Irene Oldfather, the ALLIANCE, writes on the opportunities for better listening to the voice of lived experience.
It is just a year ago at the last NHS conference that Alex Neil, then Cabinet Secretary, announced his intention to give a stronger voice to those who use health and social care services.
In that intervening period, an explosion of activity has taken place including a national conversation across Scotland involving around 1,000 people in face to face and virtual events around what “Our Voice” should look like. I had the privilege of working as part of the national project team to deliver the framework, and in doing so had the opportunity to attend events across Scotland to listen to what stakeholders wanted from “Our Voice”.
There was a general consensus that “Our Voice” should be able to show outcomes and impact based on public, patient and staff participation. In other words, there should be meaningful engagement opportunities which can demonstrate ideas and contributions being brought to life and not just left to collate dust on a shelf. However there was also a recognition that people’s expectations are not raised to expect the undeliverable, but that their experience is used to design things well within the context of mutual respect and understanding between professionals and those who use services.
It is difficult to overestimate the concerns that people have about “the fear factor” of complaining, particularly in relation to those regarded as vulnerable and in care. Feedback should be regarded as positive and a way to improve services, building on constructive approaches such as Care Opinion and Patient Opinion. We need to move away from a culture perceiving complaints as a threat to a more positive, constructive approach. I particularly liked the suggestion of “what works well -even better if” as a way of encouraging people to think and talk about their experiences. Working together to make things better within the context of a rights based framework is central to driving improvement and culture change. The Peer Support Network should promote and facilitate that safe space with a helping hand along the way to support.
If we want citizens to engage, then we have to have conversations in safe places and with a clarity and language which people understand. It should also be remembered that often when people are accessing health and social care services they are at their most vulnerable. The new framework facilitates engagement at individual, local and national levels and it is vital that people are supported to access the Voice across that range.
Discussions with service users also highlighted the importance of “active listening” and identified four levels of listening:
1. waiting for a turn to speak
2. taking on board new information
3. listening with our heart
4. acting on, making changes from listening
It was recognised that often we have conversations at the first and second levels. Could and should “Our Voice” promote listening at more empathetic levels? Service users strongly identified with this concept and felt the power of the lived experience should be better captured within decision making processes.
The new Citizen Hub will be an opportunity to consider how best and at what levels support is required. For me the real test will be humanising the Voice, ensuring that it is independent and that seldom heard hard to reach groups are fully supported to participate. Organisations like the ALLIANCE and Scottish Health Council have a track record of involvement and participation at grass roots levels. This experience must be harnessed to ensure that we don’t create new systems and structures for the sake of it.
“Our Voice” needs to be bottom up, with a strong commitment to implementation at the most senior level. It must demonstrate an operational process which is listening and drives change, with Champions and Ambassadors who are willing to be agents of that change.
Over the next year, I hope that another explosion of activity ensures that “Our Voice” is recognised widely by citizens across Scotland, is firmly on the integration agenda and is central to service design and delivery with people at the heart.
If you would like to contribute ideas to the new “Our Voice” project please attend the “Our Voice” sessions at the NHS and ALLIANCE conferences.