change so long as the Minister was dragged kicking and screaming into the Newsnight studio to explain. Even though ministers - like the Head of the NHS and the Head of Ofsted - are not really 'in charge' of the system, they are the ones who get verbally berated when stuff goes wrong.

The second factor is what we say to opinion pollsters - essentially that we don't like 'postcode lotteries' and therefore we don't like difference and variation within national systems. Our slightly warped idea of 'fairness' tells us that everybody should get the same, even if that 'same' is mediocre because the avoiding of difference destroys innovation, initiative and creativity.

All this brings me to the third thing government won't let choice and markets play with - money. It seems to me that what we might called 'modern applied macroeconomics' is predicated on the continued 'control' of money by government. But, just as with health and education, there's only an illusion that someone is in charge of the system. There's Mark who is the boss at the Bank of England - he gets to set interest rates (and, were I a cynic, keeps his job if he doesn't stray too far from what HM Treasury wants to do) but it doesn't seem to me that he's really in charge.

There may be very good reasons for all this lack of choice - that idea of fairness, the convenience for all of a defined and guaranteed currency. Plus, of course, the big important thing for government - collecting taxes. Indeed the scared rabbit reaction of banking regulators to 'cybermoney' like Bitcoin is rather revealing of this fact!

It seems to me that the next few years - perhaps a couple of decades - will see a huge tug-of-war between these big three government monopolies and a set of technology-driven innovators. Some of these innovators will be looking for a fast buck through exercising some sort of arbitrage while others will be seeking to develop choice models within the systems themselves - building on the availability of data to disrupt that desire for sameness I described earlier.

I don't know how this contest will play out but I hope that, whatever the long term role for government systems, it results in more choice. Or rather in systems where consumer sovereignty is allowed to operate. I hope for this result because it will deliver the greatest rate of improvement for the least effort (and probably least money). There's a big debate in the NHS about a future funding gap - it seems to me that the solution to this challenge isn't running the good old centralised NHS and trimming a bit here or rationing a bit there. Rather the funding gap is closed by allowing innovators to innovate and the best way to do this is by the development of real choice systems rather than the current 'plan and provide' approach.

The same goes for education. And for money. Choice is the best driver of improvement both through consumers exercising that choice and through providers responding to consumers is developing new, different and better way to serve their needs. And what works for bread and cheese, what delivers for mobile phones, TVs and insurance, will given a chance deliver for schools and hospitals and will provide a more stable economy less open to the abuse of politicians buying their way into power or bankers manipulating their way into wealth.

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In which George shoots the messenger (and misses)

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Back in 1957 an unemployed market researcher called Vance Packard published “The Hidden Persuaders”, a work purporting to expose the evils of advertising and, in particular, the application of psychological techniques in what he called “subliminal advertising”. Packard’s ideas are still popular even though there is almost no evidence that the methods he describes work.

However, we still see of advertising depicted as a sinister, occult science dedicated to using psychological techniques to dull the consumer’s mind and manipulate her into almost robotic purchasing behaviour. Here’s George Monbiot:

Advertising claims to enhance our choice, but it offers us little choice about whether we see and hear it, and ever less choice about whether we respond to it. Since Edward Bernays began to apply the findings of his uncle Sigmund Freud, advertisers have been developing sophisticated means of overcoming our defences. In public they insist that if we become informed consumers and school our children in media literacy we have nothing to fear from their attempts at persuasion. In private they employ neurobiologists to find ingenious methods of bypassing the conscious mind.

The idea of subliminal manipulation remains despite this:

The notion that subliminal directives can influence motives or actions is contradicted by a large body of research evidence and is incompatible with theoretical conceptions of perception and motivation

Or this:

Conducted a meta-analysis to demonstrate the ineffectiveness of subliminal advertising in influencing the consumer's decision between alternatives. A review of narrative reviews is provided to illustrate that sample size and effect size are seldom used as the basis for evaluating whether subliminal marketing stimuli are an effective means for influencing consumer choice behavior. The results of the meta-analysis of 23 studies indicate that there is very little effect.

In simple terms Monbiot is talking nonsense. However, it is a seemingly persuasive nonsense since he goes on to conflate subliminal methodologies (the “bypassing of the conscious mind” bit) with the concept of brand equity:

The first time we see an advertisement, we are likely to be aware of what it's telling us and what it is encouraging us to buy. From then on, we process it passively, absorbing its imagery and messages without contesting them, as we are no longer fully switched on. Brands and memes then become linked in ways our conscious minds fail to detect.

Now it’s true that brands – like many other things – are heuristics and employ the idea of mnemonics to achieve (or rather try to achieve) the situation where, when faced with a decision about a given purchase, the consumer recalls the brand. Most likely this is within a choice set rather than solus – we are likely to recall both Pepsi-Cola and Coca-Cola when considering purchasing a fizzy soft drink.

However, brand heuristics do not sit in isolation from other non-advertising heuristics such as personal taste, socialisation and preference.

The essence of the ‘advertising is evil’ argument cannot rest on subliminal manipulation (it doesn’t work) or the misrepresentation of brand equity leaving just the argument that advertising makes us buy more stuff:

People who watch a lot of advertisements appear to save less, spend more and use more of their time working to meet their rising material aspirations. All three outcomes can have terrible impacts on family life. They also change the character of the nation. Burdened by debt, without savings, we are less free, less resilient, less able to stand up to those who bully us.

I’m sure George Monbiot watches the BBC so isn’t in this category and fails to present a source for his contention. However, it’s pretty difficult – if you think about it for a second – to understand how you set a control group for the sort of study Monbiot refers to – there is a good longitudinal analysis by researchers at Warwick University linking advertising effects and longer working hours in the USA but this shows a general correlation between rising advertising expenditure and longer working hours which isn’t quite what George is arguing.

If there is a problem – and I’m not entirely sure that there is one – its cause does not lie with advertising but, as Monbiot spots, with values. And I do not think – actually I know – that advertising is a mirror to our values not the creator of those values. If we are to seek salvation from the sinful consumerist world, which I guess is Monbiot’s objective, the answer doesn’t lie in half-baked psychology or misplaces and misdirected attacks on the messenger.

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On the vexed matter of accountability...

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Hardly a day goes by without someone – usually a politician, journalist or quangocrat – uttering the word “accountability”. This could be in reference to spies, to the BBC, to family courts and to the actions of ministers. In all of this debate though we really don’t get to ask – let alone answer – the central question: what on earth do we mean by “accountability”?

So, in the interest of clarity and understanding, I thought I’d have a bash at defining accountability. And, as ever, it turns out to be harder that one might expect. Indeed, what many term “accountability” isn’t accountability at all but transparency. Take that family courts example:

“Measures to increase the public confidence in the family courts are being introduced in stages. The rule change in April 2009 allowed journalists to attend most family cases in county courts and the High Court, as well as family proceedings courts to which they already had access. However, the media were still only able to report the gist, rather than the substance, of proceedings they attended.”

Allowing reporting is not increasing accountability – it is welcome but does not “hold to account” in any substantive way, those charged with administering the family courts or those delivering “justice” in those courts.

In the case of the BBC we face a different aspect of ‘accountability as transparency”:

A cross-party committee of MPs has called for greater transparency regarding its executive and talent costs and accusing it of presenting some of its audience figures "in a somewhat cavalier manner".

Now the ‘committee of MPs’ do have a role in holding the BBC to account – although they have no direct power to act being limited to what they have done – publishing criticism. The BBC can – and does – ignore such actions so they cannot be seen to define “accountability” either.

And the same goes for spies – a committee of MPs meets privately and reports publicly on the activity of the security services. Again this is welcome transparency but does not really address the matter of accountability. In a democracy, public bodies are accountable (or should be) to the democratically elected government – to ministers. And it is ministers who are accountable.

All good so far. But this is “democratic accountability” – a particular flavour of accountability. Is that the only form of accountability? Or can we begin to see a different, less corruptible form of accountability emerge? Accountability to the consumer. Let me explain.

We live in a mature consumer society and most of us are informed and confident enough to challenge businesses providing poor service or a bad product. And in doing so we want some reparation – we hold the business to account for its failure to give us what we require. Businesses operating in competitive markets know that persistent service or product failures threaten the sustainability of the business and will act to reduce the number or impact of these failures. The business is very aware that the consumer can go elsewhere.

In the case of government supplied goods and services, this consumer accountability is moderated by the fact that, in most cases, the consumer is not the customer. The customer for, let’s say, the issuing of passports isn’t the individual wanting a passport but whoever holds the power to issue the contract to the passport agency. I cannot hold the passport agency to account (by, for example, purchasing that service from a different supplier) and rely on the long, complicated and deniable chain of accountability up through the Home Office to a minister.

We can see that the same circumstances apply in almost every case (although accountability may be to a council leader or police chief rather than a minister). Since I have no choice in who I get the service from, I am unable to use my ability as a consumer to ensure that the provider is accountable for service or product failure.

There is absolutely no reason why a whole range of government products and services – issuing passports and driving licenses, administering the vast array of benefits and tax credits, schools, hospitals, student loans and grants – cannot be delivered in a competitive market. The impact of creating such a competitive environment would be to drive down the cost of providing the services - a direct benefit to us as consumers and as taxpayers.

Indeed, any public service delivered to us an individual users could be considered for such an approach. And in doing this we would apply to government the power that consumers have to hold business to account.

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