user involvement

Published: 24/04/2003, Volume II3, No. 5825 Page 28 29

Involving service users in the selection of managers can be challenging, particularly in the case of those with learning disabilities.

But it can also be valuable, as Alison Last reveals

How can service users be involved in the appointment of managers who will shape services for years to come? In July 2002, the director/lead officer for learning disabilities services at South Birmingham primary care trust announced that she would be leaving. Replacing her was a challenge for the PCT and Birmingham social services. The two organisations had made some progress involving service users and carers in planning and delivering services.

However, this was a chance to act on the strong message of the Department of Health service users' advisory group report, Nothing About Us Without Us, to involve users when recruiting leaders of learning disability services.

1From the beginning, there were signs that not everyone fully understood how complex the process of involving people with learning disabilities would be. Time constraints meant that a job description and personal specification were agreed between health and social services; the job was advertised and candidates shortlisted without involvement of service users or carers.

Three user groups and three carer groups were contacted and each was asked to nominate a representative for an interview panel. The panel was asked to advise an 'executive panel' (the most senior people from the Birmingham PCT and social services department) before a final decision was made about who was appointed. In the event, we ended up with two service users and four carer representatives.

Two weeks before the interviews, the panel was told to plan for its part of the process. Everyone felt the sudden pressure, but none more so than the people with learning disabilities and their support workers, who all needed time to prepare.

The panel met for half a day for recruitment training. It was supported by two facilitators: the clinical governance lead and a radiographer, who is also a clinical governance facilitator. The users talked about the job description and personal specification. They then decided what questions they wanted to ask the candidates and how they could score them.

The service users had some skills in verbal communication, reading, writing and numbers and helped decide the five questions to be asked.

It was agreed that a score of zero to 10 would be given for each answer. This did not follow previous trust approaches, but was best suited to the mixed abilities of the group.

During the training the panel set rules about confidentiality, respect, listening, timekeeping and presentation.

The PCT chief executive said no-one would be appointed if the user and carer panel considered them inappropriate. This made clear to users and carers that their views carried weight.

Four days before the interviews, copies of the application forms and CVs were passed to the facilitators and hand-delivered to users and carers.

With so little time to read and understand five application forms and CVs, the panel and its support mechanisms had to work hard.

The facilitators wrote a letter to go with the packs to explain the importance of the information and that the panel should not talk about it with others.

The facilitators included a copy of the questions to ask candidates so they could all be reminded of them and, in some cases, so they could rehearse asking them.

The person delivering the packs spent time with the support workers so they could then take as many sessions/hours as each service user needed to understand the information.

On the day of the interview, the facilitator reminded the panel of its ground rules. During all the interviews, one of the facilitators remained in the room while the second facilitator made sure that candidates were met on arrival. They also took a photograph of each candidate as they arrived, to help the panel later when it discussed the candidates' answers and scores.

In the interview room, the panel welcomed each candidate and followed the agreed format. A support worker helped one of the service users throughout all the interviews. At the end of each interview, the panel members did not discuss their thoughts, but wrote down their own score out of 10 for each question.

After all the interviews were finished the facilitator asked each person to say how they scored each question. They then talked about why they had given that score. No-one chose to change their scores - each panel member held a healthy respect for the views of the others, regardless of disability or previous interview experience. An overall score for each candidate was calculated by adding up all the individual scores.

When the panel members had finished talking, they were asked: 'If this person had been the only person you interviewed, do you think you would ask the trust to re-advertise the post?' The answers were always unanimous and were noted down for reference.

Much later, before any final decisions were made, one of the facilitators gave a report from the user and carer panel to the executive panel.The report directly quoted the words of the user and carer panel.They used words such as 'warm' and 'cold' in describing the candidates' styles.The facilitator also gave comment on how actively the users had been engaged, based on observations.This provided a useful 'fly on the wall' insight to the executive panel.

At the end of the report, the immediate, and very satisfying, response from the executives was 'we could have saved ourselves a lot of time and left it all to the users and carers'.The service users and carers had reached the same conclusions as the executives.

The most obvious message from our experience is that people with learning disabilities and their carers showed they were able to reach a unanimous decision about who they believed was best for the job.Neither lack of experience nor disability got in the way of the process, with decisions based on years of life experiences and of receiving (or not) services from health and/or social services.

Most importantly, if people with learning disabilities are to be fully involved there needs to be understanding and support at the most senior level.

Recruitment is not just about interviews. Some people with more severe learning disabilities may not be able to be involved in the face-to-face interviews, but can be involved in deciding the skills the job calls for and the personal qualities they require of the person appointed. People therefore need to be involved in the development of job descriptions, personal specifications, advertisements and shortlists, as well as being involved when the final decision is made.

Real partnership working is what users and carers want and this can only be achieved with full involvement.This model of user and carer involvement in the recruitment of staff has been very helpful, but it is just a start, not the complete answer.

For the facilitators, supporting the process was demanding but rewarding. It was striking to watch the user and carer panel at work unconstrained by professional and political boundaries and language and it is something all recruiting managers should see.

Basic training is essential.

Without it, a fair process cannot be guaranteed.Without additional support of facilitators and direct support workers, panel members could not have been really involved and made an informed choice.Working to tight deadlines and schedules is unrealistic when involving people with learning disabilities and is to be avoided.

Involving people with learning disabilities is not an easy option, but one that we are committed to.

Having seen it in practice, the PCT chair and chief executive believe service users should be involved in all recruitment from now on. It involves a lot of effort, but it is well worth it.

The questions agreed on were:

1.Could you give a summary of your professional background and experience?

2.How will you make sure you talk to service users and carers in future developments of the service?

3.How would you make sure that people with learning disabilities, with many different needs and backgrounds, are able to access health services?

4.What are the three main issues for people with learning disabilities in Birmingham?

5.What do you think Birmingham learning disabilities service will look like in five years' time?

Key points

Involving service users in the selection of a manager for learning disabilities services proved successful when implemented by a primary care trust with the use of facilitators and special training.

The PCT chief executive made it clear that no-one would be appointed if the user and carer panel considered them inappropriate.

The users were involved in drawing up five questions for each of the candidates.

On the basis of their answers, each candidate was scored by the service users.

The users, carers and managers were unanimous in their choice of candidate.


1Department of Health.

Nothing about us without us. Learning disability service users' advisory group, 2001.

Alison Last is clinical governance lead and manager of allied health professions, learning disabilities directorate, South Birmingham primary care trust.