Guest post by Caroline Tomes
Dear Lyn Brown MP,
Your role as an MP is to represent the views and concerns of your constituents, both those who did and did not vote for you. There are many ways to obtain this information, and I for one am glad to see my local MP engaging with Twitter and other social media.
One of the challenges is in assessing whether information you obtain is representative of your constituents. The old saying “garbage in, garbage out” is a useful reminder about the importance of survey design. And I have some very real concerns regarding the surveys you have hosted recently on your website.
You had a survey online asking for local views on healthcare. This was the first question:
Now there is nothing wrong with asking for people’s general opinions of health services (although I do wonder why you feel the need to repeat the work which Healthwatch Newham aptly do). However the response options are limited to ‘excellent’ ‘good’ or ‘satisfactory’, thereby preventing any negative feedback. This is ridiculously biased, and any results from this question will be inevitably skewed.
Do you not care if someone is ‘unsatisfied’ with their healthcare?
After I highlighted the poor question design you claimed something had gone wrong with the website ‘download’ (although the source code suggested the issue was with the survey design rather than things not being displayed). Either way, I was glad to see the healthcare survey taken off your website and hope you’ve deleted any data from this flawed survey.
However that wasn’t the only biased survey on your website. Your local business survey on the Olympics includes the following question:
Now where do I start?
Survey design faux-pas #1: leading questions; suggesting the Olympic Games had a positive impact.
Survey design faux-pas #2: the scale is biased and it also doesn’t make sense.
It’s just a terribly written question. For example: what would you select if you felt the Olympics had a big negative impact? What is the difference between impact two, four or six? I’m not sure what responses you’ve had to this survey, but I’m very confident that you won’t be able to use this information in any meaningful way.
I enjoy being a Newham resident. I’ve encountered many friendly local people, and the diversity of ethnicities and cultures makes Newham an exciting and vibrant place to be. That said; not everything is perfect here. For starters, Newham is currently the most deprived borough in London*, the TB capital of Europe, and I do wish there were more bins / fewer chicken bones in the local parks where I walk my dog.
I’m also pretty concerned that 100% of Newham’s elected representatives belong to the Labour party. Not because I necessarily disagree with that party politics but I strongly beleive that a one-party dominant system is just not healthy. Which is why it is so very important that any local surveys you conduct are unbiased and are representative of Newham people.
With the forthcoming general election next year, I’m going to need a lot more convincing that you care about the real views of local people to get my vote.
Yours sincerely,
Caroline
Caroline Tomes is a PhD researcher at UCL, public health professional and Newham resident. You can follow her on Twitter @carotomes
*Correction: originally published as ‘most deprived ward in London’. Edited to amend ward to borough.
forestgatedotnet 
Rather reminds me of a survey a manager of mine ran when I worked as a civil servant. He asked the public that attended our office whether we gave a good or very good service. Having collated the replies he reported to our Whitehall masters that the 95% of the public said we gave a good service!
I have been sent the surveys that Lynn does and I can only agree they are very badly designed. I don’t complete the ones that are. I am sure it is not her intention as in my experience she is one of the better constituency MPs around, as is Stephen Timms. Unfortunately they are tarred with the same brush as the Mayor and councillors, which must be very frustrating. The way in which the Labour Party is organised and managed locally means they can have little influence over some of the more stupid actions of the Mayor which must be as equally frustrating.
Lets hope that Lynn listens to Caroline Tomes expert comments on her surveys and improves that aspect of her work.
I came across this very relevant blogpost today which asks whether local consultations are the best means of engagement with local residents.
“Yes, that’s a fine result but what does it really mean?” >>
http://www.ipsos-mori.com/newsevents/blogs/makingsenseofsociety/1585/Yes-thats-a-fine-result-but-what-does-it-really-mean.aspx#.VAXwIGq2cL4.twitter
Hello Caroline
Interesting post. BUT:
1. Why shouldn’t Newhammers have a completely Labour council, if that is what they want and vote for? That is democracy isn’t it? And far from ‘unhealthy’, it sends a very clear and united message to the current government about what we think of them (a bit of good old working class solidarity!). And of course if they mess up, they will be booted out, as has happened in other boroughs.
2. I don’t think you can just see MPs as glorified polling agencies. Their job is to lead, engage and have dialogue with their constituents. Online questionnaires, however technically ‘flawed’, are one simple, eye-catching way of generating ideas and discussion.
I see you are doing research on public health at UCL. That is great; it really is one of the most important areas there is. I guess you must be down the corridor from Michael Marmot and the wonderful Institute of Health Equity? His work on the social gradient, social standing and health inequalities is brilliant. It explains with crystal clarity your other points about deprivation and TB in Newham, showing that these are due to deep structural flaws in society (unfortunately way beyond the reach of the local council).
All good wishes
Phil Bradbury
Dear Phil,
Thanks for your thoughtful reply. Apologies for the delay, I had only spotted your reply today! In case you are interested, here are my thoughts on the points you have raised:
1 – My personal view is that coalition councils or governments produce better results. Firstly, I believe the current voting system encourages tactical voting rather than voting for policies – meaning people do not always vote for what they want, but tend to safeguard against what they fear. This also makes it difficult to challenge any dominant party. Secondly, coalition systems are forced to consider the objections of other parties – which may slow change processes – but results in change which is more considered about the divergence of views in the area.
2 – Agreed, MPs as democratically elected representatives should engage with their constituents far and wide. Online polls are a great tool to support this engagement role. However they do need to be designed properly to be useful. The questions I’ve highlighted above are poorly-designed, biased and therefore leading – and any data collected will be impossible to interpret fairly. My concern is that such questions are being used to support the MPs political agenda rather than obtain real information regarding the cares and concerns of her constituents. If the purpose of the survey is to generate ideas and discussion, I would suggest open ended questions would be best (e.g. do you think the Olympic games will influence businesses? Why? How?…etc).
3 – The work and influence of Marmot has been great, and it is quite correct that the biggest influences on health tend to be from the ‘wider determinants of health’ – the structures within society such as education, poverty, environment, housing…etc. Arguably, these are exactly the issues which the council can influence. This is one of the reasons why the bulk of public health professionals were moved from the NHS (Primary Care Trusts) into local authorities following the Health and Social Care Act (2012).
Best wishes, Caroline
Hello Caroline
Well. Yes I am interested in your thoughts. On the first two points, I guess we just have to agree to differ. With the first, for example, there are many cases of ‘dominant’ parties being both ‘challenged’ AND booted out when the electorate gets fed up with them. Newham Council is as it is because of the overwhelming backing of the electors. With your second point, open questions are usually too bland to generate discussion; far better to have a robust political statement to provoke a response. (Actually Lyn’s questionnaire should never be seen as a ‘scientific’ survey and should not be judged as such; her questions were just fine.)
The third point, though, is the one that really had me choking on my home-made muesli. (Fortunately, daughter – a trained nurse, health visitor and medical anthropologist – was at hand to administer a deft Heimlich manoeuvre!) Marmot’s work (not to mention many others) shows ill-health and deprivation are absolutely rooted in poverty and growing inequalities. Local councils can’t fix this; it is a national and global problem. Moving health workers from one office to another brings to mind aphorisms about shifting deckchairs on the Titanic. And, frankly, it really does not make sense to juxtapose ‘deprivation and TB’ with ‘litter in the park’.
If I seem a little over-exercised about this it is because of my certain belief that the only way to begin to remedy these matters is at the General Election in May. So when you suggest your vote will be decided by your dislike of the way the local representative frames her questions on her website, I think this needs to be challenged. Very vigorously!!
On the other hand, I can find nothing to disagree with in your informative and useful post (Feb 2) responding to Evan Harris.
All best wishes
Phil
Hi Phil,
I believe there is some debate to be had between our viewpoints, and unfortunately I remain unconvinced by your arguments!
There are a whole host of influences upon voting behaviour. Smaller parties in the current system are at a disadvantage, not least because people tend to vote for who they have always voted for or whoever is currently in power (the power of social norms), but also due to the FPTP system which encourages tactical voting and wastes huge numbers of votes. You may be interested to know that the ‘vote for policies’ website reports 30% of West Ham constituents support Green Party policies compared to only 20% for Labour (http://voteforpolicies.org.uk/) – yet this is not supported by the current set-up. Labour is in power because they have been voted it, but that does not mean they represent the views of the majority of residents. I remain optimistic that the forthcoming election on 7th May will bring necessary change to the local area!
Open and closed questions are different tools for different purposes. Closed questions are quick to answer and provide easier data to analyse, but are restrictive in what information can be reported. Whereas open questions are more exploratory, tend to be less assuming but can be more complex to analyse. Open-ended questions are not ‘too bland to generate discussion’ – if anything, they generate discussion much better than closed-questions! They are useful when you wish to find out the breadth of views in the community.
Hence, if Lyn had wanted to find out what her constituents thought the impact of the olympics would be on local businesses – an open-ended question would be best to pick up the range of views in the community. However the question used in Lyn’s survey assumed constituents only think the Olympics would have had a positive impact, which may not be a true. SImilar with the question on health care: Lyn’s question assumed that constituents had no negative experiences; based on this question she may well conclude that 100% of respondents were satisfied with their healthcare experience – which would be incorrect.
I agree, Lyn’s questionnaires were far from scientific ideals. However her questions were not fine; they were leading, biased and suggest to me that Lyn was more concerned with gathering evidence to support her views, rather than finding out the views of the constituents whom she serves. I stick by my previous statement: “I’m going to need a lot more convincing that you care about the real views of local people to get my vote.”
It is puzzling to me that you agree with the view that inequalities and deprivation lead to poor outcomes, yet fail to appreciate the role of local councils in addressing this. Do you think Newham Council is merely an administrative body with no ability to improve the lives of its residents?
There are many levels upon which to tackle inequalities, including local level. Take the 1st Marmot principle: give every child the best start in life. What can local authorities do? Ensure early years initiatives (e.g. education, childcare, parental support – services which are commissioned and funded by the council) which promote child development are available where most needed in the population. This is absolutely within the remit of local authority influence. Tackling inequalities is not a solo task – sure – but the actions and decisions of local authorities can make a difference. Currently, 70% of local authorities are working to embed ‘Marmot principles’ in their approaches to improving health and reducing inequalities (https://www.ucl.ac.uk/impact/case-study-repository/marmot-review).
Best wishes, Caroline
Excellent post
But just wondering what you think, on refection – as a public health professional – of your line “Newham is currently … the TB capital of Europe”.
1) The article you link to has a headline “Newham is ‘TB Capital’ of Western Europe”
Now I am no expert on TB, but I suspect that there is a reason why that article said Western Europe and not Europe.
2. The post you linked to has no references for the data it cites. It has certainly gone nowhere near peer review. Or even review.
3. It states “In 2012, there were 8751 new cases identified, with 39% of these in London. The city has the highest rate of TB in Western Europe, while Newham has the highest in the whole of the UK. ”
Is it judging the “highest rate of TB” on prevalence or incidence? Probably incidence but it is not clear. It uses 2012 data. Why?
4. Is stating that “Newham is the ‘TB capital” of Europe” helpful? Won’t people say – as Labour did in the 2000’s – “time to pre-screen new entrants for TB from high prevalence countries” with no evidence this was effective?
5. What is a disease “capital”?
Dear Evan,
Thanks for your reply – you’ve made some excellent points.
1 – Good point – my error. I should have stated Western Europe rather than Europe in the blogpost above. Comparisons tend to be made between England and other Western European countries for a number of metrics, including TB. However the key point is that rates of TB have been rising in England over the past 20 years, and Newham has the highest rate in the country – which is a great cause for concern.
2 – Agreed. In hindsight it was not the best reference. I believe this is the data being cited. The most recent TB data for Newham reported 113.7 new cases per 100,000 population (incidence) of TB per year. This is much higher than the 35.5/100,000 incidence rate for London and 13.5/100,000 incidence rate for England (link to data source: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/358226/TB_Official_Statistics_230914.pdf)
3 – By definition, new cases of disease refers to incidence, whereas prevalence refers to all cases of disease (both newly diagnosed and on-going). Therefore the quoted data refers to TB incidence – the number of newly diagnosed cases in a specific area in a defined time period. This is a helpful indicator of risk in the population.
TB surveillance is currently led by Public Health England, who produce 3-year average TB rates at local authority level. 3-year average data is often useful for smaller areas/uncommon conditions as it helps to balance out fluctuations and give a more accurate picture of trends over time compared to annual rates.
4 – I do think it is helpful to highlight local health issues; recognising the issue is necessary in order that actions can be considered. TB is a serious bacterial infection – however it can be prevented (through vaccination) and treated (typically a 6-month course of antibiotics). But, there are two important points to consider, a) TB is a highly stigmatised condition and needs to be discussed in a sensitive manner, and b) what actions are effective?
Current evidence suggests the following are effective interventions: BCG vaccination, targeted case-finding and early treatment, and initiatives to support compliance to treatment (to reduce antimicrobial resistance and re-infection). The current approach for new immigrants continues to be pre-entry TB screening which requires individuals with active pulmonary TB to complete treatment prior to having their UK visa granted. Its still in the early stages of roll-out, but the initial data looks promising and it will continue to be evaluated. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/328468/TB_preentry_screening_brief_report_2013.pdf
However, is it estimated that 5% of individuals with TB have active disease, therefore the pre-screening initiative will not be able to identify those with non-pulmonary or latent disease. So its necessary to compliment this approach with other known effective interventions in the population.
5 – Disease “capital” suggests a location where there are more cases of disease than other areas. Its not a formal term.
Essentially I wanted to highlight that TB, a condition which is both preventable and treatable, is a serious public health concern for Newham.
Best wishes, Caroline
Thanks Caroline
Your post (Feb 9th) makes clear that you are a Green Party activist. Also, your initial post was couched in highly combative terms, pejorative and perhaps a little patronising (‘garbage’, ‘ridiculously biased’, ‘inevitably skewed’, ‘poor design’, ‘flawed’, ‘faux-pas’, ‘terribly written’). There was really no need for all that.
I am suggesting that your arguments are informed more by party political considerations than methodological rectitude. I insist, again, that Lyn’s questions ARE fine; only if/when she misinterprets any answers/responses can she reasonably be criticised.
When I first read your initial message, I thought you were probably a Tory (sorry!). The local Tories often used to suggest that poverty and deprivation in Newham was the fault of Labour councils (stopping only when it was clear local electors took a different view).
The ‘social gradient’ (which Marmot and colleagues identify) locates an immutable link between health and social status (what we used to call ‘social class’). Poorer and more working-class people are more likely to get sick. Newham is one of the most working-class boroughs in the country and the social gradient determines that it will therefore have the largest proportion of sick people.
Marmot says that “focusing solely on the most disadvantaged will not reduce health inequalities sufficiently; actions must be universal with a scale and intensity proportionate to the level of disadvantage”.
It is widely believed that the five years since publication of the Marmot Review have seen a big increase in inequalities, with depressed wages, zero-hours contracts, part-time working, poor and insecure work conditions, self-employment, bedroom taxes, deep cuts in welfare benefits and soaring rents. If this is so, the social gradient would predict a consequential increase in poor health. And we do get almost daily reports of huge strain on the NHS because of increased usage (despite it being said to be ‘ring-fenced’). So it would be very interesting to find out whether there actually has been a significant increase in inequality and a commensurate increase in sickness, and if any such association is causal. Sounds like a really good project for a public health researcher somewhere ….. .
All best wishes,
Phil
To be clear, Phil, my 9th Feb post does not denote which political party I support. I mention the Greens because they came top of the ‘Vote for Policies’ poll, both locally and nationally.
Incidentally, I did join the Green Party in Nov 2014, however my original piece was written before I become a member. Contrary to your suggestion, my original piece was not informed by any political party considerations. It was written to highlight the methodological issues with Lyn’s surveys, and to outline the implications of these issues. May I reassure you that I would’ve highlighted these issues, irrespective of the associated political party, because I believe it is important for the views of local people to be fairly represented.
I am glad that I’ve not seen Lyn use any data collected from the above mentioned surveys, and also have observed that the survey section has been removed from her website. This however does not detract from my original criticism. Lyn’s survey questions have proved to be fine teaching examples of poor practice, and if you wish to continue insisting that Lyn’s questions are fine – I suggest you either re-read my original post or obtain a book on research methods to help your understanding.
Hello Caroline
The books will tell me that Lyn’s questionnaire is not a textbook sort of survey. To persist in treating it as one is to make a category error (like treating a bicycle as if it were a car, just because it has wheels). Another good example of a non-textbook survey is the ‘Vote for Policies’ one you freely quote above. This would not pass muster against even the most rudimentary methodological scrutiny. If you were being even-handed, you would disown it. Your claim that ‘30% of West Ham constituents support Green Party policies compared to only 20% for Labour’ is a breath-taking misrepresentation (the sample is small and self-selected, so the chances of it being representative are infinitesimally small). Despite evident failings, though, it is still a good and worthwhile site because, like Lyn’s, it encourages people to think about and engage with politics and policies.
Best wishes
Phil