To you and me, the purpose of a consultation is to consult – to seek advice and guidance from interested parties, and to use that advice to shape your plans.
This is not how the people behind the Medical Innovation Bill (the Saatchi Bill) see consultation. To them, consultation is a means by which you get people to answer your questions the way you want them answered. As Lord Saatchi himself put it in one of the many articles the Telegraph – the bill’s media partner – obligingly published for him:
In democratic politics, perception is reality. If the people perceive a problem, there is one.
The campaign for the Saatchi Bill has been, at its heart, an advertising campaign, a campaign run with the aim of making sure that people “perceive a problem.”
Some of the statements made by supporters of the Bill (although not by the Department of Health) during the consultation period were misleading but received much publicity.
(Report on the consultation on the Medical Innovation Bill - Department of Health)
While Lord Saatchi and his bill team have come in for much criticism for making claims that are variously misleading, incorrect or contradictory, in this article we will look at one particular area, the public consultation. What we will see is that the actions of the Saatchi Bill team had the effect of undermining the official Department of Health consultation on their own bill in a number of ways. Firstly, by adding a feedback web page and petition of their own and promoting this ahead of the official consultation routes. Secondly, by not waiting for the results of the official consultation before driving the bill through the House of Lords. And thirdly by misrepresenting the results they had gained by their own routes in a way that over-inflated the apparent strength of public response, while ignoring the results from major organisations that had serious concerns about the bill.
Along the way, we will see just how much influence PR spin can have on how people answer questions, and how it is possible to manage a consultation to make the results appear to say what you want them to say.
When the Department of Health launched its consultation into the Saatchi Bill, they published a web page with documents to explain what they were doing. The draft bill was clearly signposted in a document on its own, with notes available in a separate file. These notes were relatively neutral in character, albeit focussing more on rising costs of medical negligence litigation (arguably a different issue) than on whether the Bill would result in a cure for cancer. It should be noted as an aside that not a single case of a doctor being sued for innovating has yet been uncovered.
People could respond via the DoH website or by completing a questionnaire. This asked a series of questions about aspects of the bill before finishing with the question “Overall, should the draft bill become law?” In this way, the respondent was prompted to think about the bill, its implications and implementation before being asked to give an answer. The completed questionnaire could be returned by e-mail or post.
Unfortunately, the Saatchi Bill team then took it further, launching an extensive media campaign, not just to publicise the bill but to get the message across to the public about what they claimed the bill would achieve.
Many – possibly most – people would have found out about the bill through advance campaigning via patient and charity groups, via articles in such places as the Daily Telegraph, and via the bill’s busy promotion on social media such as Facebook and Twitter. The bill had its own Twitter feed, its own Facebook page, a website (later expanded to two sites), and a nominated “media partner” in the form of the Telegraph.
Promotion of the bill was misleading from the outset. It was not mentioned that Dominic Nutt, when writing in glowing terms about the bill in the Telegraph, was the Bill’s Communications Director, nor that the Telegraph was the Bill’s media partner. If you write an “advertorial” about a product in a newspaper or magazine, you are required to label it as an “advertising feature”. Not so, it seems, if you are advertising a parliamentary Bill, where behaviour bordering on astroturfing appears to be considered acceptable practice.
Campaigning by the Saatchi Bill team in the run up to the consultation was very much characterised by a clear message that this bill would, if passed, probably give us a cure for cancer. In an interview in the Telegraph, Lord Saatchi was very clear about his intent:
I intend to cure cancer, you see. I mean to do it. I expect to do it.
The front cover of the guide the Bill team produced in advance of the consultation, said, “HOW CAN AN ACT OF PARLIAMENT CURE CANCER?”
The document continued, for 104 pages, with alarming scenarios:
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This was really quite astonishingly nasty stuff. Nevertheless, it made confident assertions regarding the problem and its solution:
These descriptions are not correct, as the organisations opposed to the bill have pointed out.
Many people would have become aware of the bill by reading the Telegraph article or the social media campaign, and followed the links provided to “respond to the consultation” which, rather than taking them to the DoH site, took them to the Saatchi Bill campaign’s own web page on tumblr. This carried the same sorts of themes – this bill solves cancer, it allows doctors to carry out more than failed standard care.
A respondent coming via this route would have had the opportunity to answer the yes/no question “Do you want this bill to become law?” and add a comment as to why it was important to them. The same question was also embedded on a number of other websites.
Anybody wanting to read a copy of the Bill itself would not have found it an easy task. It was included in their briefing document, so if the reader was prepared to take 102 pages of hard sell along with the two pages of the bill, they could access it that way. There was no easy way to see it without the accompanying spin.
The other possible “Saatchi” approach was to sign a change.org petition the campaign was simultaneously running. Again, this used highly emotive language to get its point across and didn’t have a copy of the Bill, or any link to the Bill at all.
So here’s the problem. It’s entirely possible, indeed probable, that a reader could get to the point of signing the petition or completing the Saatchi web form without ever once having read the Bill itself. There’s no encouragement to read the text of the Bill, the emphasis is far more on reading the stories of people who have been affected by serious illnesses and pleas that you sign up. A reader would almost certainly have ended up relying entirely on what the Saatchi campaign told them.
On the petition page – like all petitions – there was no possibility for the reader to say no. It’s worth emphasising: a petition can’t be a valid consultation because all a petition does is ask the reader to say yes, it’s not interested in anybody who says no. How many people didn’t respond because they couldn’t say no? We have no idea. For a process intended to “reveal the diversity of views, both support and opposition”, it’s a bit of a shame if your chief method of response only attempts to capture the support, not the opposition. Anyway, as Earl Howe, representing the DoH, said himself, petition responses can’t be “treated in the same way as a detailed consultation response from an organisation speaking for thousands of members.”
Once the Saatchi bill team had their own site and petition, they started promoting it as the primary way to respond to the consultation. On occasions when the official consultation page was mentioned by the Saatchi Bill campaign at all it was generally in a subordinate role, for example in this Telegraph article. As a result, it was entirely possible that people could get the mistaken impression that by responding on the Bill’s website or to their petition, they were responding direct to the Department of Health's official consultation.
Worse, it is likely that there would have been very many duplicates – people who signed both the petition and the Saatchi web form. There was no indication that these were two different aspects of the same process, so no apparent reason why the reader shouldn’t have signed both.
The consultation closes
The consultation closed on 25th April 2014 and the Department of Health set about examining the responses they had received.
There is no good reason why one would go to all the effort of having a consultation and then not wait for the results. But Lord Saatchi didn’t want to wait. He issued a new draft of the Bill and moved right ahead with introducing it in the House of Lords. This was accompanied by a 52 page briefing note that described the results of the consultation. I’ll pause to let that sink in: the Department of Health hadn’t finished analysing the consultation responses (and wouldn’t for another two months) yet here was Saatchi publishing a document purporting to be an analysis of what it contained.
According to Saatchi, the consultation generated 18,502 responses in favour of the bill and only 33 against. What the briefing note did not mention was that these responses were from the Saatchi team’s own separate channels, and the vast majority (around 16000) from the petition they had run. Despite not being on the Department of Health’s list of ways to respond, the Bill team’s additional website and petition were described here by the Saatchi team almost as if they were the chief part of the consultation, while the official DoH responses were dismissed in a single sentence and never mentioned again.
Any potential confusion that may have arisen here was compounded by the fact that the Saatchi team did not respond to questions about how they arrived at the figures they quoted, how they ran their data collection, who had access to the data, or any other response that would have lent transparency to the consultation process and the conclusions they drew from it.
The Saatchi team have, ever since the close of the consultation, repeatedly claimed 18,000+ (sometimes more than 20000) respondents to the consultation, unfairly promoting their petition to a presumed level of evidence that is not supportable. While Earl Howe, on behalf of the government, has said “The purpose of the consultation was not to discover the numbers of those supportive or opposed, it sought instead to reveal the diversity of views on the topic” the Saatchi team have been busily quoting their numbers here, here, here, here, here, here, here, here, here… These numbers have been heaved around by the Bill team as if they are very important, in Parliament, to the Welsh Assembly, in the press and on social media, and they are still doing it. In this respect alone it matters what those numbers are. It matters how those numbers were arrived at and it matters what they mean. For example, when Lord Saatchi claims more than 18,000 patients responded, how can he possibly know this? His petition did not gather the data to be able to tell him what sort of people responded.
The Saatchi campaign claim that the response to the consultation was overwhelming because the Department of Health had told them 600 responses would be a good result, again citing the 18000 figure. But the DoH can’t have had the petition and website responses in mind when they gave Saatchi the 600 figure; those methods didn’t exist when the consultation was launched. Also, Saatchi describes the consultation in the Telegraph as one of the largest ever undertaken. Yet even the Bill’s own website cites a consultation that had 665,989 petition responses, more than forty times bigger than Saatchi’s.
The Department of Health publishes...
The DoH published a summary report on its consultation on 30th July 2014, by which stage the Bill had already passed the first two stages of its progress in the House of Lords. It can clearly be seen (paragraphs 4 and 5 of the report) that the Saatchi Bill team’s response methods were separate and distinct from the consultation the DoH had run.
It is also clear from reading through the text, though no outright numbers are given, that there was a great deal of considered opposition to the bill. A subsequent FoI request has revealed both the numbers and the broad composition of the responses. There were 170 respondents, and their responses were assigned to one of five categories:
Immediately we can see that more than half the respondents actually opposed the bill. Less than a quarter gave unqualified support. Contrast this with Lord Saatchi’s briefing, which claimed 99% support and less than 1% opposition.
We can also look at the types of respondent, to see whether responses differed between groups. (Patient/relative/carer has here been abbreviated to “patient” for space reasons.)
Despite claims by the Saatchi Bill team that there was widespread support from doctors, patients and organisations, what we see from the official consultation is that no doctors gave the bill their absolute support, only 7% of organisations, and only about a fifth of legal or other respondents. Support came predominately from individual patients, carers and relatives. While it’s important to take these into account, absolute supporters from this group represented only 10% of the responses, and weighed against these individual responses are organisations representing tens of thousands of members.
While the Saatchi briefing note did not name any organisation opposing the bill, and labelled opposition as a minority “comprising in part, but not exclusively, of medical negligence lawyers, individuals opposed to quackery and some institutions”, the opposition in fact included the BMA, the GMC, The Patients Association, NICE, NHS England, The Academy of Medical Sciences, The Medical Research Council, The Wellcome Trust, the Royal Colleges, The Medical Defence Union, the Medical Protection Society, Healthwatch, the Motor Neurone Disease Association, and many more.
This is PR in action.
No wonder the bill’s promoters didn’t wait for the DoH analysis to be published, or to make any more than scant mention of it – it would have been poison to the Bill. Opposition was much stronger than their briefing notes would seem to imply, and on the negative side were some very large, heavyweight organisations. Respondents were four times less likely to give unqualified support if they had actually read the bill rather than the spin.
The Department of Health, as represented by Earl Howe, and the Saatchi team have clearly worked in concert for much of the Bill’s progress so far, particularly in the later stages in the House of Lords, where Howe and Saatchi were very much a team. But this closeness muddies the waters when one tries to understand the Bill, to understand who represents what aspect of it and, most importantly, who has the responsibility to represent it accurately and impartially in discussion.
When Lord Saatchi’s team wrote their report for the House of Lords about the consultation process, they clearly didn’t feel a duty to be even-handed or to represent all views. For a stakeholder, a particular interest group, this may not matter. You don’t expect Bernard Matthews to give an unbiased report on turkeys. But Lord Saatchi’s campaign is effectively keeping a foot in both camps, as both an interest group pushing for the Bill and, through its “one team” philosophy with the Department of Health, as a part of the body meant to give a fair hearing to all the views, a duty to represent them in the Lords and publicly. What is without doubt is that the consultation process was seriously undermined, and that the Department of Health has been insufficiently rigorous in preventing this damage.
It is arguable whether a consultation has in any meaningful sense happened at all.