Public Service

We’ve got ourselves into one of those subjects where the moment people stop listening to each other… debate becomes useless.

A key aspect of trust and decision-making in public services is the ability to engage effectively with communities.

This incident has raised questions about trust and decision-making in public services, highlighting the need for better communication.

Trust and decision-making in public services can be affected by various factors, including community engagement.

The dreadful circumstances surrounding the death of Henry Nowak has reignited a familiar argument…

The intersection of trust and decision-making in public services is vital for building effective relationships.

…when institutions appear to make poor decisions, are they; acting out of racial prejudice, unconscious bias, fear of appearing prejudiced, poor training, group think or simple incompetence?

The answer is often much more complicated.

Understanding the link between trust and decision-making in public services is essential for reform.

Most public services operate under intense scrutiny around race and discrimination.

Trust and decision-making in public services is critical for the effectiveness of these institutions.

It is crucial to address trust and decision-making in public services to improve outcomes.

Rather than fear, we should promote trust and decision-making in public services.

That scrutiny is justified.

To foster improvement, we need to examine trust and decision-making in public services closely.

The Macpherson Report fundamentally changed the way public institutions think about race. The concept of ‘institutional racism’ entered the lexicon of life.

Trust and decision-making in public services is pivotal for overcoming systemic challenges.

Since, organisations have invested enormous effort into preventing discriminatory behaviour, and…

… a well researched paradox has emerged.

Staff become so concerned about avoiding accusations of prejudice that they can become hesitant, over-cautious, or distort their decision-making.

They stop asking straightforward questions for fear of how they might be interpreted. That is not racism, but…

…neither is it good decision-making.

NHS maternity services have repeatedly reported poorer outcomes for some ethnic minority women. Reviews continue to shown differences in maternal mortality, stillbirth rates and access.

The danger is; the debate divides into two camps…

One side says the explanation is racism. The other says racism has nothing to do with it.

Reality is more nuanced.

Almost 1 in 3 nurses, midwives and health visitors combined, are from minority, ethnic backgrounds.

The allegation that maternity services are racist doesn’t do justice to the issue being more complicated.

The major maternity reviews all point to…

poor listening,
communication failures,
staffing shortages,
inadequate escalation,
organisational culture,
deprivation
social factors,
and in some cases stereotyping or bias.

The uncomfortable truth is that maternity services sometimes fail women of all backgrounds

The word ‘racism’ carries enormous moral weight. If every disparity is automatically described as racism, people stop engaging honestly.

Equally, if every suggestion of racial disadvantage is dismissed as ‘playing the race card’, genuine problems are ignored.

We must engage with the concept of trust and decision-making in public services for effective governance.

Neither approach helps.

The more useful question is; what exactly happened and why?

The narrative surrounding trust and decision-making in public services must evolve for progress.

Not; who can we blame?

However, the ‘what’ requires evidence.

Many organisations focus on intentions. What matters is outcomes.

A Trust can run hundreds of diversity workshops and still have poor maternity outcomes, at three o’clock in the morning in a birthing unit.

A police force can produce thousands of pages of equality policies but officers arriving at a rowdy and confusing crime scene can still make bad operational decisions.

Culture is not written in policies. Culture comes from the environment in which the activity takes place.

The answer might be in something we have in abundance. Data… used it to understand variation and foretell it.

If maternity outcomes differ between groups, the first question should be; ‘What does the data tell us?’

Not… ‘what narrative do we already believe?’

There’s a phenomenon called; the Single-Cause Fallacy. Complex systems rarely fail for a single reason, yet…

… we have a strong preference for simple explanations…

… racism… funding…. management… technology… resources.

The reality is usually several interacting causes.

Good data tells us whether problems arise; from access, deprivation, staffing, communication, geography or bias.

Without data, everyone retreats into ideology, and…

… the discussion becomes relevant to both policing and healthcare…

Engaging communities is critical for trust and decision-making in public services.

We need transparency to enhance trust and decision-making in public services.

As explored in Itself, complex systems rarely fail for one reason alone and simplistic explanations often obscure the real causes.

Building effective relationships requires trust and decision-making in public services.

…it’s about trust.

If minority communities do not trust institutions, they’re less likely to engage.

If staff feel they’ll be accused of prejudice whenever something goes wrong, they become defensive and risk-averse.

Both sides lose trust simultaneously, and that’s the most dangerous outcome.

Five principles seem applicable to both policing and the NHS.

Follow evidence, not assumptions.

Every incident should be examined on its own facts.

Focus on outcomes.

Measure what happens, not merely what policies exist.

This principle reflects the argument made in From “Hard to Evidence” to “Publicly Measurable”, where outcomes matter more than intentions.

Improve cultural competence without ideological rigidity.

Understanding communities is different from stereotyping them.

Use data relentlessly.

Identify where disparities exist and investigate why.

Rebuild trust through transparency.

Explain decisions openly. Admit mistakes quickly.

Trust and openness are recurring themes in Say so, where confidence in organisations depends on honesty, communication and accountability.

The lesson from maternity services may be that inequalities are real, but the causes are rarely simple.

The lesson from policing may be that fear of appearing prejudiced can sometimes distort judgement just as surely as prejudice itself.

The goal should not be to prove racism exists everywhere, nor to prove it exists nowhere.

The goal is to create institutions that are;

fair enough,
confident enough and
transparent enough…

We must focus on the role of trust and decision-making in public services if we are to progress.

… to treat every individual as an individual…

… and that is one of the hardest management tasks in public service.

Ultimately, trust and decision-making in public services are interconnected, influencing how communities perceive services.

As discussed in Nothing moves, progress depends on evidence, leadership and the confidence to make sound decisions rather than merely appearing to make the right ones.

News and Comment from Roy Lilley
Contact Roy – please use this e-address roy.lilley@nhsmanagers.net
Reproduced at thetrainingnet.com by kind permission of Roy Lilley.