The Bickerstaffe Record

The world beyond West Lancashire

Building Democracy Fund

08.07.08 | Comment?

Here’s the Ministry of Justice’s Building Democracy funding competition, opened the other day and closing for applications 26 September.  I’ve submitted an outline for online discussion –  a project I’ve had in my head for a while and discussed with receptive Primarry Care Trust types. 

My outline is below – comments are welcome either here or on the competition site.  As can be seen, I’m ‘realistic’ abut the way people view elected representatives like me and local democracy in general, but positive about what can be done to ‘meld’ the traditions and legitimacy of elected democracy with different forms of participative decision-making.  I’m doing my best, in my own little way, to put into practice some of the theory I drone on about here

 Well, you’ve got to try.


Democracy in Health

Describe your idea. What will you do?

 In our experience people can find it easier to engage in (participative) democratic decision making processes in areas where there is little no potential for conflict with more traditional forms of elected democracy (at local level, councillors, because the latter form tends to defend its own ‘legitimacy’ more or less forcefully, AND because it is used to articulating its opinion, and having that voice heard.

Just such a ‘space’, largely free of elected democratic input (except through Overview and Scrutiny), comes in primary health care. In this ‘space’, public health practitioners tend to be positive in their welcome of ‘newer’ forms of participative democracy, not least since such engagement can be defined as ‘healthy’ in itself.

At the same time, the decentralisation of decision-making which is taking place through ‘Practice-based Commissioning’ in the NHS has created a real opportunity for members of the public to have a voice on what services and initiatives are delivered in their localities, in a way which meets the practical needs of the new ‘purse-holders’ for primary care budgets i.e. groups of GP practices.

Taken together, there is a real opportunity for the development of one or more local social enterprises (with subsequent national roll out)which can employ/retain members of the public to make informed decisions about primary care services, in conjunction with GP practices AND be paid for that service through a small cut from the practices management fee (paid by Primary Care Trusts to the practices).

What will the benefits be?

The key benefit in terms of the ‘democracy building’ will be through the new opportunities created for people to engage in real decision making processes about services. This will not only benefit the health service, but will create a ‘body’ of people in any one locality that is, by dint of the experience, then more able and confident to engage productively with the more traditional forms of elected democracy, whether this be through seeking election to Parish/Town/Borough/City Council or more generally through developing local ‘civic awareness amongst peers about democratic processes. This ‘crossover’ from the relative ‘safety’ of engagement in health towards the more formal and sometimes more difficult-to-engage-with local government democracy will be an explicit objective of the project/social enterprise (as will links into the somewhat more formal democracies emerging thorough Foundation Trust electoral and membership arrangements).

Who will you target?

The group will be diffuse but can be defined by the fatc hat they woud not otherwise engage in democratic processes. Clearly, the initi health focus will be likely bring on boad ‘atypical’ and under-represened groups e.g. disabled people, peopleioth Life Limiting Illnesses, young mothers etc.

Is your idea linked to a particular town or region?

There are one or two areas where it could move quickly because of good relations with the Primary Care Trusts (PCTs), who would need to back the project in conjunction with GP communities. However, we are not prissy about location, and it would be interesting to pursue something along the lines of a tender exercise in which we ask PCTs how they would best support the initiative before selecting the most willing/appropriate.

What kind of assistance would you like from others?

Clearly we need ‘buy in’ from a PCT and its GP community to move this forward. Desirable also would be acknowedgment of the worth of the project from elected councillos in the area.

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