EXERCISE 3

STATEMENTS ABOUT PARTICIPATION

‘The people have the right and duty to participate individually and collectively in the planning and implementation of their health care.’
Source: 1978 World Health Organisation (WHO) Declaration of Alma Ata

‘For equity policy to be effective we need to encourage people to participate in every stage of the policymaking process.’

‘…plans and actions should be based on what people feel are their own needs, not on solutions imposed from outside.’
Source: WHO: The Concepts and Principles of Equity and Health, 1990

‘The public should have the chance to help identify the key health issues affecting them and the action needed to promote health’
Source: Scottish Office Dept. of Health – Working Together for a Healthier Scotland, 1998

‘Under the banner of social inclusion, the Government is introducing a range of measures which will increase choice and participation in Scottish life for people who are currently marginalised’
Source: Scottish Office Dept. of Health – Towards a Healthier Scotland, 1999

‘…we are providing an opportunity for a wide range of people and organisations to contribute to the development of this Plan and to influence the delivery of policy at a local level’
Source: Scottish Executive – Our National Health -A plan for action, a plan for change, 2000

We heard from the citizens of Scotland about the importance of communication, participation, being listened to and having the opportunity to play a stronger part within the NHS…That vision is based on a shift from the current position where we see people as “patients” or “service users”, to a new ethos for health in Scotland that sees the Scottish people and the staff of the NHS as partners, or co-owners, in the NHS.
Source: Scottish Government, 2007; Better Health, Better Care - Action Plan

How can the public take part?

The Scottish Government wants you to:

• get involved in health service planning and development
• contribute to NHS decision-making on services and how they are provided
• receive information about health services and your own treatment and care. The Participation Standard will measure how well NHS Boards are doing all this and will help improve services for everyone. Each Board’s performance against the Standard will be available for the public to see.

How will this change things?

Involving the public in healthcare decisions will help ensure that health services better meet their individual needs and preferences.
Source: A Participation Standard for the NHS in Scotland: Scottish Health Council: 2010

EXERCISE 3

FEELING POWERLESS

Think of a situation where you have felt completely powerless. Try to remember the exact moment when you felt this. Then answer the following questions:

1.    Where and when did this happen?

2.    What happened? What was said or done?

3.    Can you say exactly how you felt at the time?

4.    What would you have liked to have said at the time?

5.    Why did you have such little power?

6.    Why did someone else have so much power?

EXERCISE 4

DIFFERENT DIMENSIONS OF POWER
Steven Lukes looked at the different ways people had tried to understand power in Power - A Radical View (1974). (Many more recent writers have discussed how we define power but Lukes remains the primary text of what they debate).

To see more discussion click here.

Summary

A view he called One Dimensional (Visible) suggests that we can see which people have more power in society, by observing groups making decisions in public - in committees, or in health board meetings, or in parliament.  Here we see whose views carry more weight and get passed, despite opposing views being present. The conflict or clash of opinions shows us where power is at work.  It is visible.

The view he called Two Dimensional (Hidden) suggested it was more complicated than this and that sometimes it was the way that things did not get dealt with or never reached the agenda of these important meetings. That it was the ability of powerful groups to keep things off the agenda, so they were not so visible, which explained real power.

Stephen Lukes felt that as well as these two types of power operating, there was a third that was even more invisible and complicated. That less powerful people begin to believe that they are not as valuable or worthy as the more powerful, so they do not even try to engage in conflict or put their ideas on the agenda or protest. That they do not deserve a place at the table. They internalise this view of themselves, so the more powerful groups don’t even have to do anything to keep their position - they don’t have to argue publicly with anyone; they don’t even have to bother to keep things off the agenda. The silence of the less powerful is a kind of passive consent and supports their position. This he called the Three Dimensional view of power (Wasted).

Drawing from your own experiences and ideas, think of examples of each of the following types of power:

One dimensional power (Visible)
When we can see power in action.  We can observe conflict between groups or interests.

Two dimensional power (Hidden)
When you cannot see any obvious conflict but things are not dealt with – less powerful groups’ issues don’t reach the agenda. 

Three dimensional power (Wasted)
When less powerful people have internalised the idea that they are less worthy, less important.

EXERCISE 5

WHY PEOPLE DON’T GET INVOLVED ……

• Work commitments
• Childcare responsibilities
• Feeling that the issue doesn’t concern them
• Feeling that they daren’t go along on their own
• Feeling that they might be asked to do more than they want
• A feeling that cliques would be running things
• Lack of information – poor marketing/publicity
• A feeling that decisions have already been made, so there is no point in attending
• Inappropriate venue(s)
• Transport
• Apathy – why should they get involved when such a small group can’t do or change anything
• No spare time
• Poor health
• Social exclusion
• Powerlessness and low self-esteem
• Lack of confidence in ‘the system’
• Lack of interest

Adapted from ‘Building Healthy Communities’ – a resource pack for multi- agency health improvement, North Cumbria Health Development Unit.

EXERCISE 5

LEVELS OF PARTICIPATION

Manipulation:
Creating an illusion of participation resulting in disempowerment.

Information:
Telling people what is planned.

Consultation:
Offering options and listening to feedback.

Deciding together:
Encouraging others to provide additional ideas and join in deciding the best way forward.

Acting together:
Deciding together and forming partnerships to act. Supporting independent community interests: Helping others do what they want.

Taken from ‘Towards Caring Communities’ a Community Development and Community Care Training Pack written by Barr, Drysdale and Henderson in 1997. Joseph Rowntree Foundation/Pavilion Publishing.

EXERCISE 5

LEVELS OF PARTICIPATION:

Example 1: A young homeless person is being allocated their first tenancy. When they go to view the flat they decide that it’s not a great area and aren’t sure they want to accept it. The housing officer reminds them “You don’t know what your next offer will be and it might be worse than this one- but it is of course your choice”. The young person feels forced in to taking the flat.

Example 2: The council has had to make a significant amount of budget cuts and has issued a document called “Tough Choices” so that people can see what changes are being brought in to save money.

Example 3: A new leaflet is being put together by the local health project. They have three different layouts for the leaflet and are interested in finding out which one their service users think is best. They hold a meeting and invite service users along to pick their favourite. It’s likely that the most popular leaflet will be printed.

Example 4: Funding has been awarded to make improvements to a local park. The Greenspace Officer is really keen to hear the views of the park users. She sets up a board in the local community centre to encourage people to provide ideas for what can be done to the park. A few weeks later, when she has had lots of ideas, she invites local people to come for a walk round the park to discuss what ideas are best.

Example 5: A local youth action organisation wants to develop a Streetwork project. They think it would be good for project workers to go out and speak to young people hanging about the streets. They want to talk to them about anti-social behaviour, alcohol and drug abuse. To do this the project organises a discussion meeting and invites representatives from other local organisations such as the police, Tenant and Resident Associations, neighbourhood response team, drug and alcohol projects and environmental wardens. The other organisations agree this would be a good idea and are keen to be involved. The organisations form a partnership to start planning the project

Example 6: A group of local women want to start a local support group for young parents. Their local health visitor advises them to contact the Voluntary Sector Gateway. They speak to an advisor who gives them guidance about becoming a constituted group and how to apply for funding for the group

PARTICIPATION AND POWER

1. What I got out of today’s session.
(Interesting information, anything new learned, enjoyed the session etc.)

2. Things I would like to know more about.
(Questions I have in my mind. Things I don’t quite understand.)

3. Is there anything you learned today that has changed your attitude towards your own health (Please give an example if you did)

4. What I put into today’s session.
(How I feel I contributed - listening well, supporting, offering my views etc.)

5. Power and Participation
In this unit you looked at different levels of power and participation in society. From the handout material you were given can you identify two different levels of participation and give a practical example from your own experience.

Example 1

Example 2