1. Give out the session notes from Unit 11 and the programme for Unit 12.

2. Remind people of the discussions throughout the course about power and democracy - how much or how little say we have over the decisions which affect our health. One of the problems is the lack of knowledge we have about many of our major institutions.  It is often hard to find more out about them and how democratic they are.

In this unit we will be trying to understand how they operate and how much influence we have over them.



1. The changes in Public Services that occurred during the 80s and 90s relied on the idea of the competitiveness of ‘market forces’ to provide efficient services. It is based on the idea of people as consumers, who can influence what is provided because they choose to buy what they want and so influence what is provided. Our views as consumers are usually fed back through individual complaints or individual questionnaires. More recently the idea of public participation and community engagement in public service provision has come more to the fore with public sector organisations increasingly expected to work together and with communities to deliver services.

This has led to a greater acknowledgement by public bodies that we can influence what goes on through our role as citizens.  Our views as citizens can be expressed by various means e.g. through the electoral system or by other forms of collective involvement and action. In this exercise we are going to look at different ideas about ways of influencing services.

2. Divide the group into two smaller groups.  Give one group Handout A and the other group Handout B. Both groups should read the handouts, answer the questions and make notes to feed back to the main group.

3. The big group share the ideas about the points made in each extract.

Invite participants also to contribute their own experiences of being consulted about or engaged in decisions about Public Services.


  • What level of engagement have people experienced?
  • Are there differences between patient/user involvement and community engagement, and if so what are they?
  • In what way could community development approaches contribute to greater patient/user involvement or community engagement?



1. As citizens and tax payers, how much control do we have over our public services? How much say do we have in the way services are planned and organised? First of all we have to know who is actually responsible for making decisions, how these decisions are made and what other factors influence this decision-making.

2. Split the participants into two smaller groups. Give one group Handout C and the other Handout D. Ask each group to answer the questions as far as they can and encourage them to ‘look upstream’ as much as possible in terms of looking at what influences there are on decision making in the health and public services.

3. Bring the groups back together and discuss their answers – does anyone have experience (both good and bad) of trying to influence decision making? If we wanted to have a say about any public services who would we go to? Where could we make our voice heard?

Can we attend the meetings where decisions are made about these services, to see what happens? Do we even know of all the organisations that may influence decisions about our health and well-being?

There are a lot of organisations that have responsibility for services or decisions that affect our lives and our health and it can seem quite confusing. However, there are many good examples of groups influencing decisions and services through using a community development approach and in the next exercise we will be looking at one such example.


CASE STUDY (30 minutes)

1. Give out Handout E, go through this with the group and draw out the following discussion points:

  • Think back to the key elements of community development: personal empowerment; positive action; community organisation; influence over policies/services – were these achieved in this example and if so, in what way?


FACE TO FACE (90 minutes)

Note – your participants may want to use this exercise as part of their community research projects. If so, you may need to structure the session differently, invite different people, etc. Alternatively, you may want to organise a trip to the Scottish Parliament, your local Council, etc. so that your participants get a chance to see how the democratic processes actually work.


1. This exercise involves inviting two guests from different organisations along to speak for 10 minutes each on what they do and how the community could influence their decision-making, followed by about

15 minutes of questions from the group. The guests should be from organisations that have an impact on health in the local area (e.g. the Community Health Partnership, the Community Planning Partnership, Health Board, local Council, Housing Association, etc.) and they should preferably be people who have some decision-making power (e.g. Chief Executive, Manager, Elected Member, Chairperson, etc.).


2. Once you know who is coming, brief the group on who they are and where they fit within the local structures.

3. Give the group 15 minutes to prepare 5 or 6 questions to ask each guest. Remind the group of the key things they’re looking for e.g. how communities can influence the decision making in the organisation, what level of public/community involvement exists, etc. Use Handout

E from Unit 5 if necessary to remind the group about different levels of participation. They may want to use this as a checklist to refer to during the exercise.

4. Decide on who is going to ask what. Try to get everyone to participate in some way – to introduce the group, ask questions, make coffee, etc. It may help to write the questions up on a flipchart to make sure they’re remembered once the discussion starts.


5. During the session, try to keep to time and give each person the same amount of time for speaking and for answering questions.


6. After the guests have left, ask the group for feedback. Use the following points to aid discussion.

  • Were the means for community influence clear in each case?
  • Were there differences and if so what were they?
  • What terminology was used – e.g. patient involvement, user involvement, public involvement, community engagement, community development?
  • What does this tell us about the organisation?
  • Was there anything else you’d like to have asked?



1. If there is enough time left in the session you may want to ask the groups for a quick progress report at this stage.


RECAP AND SUMMARY (15 minutes)

1. Go over the main points of the session referring to the flipchart notes if necessary:

  • Participation and citizenship
  • Democracy and Decision Making
  • Face to Face

2. Give out Learning Log for this unit and allow participants time to fill it in before they leave