Engagement in the Digital Age.

Social Media is a massive opportunity for the NHS. An opportunity to engage with Patients and Public on a scale and to a depth never before possible. It’s easily the best engagement tool to arrive since the printing press. So isn’t it time we started making good use of it?

Generally, in NHS organisations, the initial responsibility for ‘coping with’ Social Media falls to the communications department. The approach taken is usually defensive; all about Reputation Management and Public Relations. The communication is one-way. It’s about telling people what you want them to think.

What a waste!  When the obvious potential lies in the opportunity to have conversations with Patients, Members and Communities.

In my opinion, the way to get digital strategies right is for them to be led by someone who understands and believes in the concepts of Involvement and Engagement. Traditional communications should step aside. The curtain is coming down,…it’s time to get off the stage.

Valuable conversations take place at the borderline of what we understand, with people who are different to ourselves.” Theodore Zeldin

Brands like ours can no longer be sustained by old style one-way communications. Spin does more reputational harm than good. Brands now depend upon what consumers are saying to each other.

Conversations about healthcare will happen, whether we like it or not, with or without input from the NHS. These conversations have always existed, even before the internet age, but now Social Media gives us the opportunity to be part of those discussions, to respond quickly to urgent concerns, and always know what our patients think about services.

… and before we get all the usual, feeble excuses, 21st century digital engagement doesn’t have to be labour intensive, if you let people talk to each other instead of thinking that you need to ‘control’ everything, then the response ratio could be 1 to 30 perhaps, not 1 to 1. The secret, if there is one, is to take part, not take over.

The Five Year Forward View challenges us to “raise the game on health technology – radically improving patients’ experience of interacting with the NHS“. Now is the time to take that leap forward. To boldy go where no Trust has gone before…


In keeping with the spirit of Engagement, this short piece is intended to be a conversation starter. Therefore I would very much welcome comments. Whether you agree with the points I have raised or not, please chip in.

Any argument needs opposition, to test, to challenge, to probe for weaknesses. The resulting proposition is stronger for it, and in the end all sides win.

by Paul Radin, Notts FT Involvement Volunteer.
Twitter: @paul_radin

Breaking Boundaries, Evidence, Healthcare, Hope, Inequalities, Involve, Involve Conference, Involvement, Lived Experience, Mental Health, MindTech, NHS, NIHR, Parity, Partnership, Patient Leaders, Peer, PPI, Research

Involvement, Fast & Slow.

Involvement, Fast & Slow.
Should I stay or should I go?

by Paul Radin

On returning home from this year’s NIHR Involve Conference in Birmingham, I had the feeling that I’d learnt something important, but couldn’t quite work out what.  Later I realised that my reserves of hope had been topped-up.  I believe in Involvement, and now I know that I’m far from being the only one.

Recently I’ve been part of a series of conversations with a friend about the relative merits and drawbacks of being Involved.  At the end of these discussions we both made decisions.  My friend decided to walk away; I decided to stick at it.  I’ll attempt to explain my decision.

A People Business !

These are not easy times for Involvement in healthcare; the purse strings are tight, and Involvement is an easy target for those who don’t really understand it well. However, the good news far outweighs the bad, in my view, and it all stems from the people Involved.

I’m impressed by the quantity and quality of people all pulling in the same direction. The direction of fairness, of rightness, of excellence, of innovation, of Involvement.

Look at the number of people doing research into Involvement.  Look at the number of people trying to work from a Peer perspective; as Researchers, as Support Workers, as Patient Leaders.  Look at the number of people who have emerged from suffering to become experts, publishing major works and earning PHDs, and look at the number of people who have chosen to help us by directing their own careers into progressing Involvement because they know it’s the right thing to do.

No-one is saying that we are fine as we are, and that no further progress is necessary.  Everyone who attended the Involve Conference wants to move Involvement further on. In that respect it is a movement; a movement for change.

Inequalities !

Of course, the way individuals are experiencing this process of change has great variation.  At one end of the spectrum there are people doing very nicely in well paid, high status jobs with interesting work to do and interesting people to talk to.   Conversely, some of us are just barely clinging on to the hope that maybe the struggle of life will seem worthwhile if we get to use our experiences & insights to make the world a better place for other ‘people like us’.

“Suffering ceases to be suffering at the moment it finds a meaning”
Viktor Frankl

Is it any wonder that some of us feel a greater sense of urgency about the pace of progress?  This can at times tip over into anger, frustration, disillusionment.  Why, we ask, are things not the way they should be?

Is it also any wonder that some of us get into a ‘them & us’ mind-set where our suspicious minds pick up on all those subtle signs that we may be playing in a ‘rigged’ game.

How hard it is, for each to see the others point of view.

The whole system is a compromise, and always will be. It’s a compromise between the people who can see how things should be & could be, and between those people who just don’t get it yet.

There are also people who got it once but lost their way. Involvement staff can forget who they are really supposed to be working for. Involvement may have started as a nice idea from a few creative & pushy service-users, but it has now grown into a mini-industry; a sub-section of the healthcare sector. It has budgets, and HR policies, and risk assessments. It’s not hard to see how the core values can get lost.

Some rare individuals might even be prepared to fake it just to hold onto a cushy little job in the NHS. They will be part of the compromise too, hopefully a diminishing minority, but those people will need our partnership more than anyone.

Ups and Downs !

PPI Reps, Involvement Volunteers & Service Users can give up on Involvement when it doesn’t seem to be delivering enough progress to maintain our reserves of hope.

To all Involvees I say this…. Don’t give up !  Have faith in the human race.  Because Involvement is right; and right will win through in the end.  Don’t lose sight of the fact that people have good intentions at heart.

There will be ups and downs along the way, and we will have to take the rough with the smooth. At this time of writing, we are all awaiting the ‘Breaking Boundaries’ Report, which, I suspect, will reflect the up & down state of Involvement in UK healthcare.

Sometimes expertise is cast aside like it never has mattered.  Sometimes we rightly need to question whether Lived Experience is valued enough. Indeed it may be time for a new Mental Health Parity campaign, this time one that seeks Parity of Value for Lived Experience and Professional Learning.

How many times do we as Service Users have to explain the difference between Involvement, Participation, and Engagement, to people who are paid to do this for a living?

Being part of a wider Involvement network is important. Then, when Involvement takes a hit in one area, it’s easier to accept when you know that somewhere else things are on the up.

Research has to be our greatest hope.  The brightest of NHS employees will instinctively know the rightness of Involvement.  The rest will need convincing with evidence.  So we need to grow the evidence base until it becomes overwhelming, and we need to spread the values of Involvement until they become endemic.

The rightness of our case will win through eventually.  It’s as inevitable as night follows day.

Carl Rogers, Mental Health & Technology, Person-Centred Approach

What would Carl Rogers do?

Extrapolating the Person-Centred Approach.

By Paul Radin

In 1951 Carl Rogers introduced Client-Centred Therapy to the world.  It was arguably the 1st real milestone of a Thought-Journey that ended too early with Carl’s death in 1987.

In his own words:

“The change which has taken place in me is to say that in my early professional years I was asking the question:
How can I treat, or cure, or change this person?
Now I would phrase the question this way:
How can I provide a relationship which this person may use for their own personal growth?”  Carl Rogers

If Carl Rogers had been around today;

• What directions would his thinking have taken?
• What would be his position on Mental Health in the 21st century?
• How would he have used the technology available to us now?


Evolution of Thinking – Towards the Good Life

Carl’s influence on the world of psychological therapy is widely acknowledged.  His Person-Centred Approach is well known in this context. Less well known is the fact that he didn’t stop there.  He practised what he preached, and continued to grow intellectually right up to the day of his death.  This is what makes me believe that his Person-Centred Approach should be extrapolated into modern times.  In the adjusted words of another great thinker of the 20th century, Gandhi “He became the change he wanted to see in the world.”

Carl’s philosophy had its roots in humanistic psychology, a movement which he helped to
found in the 1950s with Abraham Maslow and Rollo May. It was based on an optimistic view of people as constantly growing and moving towards their true potential.

He describes this as ‘the good life’:

“This process of the good life is not, I am convinced, a life for the faint-hearted. It involves the stretching and growing of becoming more and more of one’s potentialities. It involves the courage to be. It means launching oneself fully into the stream of life.”  Carl Rogers

To fully appreciate how far Carl’s thinking progressed over his lifetime, it’s worth looking back to the 1940s when the earliest incarnation of Carl’s ideas was actually Non-Directive Therapy. By the time he published ‘On becoming a person’ in 1961, Client-Centred Therapy had become Person-Centred, but there was more progress to come. Much more.

Carl knew that the principles he was advocating could be applied in a wide range of concerns, not just in psychotherapy.  Because of this, he switched to using the term Person-Centred Approach to describe the overall theory.  From this point on, he was obviously trying to change the world, not merely the world of counselling.

Other applications have included:

• A theory of personality and human relationships,
• Education (student-centred learning),
• Cross-cultural & international relations (Rogerian rhetorical method),
• Other ‘helping’ professions including nursing and social work.

He was instrumental in the Encounter Group philosophy of the 1960s, which encouraged open communication between individuals.  He was responsible for the spread of professional counselling into a variety of workplaces, and was a pioneer in attempting to resolve international conflict through more effective communication.

Indeed, Carl’s later years were dedicated to peace; challenging political oppression and conflict.  The application to global cross-cultural relations has included highly stressful conflicts and challenges in South Africa, Central America, and Northern Ireland.
His international work for peace brought national figures together as people who heard one another and established real personal connections.

The Death of Carl Rogers – The Birth of New Technology

My assertion is that Carl Rogers was born at least 50 years too early, and it really is a shame that he didn’t get to see the technological developments that have occurred since his death. His Person-Centred Approach brought into the context of modern technology has the potential to be philosophical dynamite.

When Carl died in 1987, the internet barely existed.  The World Wide Web didn’t arrive until 1991.  The rise of communication & information technology, due to improvements in the internet and the computer, has reduced the barriers to human interaction.  Carl could not have known how the connectivity of computers would change the world.

Mobile technology has improved exponentially and culminated in the smartphone with its countless ‘Apps’. Computers are everywhere now; all pervasive, and integrated into our lives.

Social networking didn’t truly take off until the founding of Facebook in 2004, generating new ways to connect with others and interact. Carl would have been a big fan of social networking.

The Internet has new relevance in global politics. Groups can use the Internet to organise, and this has given rise to Internet activism.  The most notable example being the Arab Spring, where Twitter was given much of the credit for facilitating democratic revolution. Carl would have a Twitter account, if he was alive today. I would follow him, and he would follow me.

Peer-to-peer interaction, increasingly facilitated by technology, has grown and is still growing. The potential for mutually supportive relationships, of a type that would have made Carl Rogers delighted, is unpredictably huge.

Carl couldn’t possibly have known how much things would change, but if he was alive today I believe that he would be advocating the fullest possible use of modern technology.

Gazing into the Crystal Ball

Predicting the future is always going to be problematic.  We’ll probably get lots wrong.  No harm in having a go anyway.  I think it’s safe to say that everything will continue to change, and there will be surprises.  Most of us will not be able to comprehend the level or scope of the change to come.

The use of technology will grow, not retreat. Power will move more and more into the hands of the individual.  What could be more Person-Centred than each of us having in our hands a tool which gives us the power to direct our own lives and to force a better world into being?

The psychiatric profession will increasingly come under threat.  Why would we need experts when everyone is their own expert?  Why would you need to study psychiatry when all you need to do to help someone is listen?  Christmas is coming whether the turkeys vote for it or not.  Carl would have known this, but would have had the generosity to welcome the democratisation of his own profession.

The initial & original Non-Directive Therapy is fast becoming Person-Centred Technologically Supported Democratised Mental Healthcare.  The Person-Centred Approach was in some respects an idea ahead of its time. Now the times are catching up, and the Approach has a much broader potential relevance than Carl could have ever imagined.

The use of tools is the thing that has always made the human species unique on our planet.
Guess what? Our tools are getting better and better and better.

Now here’s a view not often expressed. The future is more ‘tech’ and more human.