Conference Report

Consultation for a Change ?

Involving Communities in Making Policy

This conference was for those who work and consult withcommunities and for policy makers. We explored the challenges

and opportunities in community consultation.

A key aim was to share experience and ideas from poor and richcountries. How can experiences and lessons learned ‘north and

south’ help us improve our practice and our policies ? Theconference considered international and UK work done by

the University of Wolverhampton and some of its close partners.

Friday 9th May 2003

Social PolicyAssociation

The HavenWolverhampton

Regional Research Institute Centre for International Development & Training

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Professor DeeCook

The RegionalResearch Institute

University ofWolverhamptonWolverhampton

Science ParkGlaisher Drive

WolverhamptonWest Midlands

WV10 9RUTel: 01902 824103Fax: 01902 824005

E-mail:rriadmin@wlv.ac.u

kWeb page:

www.wlv.ac.uk/rri

Philip DeardenCentre for

InternationalDevelopment and

TrainingUniversity of

WolverhamptonTelford Campus

Shifnal RoadPriorsleeTelfordTF2 9NT

Tel: 01902 323219Fax: 01902 323212

Web page:www.wlv.ac.uk/cidt

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CONTENTS

Acknowledgements 3

Conference Programme 3

Keynote Speakers:

• Beyond Consultation: Community Participation in Making Policy 4Dr Jo Rowlands, Oxfam, Policy Advisor

• The Participation of People in Poverty in Decision Making that 5Affects Their LivesProfessor Ruth Lister, Professor of Social Policy, Loughborough University

Workshops

1. Children and their Parents 9Paul Wiseman and Sarah Thomas

2. Community Safety and Hard to Reach Groups 11Martin Roche and Helen Howard

3. Transport, Livelihoods & Poverty in Africa 12Scott Jones and Annabel Davis

4. Involvement for Modernisation in the NHS 13Sandra Squires and Mike Clark

5. Mental Health Service Users 15Suki Desai and Karen Gill

6. Participation and Change in Education – China and Jamaica 16Mary Surridge and Sarah Thomas

7. Substance Users 17Derek Bunce and Sue Finn

8. Consultation and Empowerment – From Wolverhampton to Russia 19Caroline Mansell and Elena Godfrey

9. Definitions of Community Health 22Elaine Cameron and Jonathan Mathers

Summing Up 24Philip Dearden

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AcknowledgementsOn behalf of the RRI, CIDT and University of Wolverhampton thanks go to a few key people who helpedmake the conference so successful:

• the sponsors:• The Social Policy Association• Oxfam and• The Haven, Wolverhampton

• Professor John Brooks, Vice Chancellor of the University of Wolverhampton

• Derrick Anderson, Chief Executive of Wolverhampton City Council

• Keynote speakers• Dr Jo Rowlands, Oxfam Policy Advisor• Professor Ruth Lister, Loughborough University

• Workshop Facilitators for their time and facilitation

• Professor Dee Cook, Head of RRI

• Philip Dearden, Head of CIDT

• Kulwinder Kaur, Kulbir Kaur, Kath Garbett and Dawn Springthorpe for providing administrativesupport

• Paramjit Singh, Martin Roche, Bruce Baker and Scott Jones for helping plan the day

Finally thanks go to all the workshop participants. Without their active participation the day simplycould not have been the success that it was.

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Conference Programme

Registration and Tea/Coffee

WelcomeProfessor John Brooks, Vice Chancellor, University of Wolverhampton

IntroductionDerrick Anderson, Chief Executive, Wolverhampton City Council

Keynote Speaker – Dr Jo Rowlands, Oxfam, Policy Advisor – Gender & ParticipationUK Poverty Programme

Morning Workshops:-Mental Health Service Users-Children and their Parents-Transport, Livelihoods & Poverty in Africa-Involvement for Modernisation in the NHS

Lunch

Keynote Speaker – Professor Ruth Lister, Professor of Social PolicyLoughborough University

Afternoon Workshops:-Community Safety & Hard to Reach Groups-Substance Users-Consultation & Women’s Empowerment: from Wolverhampton to Russia-Definitions of Community Health-Participation and Change in Education: China and Jamaica

Refreshments

Summary of Workshops

Summary of Event - Philip Dearden, CIDT

Depart

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Keynote Speaker: Dr Jo Rowlands

Beyond Consultation: Community Participation in Making Policy

The Uganda experienceThe Government Participatory Poverty Assessments asked for:

Poor people’s own assessments of povertyWhat are the consequences and how do they cope?What are their dreams for the futureWhat are their perceptions of government policy

Whose participation?The first time the exercise was undertaken in Uganda the focus was on people in poorcommunities. The second time it also investigated particular marginalised groups, such asstreet children, women-headed households and disabled people

What did they find?First, that assumptions are not always accurate, for example on what people wanted asregards Classrooms and Roads. Second, that people have good understanding of theircircumstances and environment: “The longer you are with them the more rational youdiscover they are. It’s just that the government doesn’t understand their rationality.”

Who did the PPA?Research teams in Uganda included: local people; local government staff; nationalgovernment staff; non-government organisation staff; everyone trained in participatorymethods together.

Key lessons from UgandaFirst, the need to use the outputs accountably: in other words, to ensure that there iscommunication about the difference the exercise has made. Second, the need to generateownership of the process at all levels. Third, the need to ‘gender’ the process and prioritisediverse voices. Fourth, to invest in the process and build in capacity at all levels, that isamong both communities and professionals.

Does it work in the UK?It is noteworthy that The National Action Plan for Social Inclusion incorporates

Awareness seminars in England, Scotland and Wales, attended by peopleexperiencing povertySeminar on Debt and financial exclusionDebt and financial exclusion raised as key issue and incorporated into NAPSI 2003Participatory process under negotiation for 2005

Further, participatory budgeting has been piloted in Manchester and Salford, whilstparticipatory gendered needs assessment has been undertaken in Gellideg, South Wales.There are many other instances of the use of participatory methods in range of circumstancesthat can be cited.

The Advantages of ParticipationIt is true that we must not raise expectations when there is not the capacity to deliver. Inaddition, if process is not well enough resourced and supported, the process may end up onlyhearing from the ‘usual suspects’. And of course it takes time and may challenge powerdynamics with negative consequences. However, participation can also: generate highquality outputs and outcomes; avoid tokenism and phoney consultation; open up newpossibilities and ideas; encourage communication across ‘boundaries’ of different experience;and encourage more active citizenship and strengthen local democracy.

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Keynote Speaker: Professor Ruth Lister

The Participation of People in Poverty in Decision-Making That AffectsTheir Lives

I want to focus in this presentation on the participation of people in poverty in decision-makingthat affects their lives. I will be drawing in particular on the work of the independentCommission on Poverty, Participation and Power of which I was a member, and also on moretheoretical work that I’m currently doing on the concept of poverty. Among the lessons I’velearned from both these exercises are, first, how lack of voice has to be understood as a keyelement in what poverty means; and secondly how our thinking about poverty andparticipation in the North can be enriched by thinking in the South – in particular, I think thedevelopment literature is more advanced in its understanding of the ways in which poverty isexperienced as lack of voice and power. This is reflected in the contrast between the analysisof poverty to be found in DfID and Department for Work and Pensions publications.

Context

As many of you probably know, the Copenhagen Declaration and Programme of Action towhich over 100 countries signed up at the UN World Summit for Social Development in 1995stated:

People living in poverty and their organisations should be empowered by…encouraging and assisting [them] to organize and involving them fully in the settingof targets, and in the design, implementation, monitoring and assessment of nationalstrategies and programmes for poverty eradication and community-baseddevelopment. The full participation of people living in poverty is a fundamental andequally obligatory part of the process.

More recently, one of the EU objectives in the fight against poverty and social exclusionadopted at the Nice Summit is ‘to promote the participation and self-expression of peopleexperiencing exclusion, in particular in regard to their situation and the policies and measuresaffecting them’ (EAPN News, 85).

In the UK, in recent years, following the example of the disabled people’s movement,demands have been emerging for the voices of those in poverty to be heard directly ratherthan just be filtered through the professional ‘poverty lobby’. A few organisations, mostnotably ATD 4th World and Church Action on Poverty, have initiated projects aimed atenabling this to happen. Both ATD and CAP were founder members of what was to becomethe UK Coalition against Poverty, which is committed to the involvement of people with theexperience of poverty in all its activities and decision-making processes.

The Commission on Poverty, Participation and Power

The Coalition was responsible for the establishment of the Commission on Poverty,Participation and Power, funded by the JRF. What made it unusual was that it emerged froma two year participatory process – the Voices for Change project - in a number of areas of theUK; and it was made up of an equal number of what were called ‘public life’ and ‘grassroots’commissioners, the latter having direct experience of poverty.

It quickly became clear from the feedback from the Voices for Change consultations and fromour own visits and discussions that ‘participation’ was in danger of becoming a dirty word forpeople with experience of ‘token’ or ‘window-dressing’ participation or of superficialconsultation exercises, limited to impenetrable questionnaires and/or from which they hadseen no positive outcomes or even feedback. Anger was expressed at politicians whoattended meetings, made speeches and then left before hearing what people had to say andat officials who simply did not listen. A classic example was the local politician, who gave aspeech and then rushed off to a meeting on democracy without listening to what any of thelocal participants had to say. Many felt exploited rather than empowered by what went for

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participation. Nevertheless, the demand for genuine participation was strong among somegroups, despite the many barriers they faced.

These barriers, as identified by the Voices for Change project, are multiple and inter-connected. Some derive from poverty itself such as the struggle for day-to-day survival,which can sap people’s energy and health – and, of course, participation should not becompulsory – another demand that makes people feel inadequate if they are unable to meetit; the inability to meet the financial costs that can be involved; lacking suitable clothes; andfeelings of stigma. These overlap with personal barriers such as lack of self-esteem and self-confidence, which may derive in part from limited educational opportunities. Additionalbarriers can be faced by some groups such as young people, disabled people, travellers,Asian women and asylum-seekers.

More institutional barriers include lacking ‘the tools of the trade’ that professionals take forgranted such as faxes, computers and internet access; the operation of social security rulesthat inhibit involvement for fear of affecting benefit entitlement; and officials who either resistparticipation or who engage in it in ways which are exclusionary rather than inclusive. Whatparticularly angers people is the use of ‘jargonistic’ language, which is experienced asexclusionary.

In addition to barriers to participation, there are problems that can arise for which there is noeasy solution. Examples are: how to engage the most marginalised people and ensure thatminority views are heard and not drowned out by the loudest voices; and how to deal witharguments that, unless people have been elected, they are not ‘representative’ of people inpoverty or have no right to speak on behalf of others. One Commission member suggestedthat instead of ‘representatives’ we should think of ‘connectors’, that is, people who help toconnect marginalised groups to decision-makers and vice versa.

The Commission report and recommendations

The main bulk of the report is given over to exploring these barriers to participation. The finalsection is headed ‘real participation’ and it looks both at how participation can work and athow to make it work. The latter includes the need for adequate resources for capacity-building– including time; and the capacity building of professionals so that they are better equipped toengage in participatory ways of working (this is a lesson which it was important to stress andwhich is beginning to be taken on board). In Scotland, in particular, the Scottish Executivefunded a national training initiative to support Social Inclusion Partnerships and Working forCommunities Pathfinder partnerships. What was innovative about this initiative was that therange of stakeholder groups – local residents, practitioners, professionals and councillors –shared a common learning experience. According to Alan Barr of the Scottish CommunityDevelopment Centre, despite initial scepticism, ‘the shared learning process proved to be akey asset of the programme and the experience contradicted many expectations’. In otherwords there is a need for some basic ground rules to help smooth the way and to ensure thatparticipation is genuinely inclusive, and that it makes a difference and is seen to make adifference.

We also set out eight principles of participation. First, participation in the decision-makingprocess of people with experience of poverty must be recognised as a human right. Second,not everyone will want to be involved; but louder voices must not be allowed to drown out theweaker or more marginalised ones. Third, we must all be prepared to change how we thinkand act to make participation genuine and effective. Fourth, people should grow up expectingeffective political representation and good responsive government, and expecting to have asay in making this happen. Fifth, participation should be a strategy, not a device; and shouldtake place throughout the process – beginning, implementation and evaluation. Again AlanBarr draws on experience in Scotland to warn that all too often approaches to evaluation‘seem to contradict the principles of community development’ and of participation and aretherefore, not surprisingly, resisted by local people. Sixth, people who hold power must learnto listen properly to the voices of people living in poverty, to understand, to communicate inways that everyone can understand, to respect people’s contributions, and to act on theirvoices. Seventh, participation needs resources on the ground, earmarked for and

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administered by community-based groups from mainstream budgets. Finally, unpaidvoluntary and community work must be recognised and valued.

Our recommendations are the weakest part of the report, as we did not have the time orresources to think through more detailed proposals. But they include a review the benefitrules, which currently discourage participation (although there’s been a minor concessionmade, a more fundamental review is needed. my idea of pilot projects); the encouragement ofuser-involvement in the DWP (this is beginning to happen, under pressure, in relation to thedevelopment of the next National Action Plan against poverty and social exclusion for theEC); a call for a change in the culture of organisations so as to make participatory approacheswork; and the encouragement of young people to see themselves as having rights to take partin decision-making (the role of citizenship education being emphasised by the Children andYoung Person’s Unit).

A formal evaluation published by Joseph Rowntree Foundation reveals the many problemsthe Commission faced and offers lessons for any similar initiative in the future – such asclearer ground-rules, adequate resources and a residential at the start. Yet for all the veryreal difficulties, it observes that ‘the commissioners and other stakeholders felt that this hadbeen a genuinely joint process that had tried to live the principles of their own report:“participation” had not been phoney.’ And it quotes a Commissioner: ‘In the Commission wefound the true guts of what equality, respect and participation is all about’.

This chimes with what I learned personally, in terms both of my own engagement in theprocess and of thinking about the politics of poverty.

Personal reflection

The meetings called for a different way of working and were often difficult, as people fromvery different backgrounds had to learn to work together. As the evaluation put it ‘this was noordinary set of meetings but a series of dynamic, unpredictable and often exhaustingencounters, with a constant tension between seeking good processes and achieving intendedoutcomes’. In the early stages, ‘public life’ Commissioners such as myself were sometimeschallenged as to what we knew about poverty - a sobering experience for those normallytreated as ‘experts’.

Yet, for all the difficulties, there was always an incredible energy and much was achieved.Moreover, for some of the ‘public life’ Commissioners the experience was, in some waystransformative. ATD has rightly observed that this kind of democratic process ‘requires us allto be ready to change’. Even for a feminist such as myself, it involved a different way of‘being’ on a committee, a way of being which means that I had to engage as a ‘whole person’,emotions and all, and not hide behind a bureaucratic committee persona.

Yet, one of the most profound lessons I learned is that, even so, I was not engaging at thelevel of the ‘grassroots’ Commissioners who had to commit so much more to the project andfor whom so much more was at stake. As one woman Commissioner said, ‘we’ve sold a lot ofour souls some of us sitting round this table – it better be worth it’. If it is not ‘worth it’, thecosts for ‘public life’ Commissioners will be relatively small, whereas they will be massive for‘grassroots’ Commissioners, both personally and because of the expectations of people in thecommunities in which they are based. Thus, the boundaries between ‘public’ and ‘private’,between ‘political’ and ‘personal’ were much more porous for ‘grassroots’ than ‘public life’commissioners.

Theoretical Considerations

In terms of thinking about the politics of poverty, what I’ve found striking from this work andthe wider movement for participation is the extent to which politics is increasingly beingcouched in a non-materialist discourse of human and citizenship rights, democracy, inclusionand respect.

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Helpful here, I think, are the notion of a politics of redistribution and of recognition which havebeen developed in political and social theory. The former is rooted in struggles against socio-economic injustice; the latter against cultural or symbolic injustice. Conventionally, povertypolitics is thought of as a politics of redistribution and at one level it still is of course, becauseultimately it is about eradicating poverty altogether through the redistribution of society’s totalresources. And recognition politics is associated with groups such as women, gays andlesbians, disabled people, and racialised groups. Groups who want to be recognized,accepted and valued for what they are. What is happening today is that the demand forrecognition is becoming more vocal in the politics of poverty also, as that politics isincreasingly expressed as a politics of voice.

Among examples of cultural or symbolic injustice cited in the literature are: ‘nonrecognition’(i.e. being rendered invisible in public representations and communications); and ‘disrespect’(being routinely maligned or disparaged in stereotypic public cultural representations and/or ineveryday life interactions). Nonrecognition and disrespect are the typical experience of thosein poverty, especially when labelled pejoratively as an ‘underclass’ or as inhabiting a‘dependency culture’. At a National Poverty Hearing in London, one of the most commonrefrains among those with experience of poverty was the desire to be treated with greaterrespect.

So this politics is in part about respect for individuals experiencing poverty. But it is alsoabout recognition of and respect for the expertise borne of experience. What is at issue hereis the value accorded to people in poverty’s own interpretation of their needs and demands.Moraene Roberts, a participant in the National Poverty Hearing, complained that ‘No-oneasks our views ....We are the real experts of our own hopes and aspirations’. The point isechoed in the political theorist, Iris Young’s latest book, which argues the importance of thepresence of a range of standpoints, perspectives and experiences, in particular those ofexcluded groups, to good judgement in policy-making.

This does not represent a denial of the material conditions that lie at the heart of poverty.What it does do is offer an opportunity to transform the politics of poverty into one thataddresses questions of power as well as material resources. At the same time, it integratesthe concerns of those in poverty into wider debates about citizenship and democracy, ratherthan treating them as separate.

Conclusion

In many ways consultation and participation represent an idea whose time has come. Butwhile government increasingly now talks the talk, we have to keep the pressure on to ensurethat it genuinely walks the walk. The Commission found that the ‘ultimate disrespect’ is ‘beinginvolved in phoney participation, by people who don’t listen, when things don’t change.Phoney because it doesn’t lead to a shift in power’. Phoney participation can lead todisillusionment and cynicism. The challenge is to ensure that consultation does achieve realchange and that participation achieves a real shift in power.

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WORKSHOPS:

1. Children and their Parents

Workshop Facilitators: Paul Wiseman and Sarah Thomas

The purpose of this workshop was to identify the causes and consequences of children’s voices notbeing heard in the policy and programme design process as well as considering ways of overcomingthe barriers to children’s participation.

Problem trees were produced by the workshop groups to identify why children’s voices are not oftenheard in the policy and programme design process and examples given by groups included:

• resistance• communication blocks• language barriers• views not valued• power inbalance• cynicism• lack of respect• lack of engagement skills• society’s perception of children, etc…

Groups also felt that the key points to bear in mind when overcoming barriers to children’sparticipation are:

• peer approaches (that is, child to child) can be more effective• approaches adopted should be age-appropriate• as with all participation, the consultation needs to lead somewhere, so that people can see the

results• be aware that age difference means power in-balance and this may influence the findings• be aware of child protection issues surrounding interactions with children and young people

and if necessary seek training and / or advice• make the experience fun, informal & interactive• own up to your own preconceptions about children and what they have to say and make a

conscious effort to set them aside• have a respect for children and do not be scared of acting on their ideas• let them know what is in it for them; think about incentives

Evaluation Model of Sure Start and Children’s Services: from Rowley Regis Sure Start andSledmere Sure Start

The aims of consultation are threefold: to provide baseline information on how well existing servicesare performing; to provide baseline data against which to measure future progress in meeting nationaland local targets; and to inform the future development of services and policy. It also supports someof the Sure Start core principles; provides opportunity for employment and training of parents andcarers; increases community involvement in the programme; and increases contact with families whowere not accessing services.

The first consultation process, in the Penn Green district of Rowley Regis entailed training communityresearchers to design and carry out a questionnaire. Issues that had to be addressed before theexercise included bureaucracy, training, payment, confidentiality, child protection, safeguardinginterviewees, sustainability and expectations. Of the 475 families in the Sure Start area, 100 wereinterviewed in a three month period.

It was subsequently felt that the consultation process could be deepened by using ParticipatoryAppraisal. This growing ‘family’ of approaches and methods enables local people to share, enhanceand analyse their knowledge of life and conditions, to plan, to act to monitor and evaluate. It includesmapping, timelines and calendars, diagrams, problem trees, ranking and scoring and transect walks toengage with the local community. These methods are to be applied in a second consultative exercise

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in Sledmere. Workshops for parents are to be held to train them in the PA tools and techniques, withsome initial fieldwork and piloting of the tools. Following the community appraisal, a communitymeeting will be held to inform the community of the initial findings and to receive their feedback.Finally a full report will be produced and disseminated among the community.

The Evaluation Model

Sure Start workers evaluate own activities

Collection and collation of monthly programme output measures (database)

Survey of families (Year 1 & 3)

Collection health, education & social datafor comparison to baseline & targets/milestonesB

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2. Community Safety and Hard to Reach Groups

Workshop Facilitators: Martin Roche and Helen Howard

The Community Safety Strategy (CDA, 1998) was aimed at reducing crime and disorder; improvingsafety within communities; and improving quality of life within communities (material and physical). Itset up Crime and Disorder Reduction Partnerships that brought together local authorities, otherstatutory bodies, the Police, voluntary agencies and community groups in an attempt to provide ‘localsolutions’ (Home Office 1998). Its brief was to consult the community and to make sure everyone hadtheir say. Yet some groups have provide difficult to involve in the participatory process.

The ‘hard to reach’ ? can be defined as individuals/groups difficult to access for purpose ofmeasuring/gauging views/attitudes for purpose of assessing/developing policies. For example: olderpeople; people with disabilities; people with learning difficulties; people from Black and Minority ethnicgroups; homeless people; substance misusers; victims of domestic violence; and young people.

Why are they hard to reach ? It may be that there are problems with consulting mechanism (eg.access as well as tools). Or it may be due to antipathy/lack of trust (eg. policy makers and/orcommunity representatives). It could be that they have “Nothing to say, haven’t got a problem!”. Or itmay arise from cultural factors (eg. language and tradition).

How are the views of hard to reach people to be accessed ? The approach may be Top Down;Bottom Up ? or a combination of the two. Concerning specific tools the options are: questionnaires;focus groups; face to face in depth discussions; and participatory appraisal. All have merits andlimitations.

Key questions to be addressed:• ‘Hard to reach’ are not one-dimensional, they differ, for instance, in terms of age, gender.• How can consultation ensure that everyone gets their say? (or is it impossible?)• What are the best tools to use for accessing them?• How are groups/individuals accessed through community? Are there ‘gate keepers’ that can

be used?• What are the cultural issues to be aware of (eg. language and tradition)?• How can the consultative process be made more culturally sensitive for certain ‘hard to reach’

groups?• What are the issues around facilitation (eg. people with disabilities).

To provide a case study of some of the issues, Helen Howard reported on research concerning racialharassment that she had done in the region.

Community Engagement and cultural change – a case study of racial harassment in the WestMidlands.

Helen Howard

This was a three year longitudinal study exploring the role of multi-agency partnerships in addressingracial harassment within a city in the West Midlands. The sample included all key agencies within thepartnership: the police service, schools, HEI’s, NHS, Housing Services, REC, religious groups, localgovernment, law and resources. Volunteer agencies and residents of the City were also includedwithin the sample group.

Research methods included: secondary data analysis of reported incidents to identify trends andpatterns; observation of key agency workers; in-depth interviews with residents of the city; focusgroups and questionnaires with residents of the City.

The question of ‘who’s speaking for whom ?’ raised issues of: gatekeepers; confidentiality; legalissues; the role of the researcher; and closing the loop?

Barriers to and enablers of the research included: previous research; commitment and trust;ownership; funding; multi-agency co-operation; and the aims and goals.

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3. Transport, Livelihoods and Poverty in Africa

Workshop Facilitators: Scott Jones and Annabel Davis

This workshop considered the relationship between transport, livelihoods and poverty in Sub-SaharanAfrica. The session drew on a video produced by CIDT that reviews Activity Patterns, Transport andPolicies for the Urban Poor in Ghana1. Three main transport stakeholder groups were identified:

• transport regulators• transport operators• transport users

Within each of these three broad groups, separate stakeholders were identified. For example,transport regulators included government, ministries of transport, licensing and police authorities.Transport operators included public sector operators (eg. state bus services), and private sectoroperators (eg. private minibus and taxis). Transport users included those who use transport for work,education and social purposes. Particular attention was paid to vulnerable groups, such as those withdisabilities, school children, and those who are geographically isolated from an appropriate range oftransport choices.

In the video, attention was drawn to the way in which transport policy normally is formulated, forexample, with heavy reliance on questionnaires and household surveys. In Ghana, research wasundertaken that used Participatory Community Appraisal techniques within a ‘Sustainable LivelihoodsFramework’. After the video, a question and answer session developed into a broader debate aboutways in which transport users could be brought into the policy making process, and their stake in theoperation of transport could be incorporated into how services actually are run.

Two major implications emerged during discussions. The first was that by asking general questions ina community about their livelihoods, and the way different modes of transport can help their livelihoodneeds, it was possible to identify needs outside the transport sector that needed a response. In theGhanaian video, the private sector transport and engineering company that assisted with the research,agreed to identify ways in which non-transport needs could be further explored and followed up byothers. An example was the need for community organisation and leadership training, where oneparticular community was put in contact with NGO’s who could assist with this, even though thesethings were not directly related to transport.

The second major implication related to the way in which data obtained from communities was actuallyused (or could be used) by policy makers. Again, in the Ghanaian video, reference was made to twofinal workshop where regulators, operators and users all discussed the data obtained. In face-to-facedialogue people began working on the implications for different stakeholders, and how to developaction plans to take things forward. Participatory community appraisal proved to provide valuabletools for integrating users’ needs, interests, strengths and vulnerabilities into the policies and practicesof transport operators and regulators. However, caution is needed in several areas:

• Participatory community appraisal techniques are no substitute for traditional methods such assurveys and questionnaires. Rather they provide a richness of policy relevant information andan opportunity for exploration and detailed needs analysis that when taken in conjunction withtraditional methods, increases the accuracy and specificity of transport policy and operations.Additionally they provide an increased sense of ownership and likelihood that transport policyand operations will be relevant to a wider variety of stakeholders who customarily areexcluded from the policy making process.

• Mechanisms need to be identified and acted on that enable regulators and operators to fullyengage with and use data obtained from transport users. Further work is needed to identifyways in which users’ voices can continue to be heard within the regulation and transportoperations, and again re-examined as policies and operations are implemented through time.

• A balance needs to be obtained between a) consulting with transport users, and enabling theirparticipation in policy formulation and transport operations; and b) raising expectations toohigh and generating ‘consultation fatigue.’

1 And also drew upon Davis, A. (2001). Transport versus service provision: a sustainable livelihoods profile ofCameroon; and Njenga, P. and Davis, A. (2003). Drawing the road map to rural poverty reduction.

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4. Involvement for Modernisation in the NHS

Synergies and Tensions in the NHS Modernisations. Where is thespace for public involvement in the process ?

Workshop Facilitators: Sandra Squires and Mike Clark (Wolverhampton City PCT)

This workshop explored 2 case studies where: Black and Minority Ethnic Community Groups wereinvolved in research to inform strategic development of dementia services in Wolverhampton; andevaluation of Health Action Zone services by local job seekers through Community Researcher posts.Together, these projects form part of a larger programme to increase public involvement in researchand in shaping the development of health care services for the local community, a governmentdirection as stated in various government policies, such as “Shifting the Balance of Power.”

The presentation explored three current positions relevant to the local and national context of themodernisation of the NHS, namely:

• Centrally defined purposes and frameworksNational Service Frameworks (NSFs), Performance indicators (star ratings), Healthimprovement targets, inspections (Commission for Health Improvement (CHI)), researchgovernance – all of these centrally impose requirements upon local health care providers.Their varied impact has included concerns about how some Trusts and some individuals feelcompelled to massage data and pervert work priorities in order to ‘tick boxes’ for theseframeworks. There has been some public involvement in developing some of the nationalframeworks (e.g. NSFs) and there is some requirement for a local representative / serviceuser to be part of the groups responsible for implementing some of them (e.g. NSFs).

• Accountability of localities-to central government for implementing their policies (CHI, Star ratings) – these are sopressing that they are likely to be domineering priorities for Trust managers-to local patients (Patient Forums, Foundation Trusts?) – it is not clear what mechanisms thereare here, and it is too early to say what the impact of the new developments will be. It is notclear that these will be able to adequately counterbalance central accountabilities at timeswhere there may be divergence between central targets and local priorities and needs.

• “Shifting the Balance of Power”Argues for an involvement agenda to increase patients’ and staffs’ ability to shape theplanning and delivery of health care services. There is another new agenda whose impactand power to influence is an unknown quantity at present.

Within the context of these three characteristics of NHS modernisation there will be synergies andtensions.

Case Study 1: Twice a Child

Aim – To explore and evaluate the experiences of Asian and African-Caribbean people inWolverhampton of Dementia care with a view to improving the services. The project arose fromconcern amongst clinicians that there appeared to be an under representation of BME clients indementia services and when they did come into the service, it was generally rather late in theprogression of illness. Initial discussion with people from the community groups confirmed that therewere issues in this area that required deeper investigation if we were to improve the service thesecommunities received.

Case Study 2: Community Researcher ILM

The aim of this project was to combine three E’s: engagement, evaluation and employment within thephilosophy of the Intermediate Labour Market (ILM).

The workshop participants made the following suggestions/recommendations:

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• “Space” for engagement across public services has to be made against the current drive forstar ratings. However, shift is occurring in mind sets to make engagement happen. CHI is alever for this in the NHS.

• Permission to fail is a healthy approach (such as in the HAZ)

• Once open for engagement, how to keep the space open and to keep the momentum going inthe longer term?

• Building capacity (inc. in communities), but what are the longer-term career prospects for thepeople involved?

• Resources – cash and time – are needed for involvement for positive changes

• Does involving people from the communities to do the consultation necessarily lead to betterinfo?

• Do organisations know the right questions to ask of the right people in the right way?

• Need to feedback to communities, to organisations and to staff, and follow through todemonstrate change

• Need organisational flexibility – HR and finance

• Need quality of work which should be part of longer term capacity building strategy andcommunity participation strategy

• Problems of funding (short term), especially for the voluntary sector

• Need to give time for projects to evolve

• Organisations need to be flexible in delivering change, some quickly and communicate whyother changes take longer or are not possible.

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5. Mental Health Service Users

Workshop Facilitators: Suki Desai and Karen Gill

In June 2002 The Prime Minister, Tony Blair highlighted the problems faced by service users:

“For too long people with mental health problems have been stigmatised by society – incommunities, in the workplace and in the media. They have not always received the supportand the services they needed. That is why we decided to put improving mental healthservices among our key priorities. Delivering on the standards set out in the National ServiceFramework will bring about the improvements that people with mental illness deserve.”(http://www.nimhe.org.uk/usersurvivor/index.asp)

Therefore the purpose of this workshop is to discuss what factors are still leading to a poor deal formental health service users and what recommendations can be put forward to improve services tomeet the needs of users.

Observations from the workshop :

• What is user-lead research ? The group defined this as knowledge that moves away fromprofessional wisdom towards user experience.

• There is a need to focus more investment in the carers of those with mental health problems.

• Marginalised communities do not use conventional services.

• Conventional services will not accommodate different ways of accessing them, such asaccess to GPs and the benefit system.

• Value of user engagement in providing a ‘stepping stone’ for people.

• Bureaucracy acts as a barrier to participation: engagement needs to be both user friendly anduser led.

• People need to shift their own views about expectations of any users or carers of services.

• What are quantifiable outcomes of user involvement?

• Institutions collude with oppressive process – including the institutions we all work for. Howcan this be challenged to voice and empower users of mental health services?

Recommendations:

• Health and other statutory organisations need to change their own practices. Put your ownhouse in order first.

• National targets need to be realistic – users/carers should be talking directly to government.

• The allocation of ‘secure funding’ needs to be radically changed – currently it does not allowuser groups to access to access it. This gives rise to problems of sustainability, and questionsthe legitimacy of any involvement

• Organisations need to hold on to their values, philosophies, mission statements and not bedriven by funding.

• Mental health services continues to remain a ‘Cinderella’ service – this needs to be challengedmore vigorously.

• Funding needs to be ring fenced for women’s groups

• Need to devise mechanisms for black and minority ethnic users to influence strategies fordelivering their services. Their question following consultation is often: ‘where is thisinformation going to now and how will it be fed back to us ?’. Feedback to users is crucial.

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6. Participation and Change in Education – China and Jamaica

Workshop Facilitators: Mary Surridge and Sarah Thomas

The workshop raised the following questions and issues:

• What is the real motivation behind community participation in resource-poor communities ?

• What is the Government agenda ?.

• Participation can promote equity and inclusion, but it can also ‘open up cracks whichexacerbate differences.’

• Changes are required throughout systems to ‘accommodate participation.’

• Underpinning attitudes are crucial and need to be addressed.

• Participation is sometimes seen as ‘threatening’ and as a loss of control.

• There has to be a realistic appreciation of the scale of the barriers to be overcome to achievegenuine participation. There is a need for a carefully staged approach.

• Participatory models evolve around programmes of work.

• Effective participation creates a momentum of its own.

• Vision, leadership and effective facilitation are essential.

• Collective learning promotes change.

• There is a symbiotic relationship between school and community.

• Feeling valued and heard is a stepping-stone to change.

• Favourable political and economic conditions facilitate participatory methods.

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7. Substance Users

Workshop Facilitators: Derek Bunce and Sue Finn

The purpose of the workshop:The aim of this workshop was to explore some of the key issues pertaining to user involvement withinthe substance misuse field. In particular it was felt important to identify how to engage with bothservice users and those who had been barred or did not access drug services. In addition it was feltimportant to engage users from identified vulnerable groups such as women, people from ethnicminorities and alcohol misusers

What is happening regionally and nationally?Since the implementation of the Patient’s Charter there has been an increasingly powerful movementto introduce some form of user involvement into the National Health Service. Within substancemisuse services this has led the Government to outline a need to develop a user involvementframework through a series of policy statements and directives. In pursuit of this the NationalTreatment Agency assisted in the funding and development of an independent body (National DrugUsers Development Agency) with the aim of encouraging users to organise various types of userinvolvement initiatives. At the same time the Government, in the policy document Tackling DrugsTogether (1999) acknowledged the increasingly significant role of drug agencies (more specificallydefined as locally-based Substance Misuse Teams) in addressing the problem of drug misuse in theUK, and reaffirmed a need to develop a user involvement framework within substance misuse servicesin general. This led the National Treatment Agency to establish a User & Carer Interim AdvisoryGroup (IAG) with the aim of developing a formal user involvement strategy that would be administeredby one of the managers at the national office.

At a regional level meetings have been held between the regional manager of the NTA, user groupsand advocacy groups such as Methadone Alliance. Following these meetings it was felt that furtherresearch would be required in this area and in pursuit of this the West Midland Regional Office of theNational Treatment Agency commissioned a study to evaluate some of the user involvementstrategies being employed throughout the region.

In addition certain Drug Action Teams within the region have employed a service user groupco-ordinator and this has led to a number of user groups being established.

Issues for User Involvement in the field of substance misuse• How do you engage with problem users?

One of the key issues outlined in the discussion is the fact that different users have differentneeds. This raises a number of questions for service providers, including:

a) How do you consult certain groups (women, ethnic minorities etc.) and do theyhave separate needs from the general service user population?

b) How do you consult users that do not or unable to access services?

c) How do you encourage participation in any user involvement initiative?

• Capacity building is important

It was acknowledged by the participants in the session that users wishing to engage in anyuser involvement programme would need to be trained in a number of areas, includingadvocacy, funding issues for substance misuse services, and the implications of “Models ofCare”

• There is a problem when U-I is run by providers

Participants felt that where providers were actively involved in any user group there was asubstantial decline in the value of any consultation exercise performed. Furthermore it wasfelt that such an approach leads to participants becoming inhibited and failing to offer effective

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feedback to providers on either the quality of existing services or any recommendations forfuture allocation of resources.

• There are conflicts for services

While substance misuse workers within services may believe there is a merit in userinvolvement they are often restricted by issues of cost and time. Most substance misuseworkers are fully engaged in their existing workload and have insufficient time or resourcesavailable to facilitate the development of user groups within their service.

• Delivering services and expectations

The terms of reference of any user group need to be identified and made clear to participantswishing to engage in any user group. Unless these are made clear it may be that memberswill become disillusioned if they feel that their representations are not being fullyacknowledged by the higher levels of management within the agency. Equally, it is importantthat users are discouraged from making unrealistic demands on both the time and resourcesof any service.

Recommendations:

• We need to go deeper than tokenism

If there is to be any kind of ownership of user groups by service users then the model ofinvolvement employed must be designed in such as way as to give a representative voice atall levels within the agency.

• There has to be a respect for difference and diversity

When implementing any model of user involvement there should be a recognition of theneeds of certain groups. In particular, participants identified that women, people from Blackand Minority Ethnic Communities (BME), alcohol users, members of the gay community wereat risk of not being given an adequate voice unless their specific needs were recognised at theformative stage of organising any kind of user involvement

• We need to tackle stigma

Participants felt strongly that substance misusers were highly stigmatised as a result of theirdrug use. In light of this they felt that it would be difficult to encourage participation in any userinvolvement strategy unless it was accompanied by a high profile campaign to destigmatisedrug misuse.

• Users must be allowed to see the process

Participants were of the opinion that members of user groups should be encouraged to seethe “workings” of the agency at all levels. In informing users about the management methods,information systems, funding issues and budgets within an agency it was felt that it wouldcreate user groups that were more capable of making decisions and recommendations thatwere realistic and viable within the agency.

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8. Consultation & Empowerment: From Wolverhampton to Russia

Workshop Facilitators: Caroline Mansell, The Haven Wolverhampton and Elena Godfrey, B.ETraining Ltd.

The purpose of this workshop was to:

• look at the process of consultation and community involvement at local / national levels and• look at the process of consultation and community involvement through transnational /

international projects• Joint learning and sharing between the above

Two case studies were used with groups.

Case Study 1: The Lifestories Project – Gaining Real Involvement

This project worked with Voluntary Sector Organisations in Wolverhampton, as supported by theHealth Action Zone, who work with homeless and abused young people. Such client groups areextremely marginalized from user group / public / community participation activities and events andare often labelled as being not engaged with or challenging to the systems and structures of bothstatutory and voluntary sector services. They are consistently the client group who are ‘not there’ interms of involvement with actual service deliverers or having their opinions heard in policy decision-making.

The young people were told of the purpose of the research, which was to encourage good practiceand operational delivery of services and also to influence the planning of statutory and voluntaryservices involved in the HAZ.

• Young people devised their own ways of giving policy-makers information –this approach wasoriginally based on a letter from a young woman from the Haven who wrote down herrecommendations for changes to statutory services due to what she saw as systemic andorganisational processes that were experienced as oppressive.

• The consultation process that the young people chose happened to loosely fit with a SocialAction Research perspective and by the process itself there were planned and unanticipatedgains and benefits for all parties

• The information was gained via: Lifestories, group discussions and questionnaires.

• Trusted housing project staff who already worked with the young people at their hostels werepaid by the HAZ to undertake this work in addition to their usual roles. This enabled a trusteddialogue within the Lifestories work.

• The Process: included long-term support and young people being enabled to choose their ownlevels of involvement/participation at each stage.

How and why did this process enable and empower young people? – Sharing their stories of`agencies responses to them in a ‘listening’ process helped them with an ‘unblocking/letting go’ ofpast trauma and frustrations with systems. The Haz back-fillied workers posts thereby the youngpeople gained more quality time with workers (workers proved more likely to be understandingwith young people if they knew their trigger issues, plus the reasons why the young people were inavoidance of agencies designed to support them), – counselling services available if the processmeant that any difficult issues for participants were raised via the process – WolverhamptonHealth Care Trust set up an OCN qualification validation process - presentations of certificates.

Copies of the Lifestories document are available from Wolverhampton NHS Trust at theOffices of the Teenage Pregnancy Unit, Oxley Health Centre, Wolverhampton 01902 445330.

The Lifestories Project - Outcomes for the Participants and Organisations:

There was a co-ordinated response from the young people and voluntary sector organisationsaround the barriers to organisational and social inclusion/exclusion.

• Young people moved on more quickly than usual in starting to make positive lifestyle choices.

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• Trigger issues were identified and explored by workers and thereby difficult to managebehaviours decreased.

• They became peer-supporters and got involved in other client-led research/consultations morequickly than usual. (They were familiarised with the various sector roles, confidence in havingtheir say increased).

• The workers gained more trust and knowledge from the young people and could enable moreself -advocacy.

• The statutory and voluntary sectors established closer working relationships.

• The Health Care Trust was able to challenge poor practice internally and with other partners.

• Utilised at National conferences and in journals/publications to influence policy-makers andstrategic direction.

Conclusion: The Haven shared a Community empowerment and the Lifestories approach with theirRussian NGO Partners wherever appropriate within the activities of the following transnational project.

Case Study 2: Russian Project

This was a two year project funded by the DFID, UK. The project aims to strengthen the RussianAssociation of Crisis Centres (RACC) and to develop a number of policies and practices, which whendisseminated will be beneficial to the whole women and children’s NGO sector in Russia. The projecthas eight partners – four in the UK and four in Russia. The lead applicant is the Women’s AidFederation of England, which is partnered with the Russian Association of Crisis Centres.

Crisis Centres are a support group working with women and children suffering from DV and abuse andprovide counselling, legal advice, training, helplines, etc… The Haven Wolverhampton is a partner tothe Crisis Centre in Ekaterinburg; Hereford Women’s Aid – with the Crisis Centre in Saratov andBirmingham Women’s Aid – partner to the Moscow Crisis Centre “Anna”.

The emergent NGO umbrella body of Russian Crisis Centres were strengthened by the utilisation ofthe information collated in a consistent way, from the partner sites, by such tools as Lifestories, whichin turn influenced social-policy makers in Russia.

Partners designed and delivered awareness raising and media campaigns, lifestories and survivorsneeds assessments. Main lessons learnt from undertaking the project include:

• Successful projects require a lot of preparatory work. Start with feasibility study to yourpartner organisations, invite partners to see your organisation, spend as much time aspossible with each other, try to understand their position, philosophy, aims and goals.

• Involve your partners in the bid writing process. Do not assume that you know what theywant. Let them be specific about their aims.

• Set up a joint development plan for 3-5 years and try to develop long term relations which willsurvive after the completion of the project. Build personal relations and friendships – systemand funds appear and disappear. Personal links endure.

• Identify different funding opportunities, do not limit yourself to EU / UK funds, ask yourpartners to search for local fundraising opportunities. Provide training in fundraising ifrequired.

• Be aware about cultural differences, do not expect everybody be similar to you in work orsocial practices.

• Prepare to be flexible in your attitudes. Learn from their experiences and be sensitive toparticular country’s environment. Research best practice in terms of equality, diversity andequal opportunities.

• From project inception determine monitoring, evaluation and accountability procedures andmethods. Keep your eyes on the objectives of the project, do not let the partners, consultants,staff or volunteers influence project development without negotiation and communication norsubstitute outcomes. If you feel that some of the outcomes are no longer relevant – discuss

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them with partners and with the funders. Do not change anything without project partnersbeing ‘on-board’ or funder’s approval in writing.

• Appoint a Project Manager. No matter how small is a project there needs to be a person whois responsible for the implementation of the project and it’s day-to-day running. Do not thinkthat it is possible to manage a transnational project on top of everything else you have to copewith. Financial management needs constant monitoring and reporting. Ideally, have a nativespeaker in your team.

• Involve your partners in every stage of the process. Transfer and share the ownership.

• Develop a strong network of consultants, volunteers, decision makers, people in authority whoare able to help with advice, contribute to the programme when partners are in the UK or whoare willing to travel to other countries. Open an account with a travel agency and visa agency.

• Allow plenty of time to organise any event either in the UK or abroad – it takes twice as long tomanage events in transnational projects as it takes in the UK alone.

• As soon as the project begins start thinking what is the next step. Search for fundingopportunities – large or small. It takes between 4 and 12 months for a bid to be approved.

• Be realistic about your organisation’s capacity to deliver the project. Even the smallest of theprojects require a lot of time, energy and expertise. Identify people who can work on theproject and contribute to its implementation.

• Share your experiences with your partners, provide practical training in areas which needexpanding – study visits, observations, discussions, sharing methods, policies, techniques,data-collation, awareness-raising campaign ideas.

• Support your partners in whatever activities they are engaged – a short e-mail a week is betterthan a 100 page document once a year.

• Monitor recruitment and selection practices in the partner organisation. Try to be present atthe interviews if possible – otherwise the project may only be working with members of onefamily and their relations and friends.

• When in your partner country try to build time in to visit as many organisations as possible –you are a UK expert in your field and may be seen to carry a lot of respect and authority. It willhelp your partners to promote their organisation and to gain access to areas otherwise deniedto them. However, think about possible imbalances of power and how these need to beaddressed.

• Learn to step back and let your partners take initiative and responsibility, even if you think thatyou can do it better or quicker. It is part of the process of capacity building and transfer ofskills.

• Involve as many people, organisations and supporters as possible. Russian partners tend tobe rather possessive about international partners and projects. Use every opportunity to buildnetworks and support groups both in the UK and Russia / country of implementation. Useevery link you have to engage people in the process.

Russian Project: Transferable Consultation, empowerment and lobbying strategies.

• Media campaigns, survivors needs assessments, pro-formas for transferable information,Lifestories work.

• In a Russian context the voluntary sector is only 10 years old. It is an emerging voluntarysector; self-help groups are gaining momentum only latterly. They are now strengthening bydeveloping umbrella bodies for awareness raising and lobbying for service provision.

• Utilising our consultation techniques and practice approaches has increased the speed ofresultant benefits to partner projects as perceived by our Russian Partners.

• We shared with our partners all of our pro-forma’s, referral forms; women’s needsassessments, Life stories methodology, and anonymous data collation techniques forLobbying purposes.

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• Other agencies such as the Police, Victim Support, Women’s Aid Federation of England andWales also shared their equivalent information.

• From these the Russian Partners then developed their own information collation anddissemination tools and techniques, fitting their own culture and community needs. They usedthese tools in a variety of ways - some similarly some differently.

• The Russian emerging network of projects needed to develop standardised information in away that was empowering to their women and which could then start to form national lobbyingstatistics from a community development perspective. Information is now being pooled anddisseminated from the Russian Association of Crisis Centres umbrella body. The informationUK partners provided and the DIFD project purchased IT equipment facilitated this process.

• The Lifestories work that the Russian Partners undertook also helped enable their regionaland national media campaigns (press releases, magazines articles etc).

• They chose how to deliver the tasks on the bid and how to best represent themselves andtheir women and children’s needs.

• As soon as the trust was established and the partners realised that we were not going to tellthem how to best deliver their own targets energy, momentum and ownership increased.

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9. Definitions of Community Health

Workshop Facilitators: Elaine Cameron and Jonathan Mathers

The HealthCounts Project and workshop aims

The presenters gave brief details and some initial findings from research in progress - theHealthCounts project. Funded by the Department of Health under its Health InequalitiesResearch Program, HealthCounts aims to find shared ways between communities andprofessionals to measure the main influences on health, illness and well-being. The project isbeing carried out across the Black Country and Shropshire by a multi-disciplinary team fromthe Universities of Birmingham and Wolverhampton2, using a range of methods includingfocus groups and interviews with local community groups and professionals from the statutory,voluntary and community sectors.

The workshop group were presented with a range of topics for discussion:

1) the value and use of people’s perspectives alongside professionals’ in developingunderstanding and knowledge about community health, illness and well-being

2) involvement of local communities in the measurement of community health / healthinfluences; good practice and challenges in designing workable relevant tools andtechniques

3) practicalities: the tools and techniques of consultation and working together. This includesquestions such as are professionals the real ‘hard to reach groups’?

The group was also asked to add any other related issues, which they felt might be a usefultopic to discuss.

1 Background

Why are these issues important? The HealthCounts project is set in a particular policycontext, but touches on many issues with wider policy and practice implications. The need forreductions in health inequalities is now widely recognised, as is the fact that there are a broadrange of determinants of health, illness and well-being. Yet while there is a consequent needto identify appropriate measures and performance indicators that profile these determinants,at present it is not necessarily clear which measures should be used to monitor and assessinfluences on health and health inequality. HealthCounts sees the knowledge and views oflocal communities and effective consultation processes as central to this exercise. Thischimes with parallel concerns across many areas where the involvement of users alongside‘professionals’ is seen as beneficial to the development of policy and practice, though besetwith many challenges.

2 Main issues and priorities discussed by the workshop group

The presenters involved the workshop members first in some of the activities they were usingto tap different groups’ views and ideas in focus groups. Some findings were then given,which included a comparison of concepts of health and well-being expressed by a group ofunemployed people and a group of professionals, and a comparison also of what each groupconsidered to be the main influences on health and well-being.

Following a general discussion of these findings, the workshop group decided to choose issue3) the tools and techniques of consultation, to explore further. The main points discussedincluded:

2 J Parry*, J Mathers*, P Saunders, Health Impact Assessment Research Unit, University of Birmingham & D Cook, W Cameron*, R Wain, RegionalResearch Institute, University of Wolverhampton. * Fieldwork team.

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(i) Current community consultation processesA range of challenges and complexities were discussed, including structural factors relating toagencies and services which typically obstruct or limit effective consultation. These includeddiffering perspectives and working practices, and one-off consultation strategies which do notprovide ongoing mainstream community involvement. Some group members spoke aboutfactors which inhibit effective consultation and which stem from within local communitiesthemselves, such as a lack of motivation. Another member raised ‘over-research and over-consultation fatigue’ which many disadvantaged and minority groups, and communities incertain geographical locations now feel.Several examples of good practice were discussed where local people have been encouragedto become involved. These included work with a range of particular groups such as peoplewith mental health problems, carers and black and minority ethnic groups, and via schemessuch as ‘hours banks’, accreditation in ‘training’ and in peer research, and innovations inprescribing practices and interagency working.

(ii) The importance of information and information exchange as part of the consultationprocess was seen as a priority.

(iii) Reciprocity was seen as an important part of any sustainable and effective involvement andconsultation within communities.

(iv) The central importance of the voluntary and community sector in contributing to thedevelopment of more effective consultation was stressed.

There was a general view among workshop members that despite the many challenges,progress can be made in community consultation and lessons can be learned from innovativeschemes which impact on both structures and agency.

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Summing Up

Phillip Dearden (CIDT)

To try and summarise the richness of the feedback and the discussion that took place during the dayis not possible. I would, however, like to highlight a few key points from the day. I suspect these maywell be personal highlights but forgive me for that.

We set out to explore the challenges and opportunities in community consultation. For all of us whohave worked in this area, we knew that some of the challenges were big ones. Indeed, as we haveshared these together we have perhaps seen exactly how big they can sometime be. It is, however,sometimes somewhat comforting just to know that others, working in different fields of work nationallyand internationally, face similar challenges to ourselves. I know from having spoken to many of youduring the conference that you, like I, found Derrick Anderson’s positive and upbeat description of thework being done locally here in the City of Wolverhampton not just comforting but really inspirational.

At the outset we set out four conference themes:

1. Tools and Techniques2. Experiences3. Lesson Learning4. Outcomes and Achievements

I would like to highlight a few points under these four themes.

1. Tools and Techniques

During the day we have shared a wide variety of tools and techniques. For some the day has been anopportunity to reflect on these tools and techniques, for others, including myself, there has been a lotof learning of new and innovative tools and techniques. Two contrasting geographical examplesillustrate this point. Dr Jo Rowland introduced us to participatory budgeting, being used in Uganda.More locally we have learnt of tools and techniques for involving both children and their parents in theevaluation of Sure Start work in neighbouring Dudley.

2. Experiences

During the day we shared experiences from a number of countries: Brazil, China, Ghana, Jamaica,Russia, Uganda and the UK. We heard about a number of very positive experiences of both North-South and, perhaps more importantly, South-North learning. For me, the many varied experiences oforganisational culture and trans-national capacity building work have illustrated the need to reallybelieve in both training and learning as ways of bringing about change. In addition, the need to reallyunderstand systems and structures was demonstrated by many participants during the day. Likewisethe need to really understand local, regional and even national politics, with both a little and big “P”,was highlighted. Finally the need to carefully unpack the often-thorny issues of power was carefullyverified by a number of presentations and participants.

3. Lesson Learning

A large number of lessons came out of the conference. I will not try and summarise all of them butselect just two key lessons for me. Firstly, the real damage that can so easily be done by whatProfessor Ruth Lister has labelled ‘phoney participation’. Secondly, the time that is required forparticipation and consultation. In the UK it would appear that some of the tools and techniques thatare now commonly used in economically developing countries are simply too expensive in terms of thetime they require. ‘Time is of course money’. On reflection, however, maybe we simply need to findcreative ways around this. If we are to really consult in a meaningful manner we need to develop toolsand techniques that can fit busy lives. In contrast, in development work, I believe we often simplyunder-value the time that is required for poor people to participate. Their time is also money and oftenthey can least afford to give it. We may need to re-evaluate the real costs of consultation andparticipation.

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4. Outcomes and Achievements

Our final theme could be illustrated by a wide number of examples. Again I will limit myself to two keypoints. The first one relates to ‘unexpected’ outcomes. During the day a number of people havestated that ‘the way they have been working’ is more important than any outcomes. The way we workis, however, in itself an important outcome!. Secondly, I have noted that the word ‘respect’ has beenused by both our key speakers and many of the facilitators. By carefully ‘practicing what we preach’,working in a truly participative manner, we can gain ‘respect’ from the communities with whom we areworking. As we have learnt, feeding consultative findings into policy may sometimes be a realchallenge and not as easy at that, but if the communities with whom we are working firstly respect thefindings and our attempts to change policies, this is surely a major achievement in itself. Otherachievements will follow.