What can we do for the 'rarely reached?'

Last week I took part in a discussion with a group of people who live with dementia. It was the latest of fifty or so similar discussions with people who either do not or cannot participate in traditional civic arenas. We have talked with older people, people with learning difficulties, the blind, stroke survivors, army wives, those living on the lowest incomes and many others. The discussions have been remarkable in all sorts of ways. And, things are emerging - things we can learn from and apply to the way we work.

I work for Wiltshire Council - a progressive forward thinking local authority. I am proud of our commitment to social inclusion and I would not want any other job. But the discussions have shown me that we have a long way to go - a very long way.

It is easy to sound a bit high and mighty about all this but I am not, really not. What we have learned turns our understanding on its head. These people are not hard to reach, no way - these people find it hard to reach us. Sad but true. We are quick to label people according to their needs and to direct them towards functional interventions with structural interfaces. These approaches often dehumanise our responses, compartmentalise and fragment our interventions and more worryingly they often exacerbate the very concerns we are trying to remove.

And the sad thing about all this is that the professionals we have worked with all share a real dedication and commitment to their work - often going the extra mile for their clients. And therein lies the root. The problem is not a lack of commitment or compassion, the problem is fundamentally systematic.

And maybe the answer to this is to design people led, situational services. Services that join up around a person and their personal situations and circumstances. Services that are designed with and by the people who need them.

At the dementia workshop people spoke about the fear of diagnosis and the feeling of terror when those fears were confirmed. This is the point where people are at a low point, depressed, confused, anxious and adrift. And this is when public services first come into sharp focus. These people suddenly need advice, support, help. Help with employment issues, benefits, treatments, transport, care, housing and much more. The advice is out there on the web, from customer services teams, in leaflets, from practitioners. It is all there, funded and waiting for the contact. But what seems thorough, comprehensive and accessible to the public sector often seems impenetrable, inaccessible and fragmented to those who seek our help. Each service does its bit, has its web page and leaflet, has its frontline staff ready and waiting. But it just does not join up - it lacks integration and coordination. The people with dementia talked of returning from the GP with a diagnosis and no clue about what happens next. Surely, that is a predictable service pathway, surely that is the point where services should be integrated - at that critical initial access point.

A comprehensive information pack for those diagnosed with dementia would be a simple step that would make a very big difference. This is just one simple insight - many, many more have emerged from the Wiltshire Voices social inclusion programme. Perhaps it is because we still view people as service clients that such obvious things are overlooked. Perhaps it is time to change our viewpoint and make these discussions part of the service design process from the very start.

So, let's start now.

The community issues system explained

In Wiltshire, we needed an easy way for the people to refer issues to their local area board. These would have to be community-wide issues not personal issues or straightforward service requests, but issues that affect the wider community. So we created a web based tool called the Community Issues System (CIS).

The system allows people to submit any local issue to the area board using a simple online form. The form comes into a community area manager who does a basic triage - weeding out issues that can be fed into the Council's usual customer channels. Those that get through this first level sift are logged. Logging places the issue online and notifies the originator that the area board is 'on the case.'

The next step is to notify the local ward councillor and the local parish council. Often this leads to a local resolution - parish councils and ward councillors can usually identify required actions and follow the matter through without further intervention. However, in many cases local ward councillors may need support from council officers or partner agencies. The community area manager will chase responses from the relevant officers and report them back by updating the online issue. Each time information is added to the issue the originator, local ward member and parish council are all notified. This means progress can be tracked online and everyone is kept up to date.

In some cases a simple solution is not available, or there are differences of opinion about the right course of action. In such cases, 'round tables' are convened bringing together the issue originator, local councillor, parish council, other stakeholders and any professionals involved. The object of this meeting is to identify practical compromises, common ground and areas of consensus. Usually, a way forward will emerge but sometimes not. If not, the Area Board can either close the issue and explain the reason why action is simply not possible; set up a local inquiry or task group or refer the matter for decision by area board. Actually, these latter options are relatively rare.

Over 2000 issues have been referred to the area boards using the system over the last 2 years and around 78 % have been resolved.

It is fair to say that not all ward councillors have welcomed the system. Some feel that it is the members' role to deal with all issues personally - and that is fine, the system can 'hand over' issues to the local councillor. Other councillors have chosen to use the system to help manage their own case work - ensuring that a response is obtained from the right officer. The system is flexible and can be used in a way that best suits each councillor.

The system was developed in-house to meet our own requirements and it works pretty well. It is evolving and being used increasingly as a mainstream reporting system for community requests - for local highway projects, speed watch schemes, road safety measures and payback projects. It will develop further and it may be necessary to redesign it at some stage - maybe a mobile app, maybe further social media integration.

The community issue system is a tool that can work for local councillors - check out some of the current issues online and see for yourself.

Empathy action

Wiltshire Voices
Empathy in action

Toward the end of his life, the great American philosopher Richard Rorty reflected on a lifetime of academic enquiry. His conclusion was simple - "It is through sentiment and sympathy, not through rationality and universalistic moral discourse, that democratic advances take place." This statement had a shattering effect on political philosophers. Rorty was turning his back on Academe and the Enlightenment by suggesting (ironically) that philosophy was of little relevance to social progress and politics. Here was the banal pragmatism of the plebiscite - social and political progress decoupled from rationality, born of the momentary expedient and swept along by ever changing tides of public opinion.

I always rather liked the notion that sentiment and sympathy should replace the rational and scientific as the rudder that guides society. But how do we make room for sentiment, empathy and sympathy in an empirical world - a world where what matters is the stuff we can count, measure, codify, meta-analyse, evaluate and interpret in a logical, rational, scientific quest for irrefutable truths? I assert the case for Rorty because I believe that democratic progress depends upon empathy - the identification of the self with the experience of the other. I believe it is this sense of identification that engenders sentiment and that in turn elicits our sympathy and motivates our response - private, social and political. For most of us, this does not entail a deconstruction of a moral dilemma, it simply leads to irrational but highly contextualised emotional responses. I might want to help, I might want to fight - the point is I want do something, change something.

The riots of 2011 would appear to vindicate Rorty's views. When empathy is completely absent the void is quickly filled with antipathy, intolerance and hatred - often expressed through violence. So, perhaps we should be trying to bring people into situations where empathy can be generated - maybe we can start to effect social and democratic progress through some form of 'empathy action.'

How can we generate empathy ? For Rorty, great literature could do it. For me it takes a bit more. I have been developing a methodology - a non empirical mechanism for generating empathy, sympathy and compassion. It starts from the recognition of difference, the identification of the other. Keeping it simple - I am not blind and I do not know what it like to be blind. I don't think about it much, it does not affect me. This is true of many, but not all. Those affected, their families, those who provide services - all have greater empathy, sympathy, knowledge and understanding. My methodology brings these people together to share and capture their insights and experiences. This is not a needs analysis because it views the participants as assets - they have the knowledge, wisdom, insight. We explore the individual narratives, highlighting the good things - the positives as well as the challenges. These conversations are captured, on tape, in words - verbatim. By repeating the conversations with different participants common themes and shared experiences emerge. Not only that - I change too. My empathy and understanding increases as the process unfolds. By the end of the sessions a set of common themes have emerged. The themes are turned into questions that are then used by a film crew to undertake documentary interviews with participants drawn from the focus group.

The films feature histories, experiences, narratives recorded in everyday settings - often powerful, often very moving. The skill of the film maker is to let the people tell their own stories, in their own words, in their own places. The films by themselves have an impact - they stick with you. The experience cannot be unlearned. The films are also used to share the empathy - on tv, in schools, with service providers, with decision makers, with politicians.

The films are powerful, but when used as part of a facilitated empathy action workshop they become an instrument of social change. By using challenging quotes from the film written on prompt cards participants are invited to reflect and discuss how the issue may be turned into a positive outcome - the 'win-sum' game. The workshop leads to positive action and it is also a powerful learning experience for everyone involved.

I am lucky to work with an extraordinary team of people in Wiltshire. The Council, elected members, partner agencies, local people and a fantastic film crew. Together we are delivering 12 films featuring people who either do not or cannot engage in civic life through traditional structures. Often these people are misrepresented and marginalised. We are working with: army wives, gypsy and travelling families, stroke survivors, people with learning difficulties, unemployed youngsters, polish migrants, older people living in residential care, people living with dementia, blind and partially sighted people, rural families on low incomes, boaters and residents living on a social housing estate in Salisbury.

The first film is in the can and it is truly something very special - something that far exceeds even our most optimistic of expectations. I'll post the link as soon as it is online and you can judge for yourself.

Of course, it will take more than a few films to change the world. But I remain convinced that this is an idea that can make a difference. Maybe, somewhere out there in the afterlife, old Rorty is grinning at my naivety.