How to write a 'not-good-enough' report when local treatment, care, or education services are below standard

towersmall3 Peter Limbrick writes: The UK coalition government brought in the Localism Act to give, they say, power to local people in England (extracts below*). We should make use of this government initiative now that we have seen how desperate conditions are in some of our maternity units, care homes and geriatric wards. We can see that our ministers are unlikely to solve these massive problems. We know that the inspection and regulation mechanism (Care Quality Commission) is defunct and will remain so for years to come.

A bit of local power might be just what is needed if we want to keep our loved ones healthy and safe!

Perhaps we can take encouragement from the Horizontalism movement in Argentina:

'I believe that if people are left to their own devices and we pay attention, we'll find that people naturally organize horizontally, and the rest is a process of unlearning hierarchy...This sort of natural coming-together appeared in Argentina when everything else disappeared. Money disappeared, the institutions disappeared, and trust in leaders and government disappeared. The system had been becoming increasingly decadent, and then it was finally left naked. And it was a natural response, for people to begin to organize horizontally.' (From Horizontalism: Voices of popular power in Argentina page 52)

This is not the chaos of revolution. Horizontalism means that people join together to improve local services – refusing to remain powerless at the base of the organisational hierarchies. It is constructive action to set standards and support service providers in meeting them. Horizontalism in the UK can be the basis for a persistent, determined, constructive, lawful and collective effort to get the services you deserve in your locality. (There is more about horizontalism here.)

The place to start could be your writing of a local horizontal 'not-good-enough' report about what is going wrong. Here are suggestions:

Don't try to go it alone. Horizontalism means working with others in the locality who share the same concern.
Keep to a single issue and give your report a title that defines the issue. For example: 'Our report about lack of night-time cover at the Green Unit'; 'Our report about children lacking (an intervention) at Brown School'; 'Our report about elderly patients on Ward X in Blue Hospital being left hungry'.
Look horizontally for support and resources. This is very important. Support might come from fellow sufferers' relatives, local pressure groups or local charities. (Some charities might have service contracts with the organisation you are reporting on and therefore might not be able to help you.) Support might come from one of the public services.
Stay within the law. The laws of libel apply and if in doubt, locate a friendly lawyer in your horizontal landscape. The report is primarily intended to raise awareness and achieve improved service provision rather than to condemn or blame.
Aim to get your report finished as soon as possible after the problem is discovered. Be brief - a short report can have as much or more impact than a long and wordy one. Keep your message simple and straightforward. Use plain language.
Send the original to the local organisation where the problem lies. If this is the first approach to them on the issue ask for a response within a number of days/weeks – depending on the severity of the issue. Let them know that you have copies to send out if they do not respond in the time period or respond in an unhelpful and dismissive manner.
If your 'not-good-enough' report follows previous failed attempts to get a helpful response from the organisation, then send out copies at the same time you send the report to the organisation.
Your copies should go to everyone who is connected, who needs to know and who might be able to help put it right. This will make the issue public and get the report onto the desks of people who might otherwise say in the future the concern was never brought to their attention. Send copies to related local organisations, relevant MPs and councillors. Keep a list of where copies were sent.

Here is a suggested list of sections in your report:

This report comes from:
Our concern is:
The change we want to see is:
The standards of good practice we want to have established are:
These are the things that have made us so concerned (in some detail):
This is what we have tried to do about it so far:
Here are our suggestions for putting it right:
This is the help we are prepared to offer: (This can include being willing to attend their meetings and/or setting up your own local meeting and inviting them to it.)

Remember: Horizontalism is a local collective effort involving a number of people with a shared concern. Concern, experience, ideas, wisdom, resources and energy are brought together in an attempt to get better local treatment, care or education services.

* Extracts from A Plain English guide to the Localism Act (published November 2011)

For too long, central government has hoarded and concentrated power. Trying to improve people's lives by imposing decisions, setting targets and demanding inspections from Whitehall simply doesn't work. It creates bureaucracy. It leaves no room for adaptation to reflect local circumstances or innovation to deliver services more effectively and at lower cost. And it leaves people feeling 'done to' and imposed upon - the very opposite of the sense of participation and involvement on which a healthy democracy thrives.

The Localism Act sets out a series of measures with the potential to achieve a substantial and lasting shift in power away from central government and towards local people. They include: new freedoms and flexibilities for local government; new rights and powers for communities and individuals...

This is written by Peter Limbrick author of Horizontal Teamwork in a Vertical World: Interagency collaboration and people empowerment in which these ideas are expanded.

Peter can offer a limited amount of informal support by e-mail for your local 'not-good-enough' report. Contact Peter at This email address is being protected from spambots. You need JavaScript enabled to view it.

Peter Limbrick

July 2013